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BackgroundSystemic lupus erythematosus (SLE) is an autoimmune disease, which presents an immune disorder that leads to the production of autoantibodies with potential involvement of multiple organs. Infections are one of the most frequent causes of hospitalization and death in lupus patients, and SARS-CoV-2 infection has been a global threat since March 2020. Immunization of these patients has been strongly recommended, although vaccine evaluation studies have not included this profile of patients.ObjectivesTo evaluate the immunogenicity and safety after 2 doses of the vaccine against SARS-CoV2 in patients with SLE.MethodsSubgroup of SLE patients from the prospective multicenter cohort of patients with immune-mediated diseases "SAFER” – Safety and Efficacy on COVID-19 Vaccine in Rheumatic Disease, a phase IV study. Vaccination against SARS-CoV-2 took place with vaccines approved by Brazilian regulatory bodies CoronaVac (Inactivated SARS-CoV-2 Vaccine), ChadOx-1 (AstraZeneca) and BNT162b2 (Pfizer-BioNTech) and this project followed in line with the guidelines of the National Immunization Plan in Brazil. Patients aged 18 years or older with a previous diagnosis of SLE (according to the 2019 ACR/EULAR criteria) were included. Patients were evaluated by telephone contact and in a face-to-face visit on the 28th day after each dose. Patients were followed up by means of blood collection for measurement of IgG antibody against SARS-COV-2 by chemiluminescence and disease activity assessed using SLEDAI-2K score.ResultsA total of 367 individuals with SLE were included, of whom 207 received 2 doses of CoronaVac, 128 received 2 doses of ChadOx-1 and 32 received 2 doses of BNT162b2. 90% of the subjects were female with a mean age of 37 years. About 42% (154) of the individuals included did not have any other associated comorbidity. 50% (182) of patients were using oral glucocorticoids and azathioprine was the most frequent immunosuppressive therapy. Regarding disease activity parameters, 38% (140) of patients had zero SLEDAI-2K at baseline and 41% (147) had zero SLEDAI-2K 28 days after the 2nd dose. Anti-DNA positivity was 30.7% (16/52) at inclusion and 32.6% (17/52) 28 days after the 2nd dose. Complement consumption was present in 18% (10/55) at inclusion and in 14.5% (8/55) 28 days after the 2nd vaccine dose. The geometric mean titers of IgG antibodies against SARS-COV-2 increased in the different vaccine groups, log 2.27 BAU/mL at inclusion and log 5.58 BAU/mL 28 days after the 2nd dose. Antibody titers after second dose varied between different vaccines, 4.96 BAU/mL CoronaVac, 6.00 BAU/mL ChadOx-1 and 7.31 BAU/mL BNT162b2 vaccine, p < 0.001. Only 3.54% (13/367) patients had covid-19 infection after the 15th day of the second dose of immunization, 9 of them having received 2 doses of CoronaVac, 4 of them of ChadOx-1 and none of them receiving BNT162b2, with p-value of 0.63.ConclusionThis study suggests that vaccines against SARS-COV-2 are safe in SLE patients. Induction of immunogenicity occurred in different vaccine regimens. Only 3.5% of individuals had COVID-19 infection with no difference between the types of vaccines evaluated. Future analyzes to explore the association of the effect of immunosuppressive medication, as well as the impact of booster doses and longer follow-up on clinical outcome will be performed.References[1]Mason A, et al. Lupus, vaccinations and COVID-19: What we know now. Lupus. 2021;30(10):1541-1552.[2]Furer V, Eviatar T, Zisman D, et al. Immunogenicity and safety of the BNT162b2 mRNA COVID-19 vaccine in adult patients with autoimmune inflammatory rheumatic diseases and in the general population: A multicentre study. Ann Rheum Dis. 2021;80(10):1330-1338.[3]Izmirly PM, Kim MY, Samanovic M, et al. Evaluation of Immune Response and Disease Status in SLE Patients Following SARS-CoV-2 Vaccination. Arthritis Rheumatol. Published online 2021.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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The objective was to present an individualized nursing plan of care for a 94-year-old woman, presenting frailty, without cognitive deterioration, coming from a nursing home and admitted to the Internal Medicine Unit by referral from the Emergency Unit, due to presenting infection by Clostridium difficile and respiratory infection by COVID-19. After assessment at admission, following Marjory Gordon's functional health patterns, the following NANDA diagnoses were prioritized: frailty syndrome of the elderly, skin integrity deterioration, and chronic pain. The desired NOC outcomes were determined for each: nutritional status, mobility, knowledge: prevention of falls, tissue integrity: skin and mucous membranes, pain: harmful effects, pain;adverse psychological response. The NIC interventions and their corresponding activities achieved an improvement in the basal score of all indicators, reaching the target score. It is essential to address care for elderly patients from the physical, mental, functional and social areas. © 2023 DAE Editorial, Grupo Paradigma. All rights reserved.
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SARS-CoV-2 has a predilection for cell groups that are rich in ACE2 and TMPRSS2 receptors, which are distributed throughout the human body, which means that, in addition to the primary site of contagion or primary infection, which is the respiratory system, the virus tends to spread by different mechanisms, affecting practically all the known organs, apparatuses and systems, with which its tropism becomes extensive, being able to condition diverse pictures together with the respiratory one.Copyright © 2023 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.
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Latinx people in the USA have had a high burden of COVID-19 cases, hospitalizations, and death, yet rates of COVID-19 vaccine uptake among Latinx individuals were lower than other demographic groups. Effective strategies to promote vaccine uptake among Latinx communities are needed. We conducted a rapid review of information available between December 2020 and August 2021. Our search strategy used PUBMED, Google, and print media with a prescribed set of definitions and search terms for two reasons: there were limited peer-reviewed studies during early period of roll-out and real-time perspectives were crucially needed. Analyses included expert opinion, descriptions of project implementation and outcomes. We found that approaches varied. An integral component with all interventions was the use of local Latinx community leaders. They could understand the nuances of vaccine hesitancy, access issues, and structural inequities experienced by Latinx communities. The mechanisms for messaging included the use of social media, radio, and promotora outreach workers to disseminate information about COVID-19 vaccines and counter misinformation. Phone hotlines for scheduling were reported. Promoting access involved pop-up clinics at shopping malls, farmer's markets, and nearby grocery stores which were popularly used to vaccinate Latinx community members. Other practices included limited registration requirements, avoiding online-only communication, and training staff to provide specialized support to Latinx clients. This rapid review provides a basis for developing strategic implementation to increase COVID-19 vaccine uptake in this ongoing pandemic and planning to promote health equity for future bio-events and health crises.
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This research addresses the challenges faced by teachers and students as a consequence of the COVID-19 pandemic, highlighting the psychological impact associated with the sudden need to adopt digital teaching tools in everyday school life. Studies of this nature are necessary to support preventive and/or therapeutic actions aimed at coping with emerging changes. Therefore, we intended to understand the current scenario of distance education and how it interferes in the mental health of teachers and students, in such a way as to enable them to deal with this new context, which tends to remain active beyond this pandemic. We performed a survey of publications in the Web of Science and Google Scholar databases. Thus, we found and analyzed eight field studies on the topic. The main difficulties reported by research participants refer to problems related to the adaptability of computer programs, the adaptation of teaching strategies to the digital model and the need to teach, simultaneously, distance and face-to-face synchronous classes. We found reports of exhaustion, anxiety, stress and fear due to the possibility of job loss and/or exposure to the virus, besides overload of work. As a gap in the literature, we noted an absence of studies on the topic involving teachers and students of elementary and high school in Brazil and abroad. Keywords: remote education;educational technology;schooling;teaching-learning. © 2021, Acta Scientiarum. Education. All rights reserved.
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Introduction. The COVID-19 pandemic has affected thousands of people worldwide. The collapse of health systems led to increased difficulties in accessing health care for people with disabilities. The objective was to define strategies to support the implementation of health care for people with disabilities. Methods. The protocol for the systematic review was registered on PROSPERO (CRD42021266341). Searches were done in seven databases, using MeSH terms related to COVID-19 and disability, in 2021. We included interventions that addressed health, education and social assistance. Results. Twenty-nine studies were included. A meta-synthesis identified strategies to assist individuals with disabilities: creation of emergency accommodation and protection programs;flexible work arrangements;cash transfer programs;community participation in planning;establishment of support networks;social assistance even in periods of health emergency;teleconsultation services, telerehabilitation and systems that facilitate the use of digital technologies for telemedicine;inclusive guidelines for computer literacy and learning. The main implementation action was comprehensive health care centered on the needs of people with disabilities, with a focus on training community informants, continuing education of health professionals and caregivers for emergency situations, decentralization of care, identification and elimination of barriers to access. Conclusions. Even though the focus was on telehealth and social assistance, achieving comprehensive healthcare requires a range of interventions that together will support the reduction of inequity faced by people with disabilities.
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Most persons living with dementia receive home health or hospice aide services during their hospice stay. To equip aides with essential knowledge and skills to effectively communicate with and care for persons living with dementia, we developed a 17-video dementia care expert program for aides, available in both English and Spanish. The objective of this presentation is two-fold: first, describe the development and refinement of the Aliviado aide dementia care expert program, including topic selection, usability testing, and cultural tailoring;and second, discuss aide knowledge improvement, along with special considerations for training aides during COVID-19. The Aliviado dementia care expert program for aides has been completed by 414 aides across 15 hospices as of February 2022;of which, 384 aides (93%) completed a dementia knowledge assessment both before and after the training and demonstrated significant knowledge gains with moderate-to-large effect sizes (p<0.0001;Cohen's d=0.63).
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BACKGROUND: Approximately every 37 seconds, someone in the United States dies of cardiovascular disease (CVD). It has emerged as an important contributor to morbidity among persons with HIV. Black and Latinx sexual minority men are at higher risk of both HIV and CVD when compared to heterosexual, nonethnic or minority men. Persons with HIV have a 1.5 to 2-times risk of having CVD than do HIV-negative persons. Data suggest that by the year 2030, an estimated 78% of persons with HIV will have CVD. The relationship between HIV and CVD in marginalized populations is not well understood because overall awareness of HIV and CVD as comorbid conditions is low, which further heightens risk. This has created a critically pressing issue affecting underrepresented ethnic and racial populations with HIV and requires immediate efforts to mitigate risk. OBJECTIVE: The purpose of this formative, mixed methods study is to use a community-engaged approach to map a behavioral intervention for CVD prevention in Black and Latinx sexual minority men with HIV in New York City. METHODS: Literature reviews focused on behavioral prevention studies using intervention mapping. In Aim 1, we will use qualitative interviews with HIV program managers and community members to understand facilitators and barriers to CVD prevention, chronic illnesses of concern, and early design elements needed for a web-based CVD prevention intervention. In Aim 2, we will conduct qualitative interviews and administer cross-sectional validated surveys with 30 Black and Latinx sexual minority men with HIV. We will assess illness perceptions of chronic conditions, such as HIV, hypertension, and diabetes. A total of 40 participants (program managers and community members) for Aims 1 and 2 will be enrolled to participate. To develop the protocol, we will follow steps 1 through 3 (needs assessment, change objectives, implementation strategy) of intervention mapping, using mixed methods. RESULTS: The study was approved by New York University Institutional Review Board in February 2021 (IRB-FY2021-4772) and also by the Yale University Institutional Review Board in June 2022 (#2000031577). We anticipate completing data collection on or before December 2022. Early analyses suggested concerns about illnesses outside of HIV and associated comorbid conditions, such as COVID-19 and monkeypox. Additionally, we noted a strong interest in using a web-based platform for CVD prevention education. CONCLUSIONS: Web-based, behavioral, CVD prevention interventions may be promising modalities to closing the cardiovascular health disparities gap in Black and Latinx sexual minority men with HIV by extending the reach of prevention interventions using community-informed approaches and technological modalities that have been underused in this population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/41602.
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Introduction The mental health impact of the COVID-19 pandemic is well documented. Portugal entered the emergency state on 19th march due to rising numbers of infected patients. The emergency state introduced regulatory measures that restricted people’s movements, applied a curfew, and closed most non-essential spaces and activities, such as shops and religious celebrations. Objectives To evaluate the rates of suicides during the emergency state in Portugal. Methods We obtained the number of probable suicides during 19th march and 2nd may 2020, 2019 and 2018 from SICO/eVM (Real Time Mortality Electronic Surveillance). This system is used for health planning in Portugal and provides provisory data which is updated every 10 minutes. ExcelÒ was used for the statistical analysis. Results During the Emergency State in Portugal there were 57 probable suicides. Comparing to the same period in 2018 and 2019, there were 62 and 70 probable suicides, respectively. Social isolation, anxiety, fear of contagion, chronic stress, and economic difficulties may lead to the development or exacerbation of depressive, anxiety, substance use, and other psychiatric disorders. Literature on suicides due to COVID-19 mention not only fear of infection, but also social isolation and distancing and economic recession as causes for suicide attempts and completions. Conclusions During the emergency state there was not an increase of probable suicides, compared to previous years. The greater vigilance of people’s movements may have deterred many attempts. However, policymakers and health care providers must be alert as the current psychosocial predispose to an increase in suicide rates. Disclosure No significant relationships.
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Background. DNA vaccines are safe, tolerable, elicit humoral and cellular responses, allow for repeated dosing over time, are thermostable at room temperature, and are easy to manufacture. We present a compilation of Phase 1 and Phase 2 data of Inovio's US COVID-19 DNA Vaccine (INO-4800) targeting the full-length Spike antigen of SARS-CoV-2. A South Korean Phase 2 study is ongoing. Methods. Participants in the open-label Phase 1 trial received 0.5 mg, 1.0 mg or 2.0 mg intradermally (ID) followed by electroporation (EP) at Days 0 and 28. An optional booster dose was administered >6 months post-dose 2. The Phase 2 further compared the 1.0 mg and 2.0 mg doses against placebo in a total of 401 participants randomized at a 3:3:1:1 ratio. ClinicalTrials.gov identifiers: NCT04336410 and NCT04642638 Results. The majority of adverse events (AEs) related to INO-4800 across both trials were mild in severity and did not increase in frequency with age and subsequent doses. In Phase 1, 78% (14/18) and 84% (16/19) of subjects generated neutralizing antibody responses with geometric mean titers (GMTs) of 17.4 (95%CI 8.3, 36.5) and 62.3 (95% CI 36.4, 106.7) in the 1.0 and 2.0 groups, respectively (Figure 1). By week 8, 74% (14/19) and 100% (19/19) subjects generated T cell responses by Th1- associated IFNγ ELISPOT assay . Following a booster dose, neutralizing GMTs rose to 82.2 (95% CI 38.2, 176.9) and 124.7 (95% CI 62.8, 247.7) in the 1.0 mg and 2.0 mg groups, respectively, demonstrating the ability of INO-4800 to boost (Figure 2). In Phase 2, neutralizing antibody responses demonstrated GMTs of 93.6 (95%CI 77.3, 113.4) in the 1.0 mg dose group and 150.6 (95%CI 123.8, 183.1) in the 2.0 mg dose group (Figure 3). Conclusion. INO-4800 appears safe and tolerable as a primary series and as a booster with the induction of both humoral and cellular immune responses. In addition to eliciting neutralizing antibodies, INO-4800 also induced T cell immune responses as demonstrated by IFNγ ELISpot. Finally, as a homologous booster, INO-4800, when administered 6-10.5 months following the primary series, resulted in an increased immune response without increase in reactogenicity. The 2.0 mg dose was selected for Phase 3 evaluation.
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Background. Global surveillance has identified emerging SARS-CoV-2 variants of concern (VOC) associated with increased transmissibility, disease severity, and resistance to neutralization by current vaccines under emergency use authorization (EUA). Here we assessed cross-immune responses of INO-4800 vaccinated subjects against SARS-CoV-2 VOCs. Methods. We used a SARS-CoV-2 IgG ELISA and a pseudo neutralization assay to assess humoral responses, and an IFNγ ELISpot to measure cellular responses against SARS-CoV-2 VOC in subjects immunized with the DNA vaccine, INO-4800. Results. IgG binding titers were not impacted between wild-type (WT) and B.1.1.7 or B.1.351 variants. An average 1.9-fold reduction was observed for the P.1 variant in subjects tested at week 8 after receiving two doses of INO-4800 (Figure 1a). We performed a SARS-CoV-2 pseudovirus neutralization assay using sera collected from 13 subjects two weeks after administration of a third dose of either 0.5 mg, 1 mg, or 2 mg of INO-4800. Neutralization was detected against WT and the emerging variants in all samples tested. The mean ID50 titers for the WT, B.1.1.7, B.1.351 and P.1. were 643 (range: 70-729), 295 (range: 46-886), 105 (range: 25-309), and 664 (range: 25-2087), respectively. Compared to WT, there was a 2.1 and 6.9-fold reduction for B.1.1.7 and B.1.351, respectively, while there was no difference between WT and the P.1 variant (Figure 1b). Next, we compared cellular immune responses to WT and SARS-CoV-2 Spike variants elicited by INO-4800 vaccination. We observed similar cellular responses to WT (median = 82.2 IQR = 58.9-205.3), B.1.1.7 (79.4, IQR = 38.9- 179.7), B.1.351 (80, IQR = 40.0-208.6) and P.1 (78.3, IQR = 53.1-177.8) Spike peptides (Figure 2). Conclusion. INO-4800 vaccination induced neutralizing antibodies against all variants tested, with reduced levels detected against B.1.351. IFNγ T cell responses were fully maintained against all variants tested.
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Background. First-generation COVID-19 vaccines are matched to spike protein of the Wuhan-H1 (WT) strain. Convalescent and vaccinee samples show reduced neutralization of SARS-CoV-2 variants of concern (VOC). Next generation DNA vaccines could be matched to single variants or synthetically designed for broader coverage of multiple VOCs. Methods. The synthetic consensus (SynCon®) sequence for INO-4802 SARSCoV-2 spike with focused RBD changes and dual proline mutations was codon-optimized (Figure 1). Sequences for wild-type (pWT) and B.1.351 (pB.1.351) were similarly optimized. Immunogenicity was evaluated in BALB/c mice. Pre-clinical efficacy was assessed in the Syrian Hamster model. Figure 1. Design Strategy for INO-4802 Results. INO-4802 induced potent neutralizing antibody responses against WT, B.1.1.7, P.1, and B.1.351 VOC in a murine model. pWT vaccinated animals showed a 3-fold reduction in mean neutralizing ID50 for the B.1.351 pseudotyped virus. INO-4802 immunized animals had significantly higher (p = 0.0408) neutralizing capacity (mean ID50 816.16). ID50 of pB.1.351 serum was reduced 7-fold for B.1.1.7 and significantly lower (p = 0.0068) than INO-4802 (317.44). INO-4802 neutralized WT (548.28) comparable to pWT. INO-4802 also neutralized P.1 (1026.6) (Figure 2). pWT, pB.1.351 or INO-4802 induced similar T-cell responses against all variants. INO-4802 skewed towards a TH1-response. All hamsters vaccinated with INO-4802 or pB.1.351 were protected from weight loss after B.1.351 live virus challenge. 4/6 pWT immunized hamsters were completely protected. pWT immunized hamsters neutralized WT (1090) but not B.1.351 (39.16). INO-4802 neutralized both WT (672.2) and B.1.351 (1121) (Figure 3). We observed higher increase of binding titers following heterologous boost with INO-4802 (3.6 - 4.4 log2-fold change) than homologous boost with pWT (2.0 - 2.4 log2 fold change) (Figure 4). Conclusion. Vaccines matching single VOCs, like pB.1.351 and pWT, elicit responses against the matched antigen but have reduced cross-reactivity. Presenting a pan-SARS-CoV-2 approach, INO-4802 may offer substantial advantages in terms of cross-strain protection, reduced susceptibility to escape mutants and non-restricted geographical use.
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The purpose of the study was to analyze the metrics available for digital tools fostering self-care to understand their effects on the population in the time of COVID-19. A search was conducted about websites, mobile applications and social networks offering information to the population about COVID-19 and belonging to the Peruvian government or health-related official institutions. A review was performed of the metrics available for each digital tool with a view to an eventual evaluation of their use. The websites identified provided information about COVID-19 as well as updated data about existing cases, self-evaluation to rule out the disease and the report of results of diagnostic tests. The most visited website was that of the Government of Peru, which contained the website of the Ministry of Health. The mobile application of the Government of Peru "PerúEnTusManos" was the most commonly downloaded by the Peruvian population. Social networks, in joint cooperation with these digital tools, are actively used in Peru to inform and interact with the population in the time of COVID-19. Due to the rapid adaptability of websites and mobile applications, these have become an ideal information tool in Peru to face the COVID-19 pandemic. © 2021, Centro Nacional de Informacion de Ciencias Medicas. All rights reserved.
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Background : Association between some analytical parameters and clinical evolution of patients infected by SARS-COV-2 is a controversial issue. Aims : Review the relationship between laboratory parameters and severity and/or lethality of the COVID-19. Methods : Observational, cross-sectional and retrospective study. Data obtained from electronic health record of patients over 18 years of age admitted in our hospital, between March and May 2020 with suspected SARS-COV-2 infection. After descriptive statistical study, we did an inferential analysis using Mann-Whitney U test for independent samples, in order to verify association between the results of analytical parameters and the clinical severity (defined by hospitalization in conventional ward vs. intensive care units (ICU)) and/or lethality (alive vs. death at the end of the study). Results : 668 patients were included, 345 men (52%) and 323 women (48%), with a median age of 70 years. 80% of patients had previous comorbidities, 10% were admitted to the ICU, and 17% died.Differences were found in hematimetric parameter between the different groups: leukocytes (10 3 /μl): 8.3 in ICU patients vs. 6.5 in those admitted to the ward;platelet count (10 3 /μl) of 182l in death patients vs. 223 in survivors;hemostasis parameters: D-dimer (DD) (μg/L) of 1379 and 1236 in deceased and admitted to the ICU respectively, compared to 734 and 786 in survivors and not admitted to ICU;and biochemical figures (increase in C-reactive protein (CRP), lactate dehydrogenase (LDH) or cardiac enzymes, the latter, especially, in patients who were deceased, with a median ultrasensitive troponin I (ng/L) of 34.75 vs. 7.1 in survivors. The differences were statistically significant ( P value <0.01). Conclusions : Correlation exist between severity of infection and the increase in leukocytes, neutrophils, DD, CRP and LDH, and lymphopenia, in our sample. Decrease in the platelet count and the increase in cardiac enzymes were associated with an increased risk of mortality.
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Background : A first publication by Tang et in March 2020 reported a high incidence of Disseminated Intravascular Coagulation (DIC) in patients who died from SARS-COV-2 (COVID-19) infection. Since then, some studies have questioned this high incidence. Aims : To investigate the incidence of DIC in patients with confirmed diagnosis of severe COVID-19, who required admission to the ICU. Methods : Observational, descriptive, and retrospective study that includes patients older than 18 years with severe COVID-19 infection admitted to the ICU of the “Miguel Servet” University Hospital, between March to November 2020. All clinical and laboratory parameters, as well as the clinical conduct, were requested and carried out according to the usual clinical practice. Results : We included 130 patients 60% men, median age of 67 years (24-79), mortality of 40.8%, 9 cases (6.9%) of established DIC were documented, with impact in survival (Figure 1). Conclusions : Mortality in our series is similar to that reported (40%), the incidence in our series is higher than a recently published metaanalysis (6.9 VS 3%). The low incidence of DIC is interesting, because the high frequency of coagulopathy and elevation of D-dimer in the published series so, this raises the question, if there really is a classic DIC in patients with COVID-19. In our series, none of the patients with DIC presented hypofibrinogenemia. These findings support the theory that coagulopathy in COVID-19 patients is different from classic DIC and requires different management and classification.
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Background and AimsThe authors analyse the anaesthetic approach in pregnants infected (PI) with COVID-19 admitted in a tertiary maternity (TM) during 12 months. They report and compare data from three-month period and data from not infected pregnants (NIP).MethodsDescriptive and retrospective observational study, with no need to ethical approval according to local committee. Data from a sample of 2288 pregnants (April 1,2020 – March 31,2021). Variables and their associations were analysed with statistical tests using the SPSS tool.Results2.8% of pregnants were infected with COVID-19. 11% of these were admitted in the 1st quarter, 2% in 2nd, 29% in 3rd and 58% in 4th.The anaesthetic approach was, with statistically significant, different between PI and PNI(p<,001). Use of neuraxial labour analgesia/anaesthesia in PI increased (42,9% -1st vs 65,8% -4th). General anaesthesia decreased (10,5% -1st vs 5,3% -4th). Comparing deliveries, there was a statistically significant difference(p=0.01): 38% of births were caesarean section (CS) in PI vs 23% in PNI. In PI there was a decrease of 8,7% in CS between the 1st and 4th quarter. The need for emergency surgery (ES) had statistically significant difference(p=0.02), 26.2% of ES in PI vs 15.1% in PNI. In PI there was no statistically significant difference(p>0,05) when comparing the occurrence of ES in the different quarters.ConclusionsAn increase of neuraxial labour analgesia/anaesthesia and decrease in GA was verified, despite the higher percentage of ES in PI. This can be related to increase in experience and knowledge, demostrating that neuraxial thecniques are safe/recommended in pregnants infected with COVID-19.
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Immune thrombocytopenia (ITP) is an acquired autoimmune disorder defined by a platelet count <100×109/L without explanation. This laboratory parameter has emerged as an important complication and have been shown to correlate with severe course in the coronavirus disease (COVID-19) caused by novel coronavirus SARS-CoV-2. Aims: To analyze the clinical characteristics, diagnostic, blood count parameters, therapeutic strategies and outcomes in patients admitted with COVID-19 infection with acquired ITP. Methods: An observational, longitudinal, descriptive and retrospective study was performed on all patients who were COVID-19 positive and platelet count < 100×109/L admitted to hospital between March 1 2020 and January 31 2021 at our centre. All patients were laboratory confirmed COVID-19 positive with a positive nasopharyngeal swab. Clinical and demographic data were collected for each patient, including age, gender, nadir platelet count, bleeding symptoms, time to recovery from start of treatment and clinical outcomes. Patients with previous hematological pathologies or thrombocytopenia were excluded. Mild COVID-19 disease was defined by presence of fever and cough only. Moderate disease was defined by presence of unilateral pneumonia by radiological evidence and/or clinical worsening. Severe disease was defined by presence of bilateral pneumonia by radiological evidence, admission to intensive care unit (ICU) during admission or met criteria for ARDS. Response to treatment was defined by documentation of platelet doubling or platelet count reaching at least > 30 × 109 /L (partial response-PR) or level reached > 100 × 109 /L or up to baseline count of that patient (complete response-CR). The results are expressed in percentages for qualitative variables, and in means and interquartilic ranges for continuous variables. The data were included in an Excel database (Microsoft.) and the IBM SPSS Statistics. 20 program was used for their analysis. Results: A total of 27 patients were identified, 17 males (62.96%) and 10 females (37.03%). The mean age at the time of the event was 78 years old (interquartile range-IQR-: 28 years). Attending to severity, 15 had severe disease (55.5%), 9 moderate and only 3 patients (11%) had a mild presentation. The mean time from first COVID-19 manifestations to first ITP expression was 5 days (0-23). and in most of our patients was an incidental finding, presenting only 22% haemorragic clinic associated. The majority of patients in our study did not receive a specific treatment for suspected ITP (e.g. only 6 were treated with intravenous immunoglobulins which were needed due to bleeding). But most patients were already treated with low doses of steroids as part of their treatment for COVID-19. The response rate was about 63% (PR and CR), with a mean of response of six days (IQR of 6.5 days). Patients with severe disease and those who died at the end of the study, had lower platelet count than survivors and patients with moderate disease. However, our differences were not statisticaly significant. Summary/Conclusion: In our study, ITP was more frequent in severe COVID-19, with lower nadir platelet count, as described in literature. Bleeding events were infrequent. Glucocorticoids were used as a treatment for COVID-19 disease, only used in few patients as ITP specific treatment. The results should be confirmed with prospective randomized controlled studies.
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IntroductionIn early 2020, governments started to implement different forms of public health measures, from physical distancing recommendations, to stay-at-home orders, to limit the propagation of COVID-19. Here we report the case of a 41-year-old woman, with a diagnosis of panic disorder. During the end of the lockdown, the patient presented psychopathological worsening, from her fear of Covid-19 infection, stemming from a heart failure disease and concerns regarding the hygiene and safety measures of those around her.ObjectivesPresentation of a clinical vignette.MethodsSelection and analisis of clinical case and review of the literature using PubMed database.ResultsThe COVID-19 pandemic and the measures adopted to prevent the spread of the disease had a huge impact on a personal, social, and economic level for the world population. The rise of fear and anxiety among people due to uncertainty about the disease are coupled with essential yet disruptive measures such as lockdowns and quarantines. The chronically ill population are especially vulnerable during such circumstances and require addressing their physical health and any psychological difficulties they might experience, being at higher risk of suffering physically from the pandemic’s disease as well as psychologically from the implemented countermeasures.ConclusionsThis vignette provides a case where a person’s psychiatric conditions are worsened due to the end of a pandemic lockdown, rather than the lockdown itself. Additional work should aim at comparing the experiences of the different countries affected by the pandemic in order to understand the size of the psychological impact, the potential risk and protective factors.DisclosureNo significant relationships.
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IntroductionPsychosocial rehabilitation is a challenge in a society with demands unsuitable for those with severe mental illness (SMI). The Mental Health Department of Matosinhos Local Health Unity (MHD-MLHU) has developed a solidarity project aiming to evaluate and elaborate individualized rehabilitative responses with people with SMI, including people from the community motivated for solidarity initiatives.ObjectivesTo describe a psychosocial rehabilitation project focused on community integration of people with SMI, considering needs and resources of the population, and to present the individualized rehabilitation plans carried out for people with SMI.MethodsIn January 2019, we began the home evaluation of people with SMI monitored in the MHD-MLHU. To develop solidary based play-occupational groups, we interviewed people from the community and from the common mental pathology outpatient clinic willing to participate.ResultsWe present the description and evaluation of the psychosocial responses developed by the project. These responses include recreational-occupational groups, tailored to interests of each person with SMI, and using the community support group built for the purpose. These responses promote face-to-face activities, and enhance the destigmatization of SMI. The constraints resulting from the COVID-19 pandemic led to the creation of digital responses aimed at people with SMI and the community in general.ConclusionsThis experience has revealed the great potential of rehabilitating the community context of people with SMI, rather than just contemplating pre-existing structured responses. The pandemic created specific challenges but made the initiative even more relevant for SMI people and for promoting the mental health of the general population.