COVID-19 WAS NOT TRIGGER FOR RHEUMATIC DISEASE ACTIVITY AFTER 6 MONTHS FOLLOW-UP: RESULTS FROM REUMACOV BRASIL REGISTER

BackgroundThe COVID-19 pandemic has brought uncertainties to rheumatology practice, mainly related to the possibility of triggering disease activity after infection in immune mediated rheumatic diseases (IMRD). To date, there are few data in the literature specifically evaluating this issue.ObjectivesEvaluate the disease activity in IMRD patients after 6 months of the infection, compared to pre infection status.MethodsReumaCoV Brasil is a longitudinal study performed at 35 study centers designed to follow-up IMRD patients for 6 months after clinical or laboratorial COVID-19 diagnosis (cases), comparing with patients with IMRD who had not had the infection at the time of inclusion (controls). Demographic data such as age, sex, comorbidities, clinical characteristics, treatment, evolution of COVID-19 and disease activity status were collected using a Research Eletronic Data Capture (REDCap) database on three consecutive visits (inclusion and 6 months). The analysis was carried out on the four diseases with the highest inclusion number in the study: systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). In addition to specific disease activity assessment metrics, we used patient's global assessment of disease activity (PGA), ranging from 0 to 10, at all visits, with 0 being no activity and 10 being intense activity. All conclusions were drawn considering the significance level of 5%. This study was registered at the Brazilian Registry of Clinical Trials—REBEC, RBR-33YTQC. All patients read and signed the informed consent form before inclusion.ResultsBetween May 2020 and January 2021, 2032 patients were included in the registry, and of these, 1322 patients (721 cases and 601 controls), completed 6 months of follow-up, being 550 SLE (42.0%), 497 RA (37.6%) and 176 SpA (13.3%) and 99 (7.4%) PsA. Most patients were female (82.0%);the median age was 46.7 (13.8). Disease activity at the time of enrollment, according to the PGA, was similar between cases and controls, except for patients with RA and AS, where it was higher in controls. After the follow up time, no worsening of activity was observed in any of the diseases evaluated in the case group (Table 1). Despite this, worsening of disease symptoms after COVID-19 was reported by 23.3%, 24.6%, 25.0% and 25.8% of patients with SLE, RA, AS and PsA respectively, not related with disease activity.ConclusionIn patients with IMRD, no worsening of disease activity was observed after COVID-19 in this cohort of Brazilian patients. Despite this, many patients noticed worsening of symptoms, possibly associated not with the triggering of the activity, but with the so-called long COVID syndrome.Table 1.Comparison of disease activity, according to PGA, comparing disease activity status at inclusion and after 6 months of follow up, in cases and controlsINCLUSIONAFTER 6 MONTHSCasesControlsp-valueCasesControlsp-valueSLE2 (0-4,5)2 (0-4)0,8102 (0-5)2 (0-4)0,172RA3 (1-5)4 (2-6)0.0013 (1-5)3 (1-5,5)0,731AS2 (0-5)4 (1-6)0,0022 (0-5)3,5 (1-6)0,044PsA2 (0-4)2 (0-5)0,8162 (0-5)2 (0-5)0,939*Median and interquatile range;Student t test;CI 95%AcknowledgementsReumaCoV Brasil researchers, Brazilian Society of Rheumatology and National Council for Ccientific and Technological Development.Disclosure of InterestsNone Declared.

Work context and clinical manifestations of COVID-19 in health professionals

To analyze associations between work context and clinical manifestations of COVID-19 in health professionals. Methods: This is a cross-sectional study, with health professionals from the northeast of Brazil, from the medical, nursing and physiotherapy categories from different areas of expertise. A Google Forms questionnaire was sent through social networks, gathering demographic, academic, work context, clinical manifestations and data related to testing for COVID-19 (the test performed was not specified) and whether the result confirmed infection active or presence of antibodies (categorized as positive). Pearson's chi-square test and multivariate binary logistic regression analysis were performed, with Wald's chi-square test, considering p-value <0.05, Odds Ratio and 95% confidence interval. Results: A total of 1,354 professionals agreed to participate in the study. Of these, 324 reported a positive test for COVID-19, with a prevalence of 23.9% (324/1,354). There was a statistical association between symptom onset and positive result (p=0.000). The work context characteristics related to the number of jobs, practice setting, contact with critically ill patients and employment in the capital were the independent variables associated with a positive result for COVID-19 (p<0.05). It was identified that 54.8% of the dependent variable can be related to the work sector, number of jobs, fever, loss of smell and taste. Conclusion: Health professionals from urban centers, hospitals, critical care units and those with more than one job are more affected by COVID-19, with the positive test result being closely related to the symptoms of fever, loss of smell and taste that are characteristic of the illness. © 2022 Departamento de Enfermagem/Universidade Federal de Sao Paulo. All rights reserved.

Incidence and risk factors for moderate/severe COVID-19 in rheumatic diseases patients on hydroxychloroquine: a 24-week prospective cohort

Objective To evaluate the incidence of COVID-19 and its main outcomes in rheumatic disease (RD) patients on hydroxychloroquine (HCQ) compared to household cohabitants (HC).Methods This is a 24-week nationwide prospective multi-centre cohort with a control group without RD and not using HCQ. All participants were monitored through scheduled phone interviews performed by health professionals. Details regarding COVID-19 symptoms, and epidemiological, clinical, and demographic data were recorded on a specific web-based platform. COVID-19 was defined according to the Brazilian Ministry of Health criteria and classified as mild, moderate or severe.Results A total of 9,585 participants, 5,164 (53.9%) RD patients on HCQ and 4,421 (46.1%) HC were enrolled from March 29th, 2020 to September 30th, 2020, according to the eligibility criteria. COVID-19 confirmed cases were higher in RD patients than in cohabitants [728 (14.1%) vs. 427 (9.7%), p<0.001] in a 24-week follow-up. However, there was no significant difference regarding outcomes related to moderate/ severe COVID-19 (7.1% and 7.3%, respectively, p=0.896). After multiple adjustments, risk factors associated with hospitalisation were age over 65 (HR=4.5;95%CI 1.35-15.04, p=0.014) and cardiopathy (HR=2.57;95%CI 1.12-5.91, p=0.026). The final survival analysis demonstrated the probability of dying in 180 days after a COVID-19 diagnosis was significantly higher in patients over 65 years (HR=20.8;95%CI 4.5-96.1) and with 2 or more comorbidities (HR=10.8;95%CI 1.1-107.9 and HR=24.8;95%CI 2.5-249.3, p=0.006, respectively).Conclusion Although RD patients have had a higher COVID-19 incidence than individuals from the same epidemiological background, the COVID-19 severity was related to traditional risk factors, particularly multiple comorbidities and age, and not to underlying RD and HCQ.

Infeccao Aguda Por Citomegalovirus Associada a Glomerulonefrite Rapidamente Progressiva No Paciente Em Terapia De Manutencao Para Leucemia Pro Mielocitica Aguda Com Fusao Pml Rara

Objetivo: O presente estudo tem por objetivo relatar caso de infeccao aguda por citomegalovirus associada a glomerulonefrite rapidamente progressiva no paciente em terapia de manutencao para leucemia pro mielocitica aguda. Relato de caso: Paciente masculino de 25 anos, sem comorbidades, em seguimento no servico de hematologia da UNIFESP por quadro de Leucemia Pro Mielocitica Aguda (diagnostico em julho/2021), em protocolo de manutencao desde janeiro/2022 com 6-mercaptopurina, metotrexato e ATRA, em remissao morfologica e molecular, evolui com quadro de febre diaria ha 10 dias associada a odinofagia e tosse, com linfopenia, sem alteracoes ao exame fisico e rastreio infeccioso ambulatorial negativo. Solicitadas pesquisas de Citomegalovirus, Parvovirus, Epstein-Barr e SARS-Cov-2, suspensos os farmacos do protocolo de manutencao e indicada internacao hospitalar. Sem melhora do quadro relatado acima, paciente evoluiu com pancitopenia associada a um aumento de DHL e ferritina, sem figuras de hemofagocitose no aspirado de medular, alem de sindrome nefrotica e lesao renal rapidamente progressiva KDIGO III com indicacao de dialise. Visto tambem que nao haviam esquizocitos em sangue periferico, alteracoes no coagulograma ou outras disfuncoes organicas. Constatadas sorologias IgM e IgG positiva para CMV alem de carga viral serica elevada para CMV, confirmando a infeccao aguda por CMV associada a glomerulonefrite rapidamente progressiva. A biopsia renal demonstrou podocitos com alteracoes degenerativas, ausencia de depositos glomerulares e infiltrado linfocitario intersticial. Apos tratamento adequado com ganciclovir paciente evoluiu com melhora da febre e retorno da funcao renal de base. Discussao: Em individuos imunocompetentes a infeccao assintomatica pelo citomegalovirus e comum, e quando ocorrem sintomas ha um quadro clinico semelhante a mononucleose infecciosa, que pode cursar com sintomas de vias aereas superiores associados a linfadenopatia, esplenomegalia e linfopenia. No contexto clinico dos pacientes imunossuprimidos e mais comum que ocorra uma reativacao viral que pode levar a lesao organica aguda com acometimento de orgao unico ou lesao multissitemica. E descrito em literatura que a infeccao por citomegalovirus associada a lesao renal aguda exclusiva esta mais associada ao contexto do paciente imunossuprimido pos transplante renal em uso de drogas com maior potencial imunossupressor, diferentemente do caso relatado. Conclusao: A partir das manifestacoes clinicas e do rastreio infeccioso direcionado as infeccoes oportunistas que acometem o paciente imunossuprimido foi possivel associar o quadro de glomerulonefrite rapidamente progressiva a infeccao aguda por CMV, quadro pouco conhecido na pratica clinica, visto a predilecao para doenca invasiva em sistema nervoso central, retina, trato gastrointestinal e trato respiratorio. Alem disso, notou-se que nesse caso o tratamento com Ganciclovir foi efetivo neste tipo de apresentacao clinica, visto o retorno da funcao renal de base apos o tratamento adequado. Copyright © 2022

Crise Hemolitica Associada a Vacina Contra Covid-19 Mrna Da Pfizer-Biontech Em Paciente Com Esferocitose

Introducao: Na esferocitose hereditaria existe uma maior fragilidade osmotica das hemacias, resultando em um maior risco de crises de hemolise - sejam elas espontaneas ou desencadeadas por infeccoes virais. Objetivos: Relatar o primeiro caso de crise hemolitica desencadeada pela vacina contra COVID-19. Relato do caso: Uma mulher de 40 anos, com diagnostico de esferocitose hereditaria desde os 8 anos de idade, iniciou quadro de astenia, mialgia, ictericia, inapetencia, nauseas, calafrios sem febre, cefaleia pulsatil e intensa em regiao de nuca com irradiacao holocraniana, com fotofobia, fonofobia. Os sintomas se iniciaram um dia apos o recebimento da 4 dose da vacina contra COVID-19 mRNA da Pfizer-BioNTech. Ao exame fisico, ictericia 2+/4+ e esplenomegalia palpavel a 9cm do rebordo costal esquerdo (RCE). Exames admissionais evidenciaram hemoglobina (Hb) 7,0 g/dL, hematocrito (Ht) 19,1%, bilirrubinas totais (BT) 3,56 mg/dL, bilirrubina indireta (BI) 2,8 mg/dL, bilirrubina direta (BD) 0,76 mg/dL e teste de antiglobulina direta negativo. Optado por conduta expectante. A paciente retornou apos 8 dias com novos exames, evoluindo com melhora completa dos sintomas, reducao da esplenomegalia, retorno ao seu valor de hemoglobina basal - Hb 10,0 g/dL, Ht 29,9% - e reducao de BI 0,91 mg/dL. A paciente apresentou quadro semelhante ha 8 meses, iniciado um dia apos o recebimento da 3dose da vacina contra COVID-19 mRNA da Pfizer-BioNTech, ocasiao na qual tambem buscou servico de saude e realizou exames laboratoriais que evidenciaram Hb 6,9 g/dL, Ht 18,9%, BT 2,5 mg/dL BI 1,9 mg/dL e BI 0,6 mg/dL. Na ocasiao, mantida conduta expectante, repetiu exames 3 dias apos, com Hb 8,4 g/dL, Ht 24,1%, reticulocitos 134880/mm3, BT 1,68 mg/dL, desidrogenase lactica 731U/L, haptoglobina 1,0 g/L. Discussao: Multiplos efeitos adversos hematologicos relacionados a vacina contra COVID-19 ja foram relatados na literatura, sobretudo imunes, tais como trombocitemia trombotica imune, trombocitopenia imune, anemia hemolitica autoimune e existem alguns relatos de crise hemolitica desencadeadas pela infeccao pelo COVID-19, contudo nao ha relatos de crises desencadeadas pela vacina contra COVID-19. A vacina Pfizer-BioNTech possui fragmentos de mRNA viral que levam a expressao transitoria da glicoproteina de superficie Spike, incitando uma resposta imune para a producao de anticorpos neutralizantes. Existe uma semelhanca estrutural molecular entre a proteina Spike e a proteina anquirina, o que pode levar a uma reatividade cruzada dos anticorpos com a anquirina e contribuir para a patogenese da hemolise. A presenca de recorrencia do quadro, de relacao temporal, de especificidade e de plausibilidade biologica reforcam a hipotese de causalidade entre crise hemolitica e vacinacao contra COVID-19 mRNA da Pfizer-BioNTech. Conclusao: O presente estudo expande o conhecimento sobre causalidade de crises de esferocitose, incluindo o primeiro relato pos vacinacao contra SARS-CoV-2. Contudo, novos trabalhos sao necessarios para confirmar essa hipotese. Devemos ter prudencia ao indicar vacinas de mRNA para pacientes com defeito congenito de membrana. Copyright © 2022

COMPULSORY VACCINATION AND FUNCTIONAL DIFFERENTIATION: THE LAW SOCIAL SYSTEM IN THE INCLUSION/ EXCLUSION PROCESSES ALONG THE COVID-19 PANDEMIC

Objective: this article aims to highlight the way in which the Law System acts in the inclusion / exclusion processes of individuals from social benefits from different spheres of world society. Methodology: the methodology to be used is the Niklas Luhmann's Social Systems Theory (2016), the basic theory for all the proposed observation. The indirect documentation search technique will be used, with a review of foreign national bibliography, and the qualitative analysis of judicial decisions. Results: as one of the results obtained, the means of the proposed analysis demonstrated how the System of Law plays a fundamental role in the dynamics of social inclusion and exclusion, both in the processes of guarantee of inclusion (access to justice and guarantee of the right to health), and in the legitimation of exclusion processes determined by the State, with a view to compel the citizen to vaccinate (compulsory vaccination), in order to reduce the risks that the contraryness to this act may generate in the Health System. Contributions: the study brings as a contribution, after a comparison between hypotheses of determination or legitimation of inclusion and exclusion by the System of Law, a balance between these decisions with the scope, above all, of highlighting the imprescindibility of a broader social observation for the understanding and resolution of the current problems of constitutional law. In the specific case of the research, the determining role of the Health System in the decisions of the Judiciary in the case of Covid-19 is evidenced. © 2022, Centro Universitario Curitiba - UNICURITIBA. All rights reserved.

INCIDENT CASES of COVID-19 and VACCINATION ADHERENCE in A MULTICENTRIC COHORT of INFLAMMATORY ARTHRITIS in BRAZIL

Background: The SARS-CoV-2 virus has caused a worldwide health crisis. Patients with infammatory arthritis are at higher risk of hospitalization and death by COVID-19 due to comorbidities or immunosuppressive treatments. Vaccination is one the most important strategies to control the pandemic. Objectives: To evaluate the incident cases of SARS-CoV-2 infection in a multi-centric cohort of infammatory arthritis in Brazil. Methods: BiobadaBrasil is a multicentric registry-based cohort study of Brazilian patients with rheumatic diseases starting their frst bDMARD or tsDMARD (1). The present analysis is a retrospective evaluation of adult patients with infam-matory arthritis (rheumatoid arthritis-RA, spondylarthritis-SpA and psoriatic arthritis-PsA) that were alive since the beginning of the COVID-19 pandemics in Brazil in February 2020. We evaluated the incidence and severity of COVID-19 infection and the adherence to anti-SARS-CoV-2 vaccines schedules, up to January 2022. Results: A total of 300 patients were interviewed and 69 (23.0%) reported con-frmed anti-SARS-CoV infection and 5 (1.7%) had a second infection. Among known infected patients, 18.8% need hospitalization and oxygen support, 7.2% were admitted at ICU, and 5.8% died. After COVID-19 infection, 31.8% reported worsening of disease activity but only 6.1% had modifcation in medication due to disease activity. Distribution of cases followed the pattern of waves observed in Brazil (Figure 1). Regarding vaccination, 285 (95%) reported to have received at least one dose of any anti-SARS-CoV-2 vaccine: 43% received the frst with the adenovirus ChAdOx1 nCoV-19 (AstraZeneca) adenovirus vaccine, 32% received the Sinovac-CoronaVac inactivated vaccine, 22% received the BNT162b2 (Pfzer-BioNtech) mRNA vaccine and 3% received the BNT162b2 (Pfzer-BioNtech) adenovirus vaccine. Almost all (98.1%) of these patients had already received the second dose of vaccine and after the frst and second vaccine doses, 6% and 4% of patients, respectively, reported worsening of articular disease activity, while, after the third dose, no patient reported disease activity worsening. Conclusion: During the pandemics, patients with infammatory arthritis had a pattern of distribution of cases very similar to general population. Adherence to vaccination is high and well tolerated.

FACTORS ASSOCIATED with SEVERE COVID-19 OUTCOMES in PATIENTS with IDIOPATHIC INFLAMMATORY MYOPATHY: RESULTS from the COVID-19 GLOBAL RHEUMATOLOGY ALLIANCE PHYSICIAN-REPORTED REGISTRY

Background: There is a paucity of data in the literature about the outcome of patients with idiopathic infammatory myopathy (IIM) who have been infected with SARS-CoV-2. Objectives: To investigate factors associated with severe COVID-19 outcomes in patients with IIM. Methods: Data on demographics, number of comorbidities, region, COVID-19 time period, physician-reported disease activity, anti-rheumatic medication exposure at the clinical onset of COVID-19, and COVID-19 outcomes of IIM patients were obtained from the voluntary COVID-19 Global Rheumatology Alliance physician-reported registry of adults with rheumatic disease (from 17 March 2020 to 27 August 2021). An ordinal COVID-19 severity scale was used as primary outcome of interest, with each outcome category being mutually exclusive from the other:a) no hospital-ization, b) hospitalization (and no death), or c) death. Odds ratios (OR) were estimated using multivariable ordinal logistic regression. In ordinal logistic regression, the effect size of a categorical predictor can be interpreted as the odds of being one level higher on the ordinal COVID-19 severity scale than the reference category. Results: Complete hospitalization and death outcome data was available in 348 IIM cases. Mean age was 53 years, and 223 (64.1%) were female. Overall, 167/348 (48.0%) people were not hospitalized, 136/348 (39.1%) were hospitalized (and did not die), and 45/348 (12.9%) died. Older age (OR=1.59 per decade of life, 95%CI 1.32-1.93), male sex (OR=1.63, 95%CI 1.004-2.64;versus female), high disease activity (OR=4.05, 95%CI 1.29-12.76;versus remission), presence of two or more comorbidities (OR=2.39, 95%CI 1.22-4.68;versus none), predni-solone-equivalent dose >7.5 mg/day (OR=2.37, 95%CI 1.27-4.44;versus no gluco-corticoid intake), and exposure to rituximab (OR=2.60, 95%CI 1.23-5.47;versus csDMARDs only) were associated with worse COVID-19 outcomes (Table 1). Conclusion: These are the frst global registry data on the impact of COVID-19 on IIM patients. Older age, male gender, higher comorbidity burden, higher disease activity, higher glucocorticoid intake and rituximab exposure were associated with worse outcomes. These fndings will inform risk stratifcation and management decisions for IIM patients.

Protocol for clinical pharmacists to perform and detect SARS-CoV-2 tests in pharmacies

WHO declared Covid-19 pandemic in early 2020 and while rapid tests kits (RTKs) were developed quickly, the spread of the SARS-CoV-2 virus continues to be a concern. In this scenario as a tentative of mass testing and prevent the collapse in the health system some countries decided to use the community pharmacist for testing. Unfortunately, despite the public's faith in these practitioners, there is no specific guide material for them, so they had to learn through their own day-to-day experiences and nearly a year after there is still no clear guidance material for them. This protocol was created throughout adaptations from guide materials for laboratories from Brazil, India, UK, USA, Canada, Australia, WHO and personal experiences. Differences in RTKs conducted, how to screen for the most suitable examination, a proper anamnesis, how to perform the tests correctively, biosafety are all new concepts placed in this protocol as these are the key concerns that these experts have when they were assigned this new and vital job. During the pandemic pharmacists are showing their major importance in combating this world public health crises as performing tests, be first and last place where population seeks for guidance and treatment and now in vaccination.

Gamification for Infectious Diseases Medical Education: Creating a Videogame to Teach COVID 19 Diagnosis and Treatment to Medical Students

Background. Brazillian authorities reported a total of 16.3 million cases and 454. 000 deaths during COVID-19 pandemic in Brazil by may 2021. It became necessary to educate healthcare professionals on diagnosis and treatment of the syndrome. Game based learning surfaced as an effective alternative, since it promotes critical thinking and problem solving skills. A team of Brazilian and Peruvian students, physicians, designers and programmers gathered to create a decision based computer game that simulates a hospital scenario and allows medical students to analise, make decisions and receive feedback. This work describes the creative process and showcase the initial version of the software. Methods. Professors and students of Medicine, Information Technology (IT), Design and Architecture from Brazil and Peru assembled a team in order to develop the computer game. Clinical cases were created by the medical students and professors, comprising medical procedures for the treatment and management of COVID 19, and a video game script was developed exploring gamification principles of challenge, objectivity, persistence, failure, reward and feedback. Algorithms (image 1) were created, under supervision of professors of Medicine, to define possible courses of action and outcomes (e.g. gain or loss of points, improvement or worsening of the patient). Students of Design created artistic elements, and IT students programmed with a game engine software. This fluxogram, written in portuguese, describes in detail all the possible courses of actions that can be exercised by the player. It is created by a team of Professors of Medicine and medical students, in accordance with evidence-based guidelines. Primarily, this document guides the programmers and designers throughout the development phase of the game. Results. Initially, an expandable minimum viable product was obtained. The game, visualized on image 2, consists in a non-playable character and a playable character (i.e. doctor), with a scenario and a dialogue script simulating a clinical examination of a COVID 19 patient. The player can interact with certain elements within the game, e.g. the computer and other characters, to retrieve test results or start dialogues with relevant information. Hospital scenario and dialogue window between doctor (player in black) and patient (non playable character) are displayer in the game engine software (Unity 2D). On the bottom half of the screen, the dialogue box allows the player to collect the patient's medical history. The player can interact with certain elements to obtain relevant information to make decision and progress in the game. Conclusion. The game allows medical students to practice diagnosis and treatment of COVID 19. Future versions will include assessment reports of player's actions, and a new score system will be implemented. New diseases will be incorporated in the gameplay to match the variety of scenarios offered by real hospitals and patients. Artificial intelligence will be employed to optimize gameplay, feedback and learning.

Synthesis and defect characterization of hybrid ceria nanostructures as a possible novel therapeutic material towards COVID-19 mitigation.

This study reports the synthesis of hybrid nanostructures composed of cerium dioxide and microcrystalline cellulose prepared by the microwave-assisted hydrothermal route under distinct temperature and pH values. Their structural, morphological and spectroscopic behaviors were investigated by X-Rays Diffraction, Field Emission Gun Scanning Electron Microscopy, High-Resolution Transmission Electron Microscopy, and Fourier-Transform Infrared, Ultraviolet-Visible, Raman and Positron Annihilation Lifetime spectroscopies to evaluate the presence of structural defects and their correlation with the underlying mechanism regarding the biocide activity of the studied material. The samples showed mean crystallite sizes around 10 nm, characterizing the formation of quantum dots unevenly distributed along the cellulose surface with a certain agglomeration degree. The samples presented the characteristic Ce-O vibration close to 450 cm-1 and a second-order mode around 1050 cm-1, which is indicative of distribution of localized energetic levels originated from defective species, essential in the scavenging of reactive oxygen species. Positron spectroscopic studies showed first and second lifetime components ranging between 202-223 ps and 360-373 ps, respectively, revealing the presence of two distinct defective oxygen species, in addition to an increment in the concentration of Ce3+-oxygen vacancy associates as a function of temperature. Therefore, we have successfully synthesized hybrid nanoceria structures with potential multifunctional therapeutic properties to be further evaluated against the COVID-19.

Maximum Entropy Networks Applied on Twitter Disinformation Datasets

Identifying and detecting disinformation is a major challenge. Twitter provides datasets of disinformation campaigns through their information operations report. We compare the results of community detection using a classical network representation with a maximum entropy network model. We conclude that the latter method is useful to identify the most significant interactions in the disinformation network over multiple datasets. We also apply the method to a disinformation dataset related to COVID-19, which allows us to assess the repeatability of studies on disinformation datasets. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Jequitinhonha organic guarantee participatory system: the challenge of participation in times of pandemic

The Participatory Guarantee System (PGS) is an organic conformity assessment methodology based on the active participation of interested actors who organize themselves in a network. The Covid-19 pandemic imposed several restrictions on social interaction and, as a result, peer and verification visits, the main social control mechanism used by SPGs, were suspended in 2020. Aiming to maintain the dynamics of interaction and also contribute to reduce the impacts of social isolation on the lives of farmers, the PGS Organicos Jequitinhonha developed a method of remote visits. The objective of this work was to understand how this adaptation took place and what results were achieved. It is an action research, in which the authors actively participated in the implementation of the researched methodology. The researchers highlight as results the social control satisfactorily exercised in a remote system, greater interaction between families, learning in the use of digital technologies that were considered inaccessible by family farmers in Vale do Jequitinhonha.

Gamifying Flipped Classes: An Experience Report in Software Engineering Remote Teaching

Context. In the COVID-19 pandemic, higher education was one of the most affected in adapting the teaching-learning process to comply with social distance measures. In this context, this research reports how we combined two active methodologies in Software Engineering Emergency Remote Teaching. Objective. Therefore, this study aims to report the experiences obtained from the application of gamified study guides in Software Engineering (SE) between November 2020 and April 2021. Method. We combined flipped classroom, an active methodology already known by them, with Gamification to improve students' acceptance and engagement. We created six gamified study guides for the SE flipped classes. 51 students participated in the classes, 12 students from the Computer Technician course and 39 students from the Computer Science Bachelor course. Each study guide had a group of checkpoints to organize the content in levels. Results. At the end of the application, we observed 83.6% of the participating students maintained their engagement. According to self-declaration, 85% felt motivated by the approach adopted, with 75.9% considering that the class format presented enhanced their learning. We also observed a positive impact on learning gain in an average of 18.3% in their grades. Final Considerations. We concluded that using Gamification and Flipped Classroom has positive impacts on learning and acceptance, although the COVID-19 pandemic and the ERT negatively affect students' motivation. © 2021 ACM.

An Article-Oriented Framework for Automatic Semantic Analysis of COVID-19 Researches

In this work, we propose an article-oriented framework for automatically extract semantic topics from scientific articles related to COVID-19 researches. Our framework has four key building blocks (i) pre-processing, (ii) topic modeling, (iii) correlating topics, authors, and institutions, and (iv) a summarization interface. The first one corresponds to apply traditional textual pre-processing strategies in the texts extracted from articles and constructing their data representations. The topic modeling block aims at finding semantic topics from articles based on the most relevant words of each discovered topic. The third block correlates these discovered topics with the articles, authors (researchers), and institutions. The summarization interface provides an intuitive visualization for these results. Our evaluation shows that our framework can automatically extract relevant features from the articles, identifying the key topics covered by them, as well as the contribution of researchers, institutions, and countries to the topics. Our framework can help research institutions and companies to form multidisciplinary teams and funding agencies to identify more promising research approaches regarding COVID-19. © 2021, Springer Nature Switzerland AG.

Occupational management of healthcare workers exposed to COVID-19.

BACKGROUND: The year 2020 was marked by the new coronavirus pandemic, resulting in millions of cases and deaths, placing healthcare workers at high risk of infection. AIMS: The aim of this study was to describe the role of an occupational health service during coronavirus disease 2019 pandemic in an oncologic hospital and characterize the most likely sources of viral infection. METHODS: The information of all healthcare workers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from 11 March to 15 December 2020 was collected through an epidemiological survey conducted during contact tracing. The data extracted included gender, age, comorbidities, occupational group, source of infection, clinical presentation, duration of the disease, need for hospitalization and persistent or late symptoms after disease or upon returning to work. RESULTS: Out of a total of 2300 workers, 157 were infected, consisting of nurses (36%), nurse assistants (33%) and diagnostic and therapeutic professionals (10%). Physicians and administrative staff accounted for 8% each. The most frequently reported source of infection was occupational (43%), owing to worker-to-worker transmission (45%) and patient-to-worker transmission (36%). The most frequent moments of infection perceived corresponded to the removal of protective equipment during meals and moments of rest in the staff and changing rooms. CONCLUSIONS: The study revealed that occupational transmission from patients and colleagues might be an important source of SARS-CoV-2 infection in healthcare workers. Spread between colleagues accounted for 45% of the occupational source infections reported. Implementing physical distancing measures and limiting the number of people in changing and rest rooms could significantly reduce infection and related absenteeism.

COVID-19 in patients with rheumatic diseases on chronic use of hydroxychloroquine in a large Brazilian cohort-a 24-week prospective study

Background: The role of chronic use of hydroxychloroquine (HCQ) in rheumatic disease (RD) patients during the SARS-CoV-2 pandemic is still subject of discussion. Objectives: To compare the occurrence of COVID-19 and its outcomes between RD patients on HCQ use with individuals from the same household not taking the drug during community viral transmission in an observational prospective multicenter study in Brazil. Methods: Participants were enrolled and monitored through 24-week (From March 29th to Sep 30th, 2020) regularly scheduled phone calls performed by trained medical professionals. Epidemiological and demographic data, as well as RD disease activity status and current treatment data, specific information about COVID-19, hospitalization, need for intensive care, and death was recorded in both groups and stored in the Research Electronic Data Capture (REDCap) database. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. The statistical analysis was performed using IBM-SPSS v.20.0 software. Group comparisons were made using the Man-Whitney, Chi-Square and Fisher Exact Test, as well as multivariate regression models adjusted to confounders. Survival curves were performed using Kaplan-Meier analysis. Results: A total of 10,427 participants mean age (SD) of 44.04 (14.98) years were enrolled, including 6004 (57.6%) rheumatic disease patients, of whom 70.8% had systemic lupus erythematosus (SLE), 6.7% rheumatoid arthritis (RA), 4% primary Sjögren's syndrome (pSS), 1.8% mixed connective tissue disease (DMTC), 1% systemic sclerosis (SSc) and others (15.9), including overlap syndromes. In total, 1,132 (10.8%) participants fulfilled criteria for COVID-19, being 6.7% RD patients and 4.1% controls (p=0.002). A recent influenza vaccination had a protective role (p<0.001). Moderate and severe COVID-19 included the need for hospitalization, intensive care, mechanical ventilation or death. Infection severity was not different between groups (p=0.391) (Table 1). After adjustments for multiple confounders, the main risk factors significantly associated with COVID-19 were higher education level (OR=1.29 95%CI 1.05-1.59), being healthcare professionals (OR=1.91;95%CI 1.45-2.53), presence of two comorbidities (OR=1.31;95%CI 1.01-1.66) and three or more comorbidities associated (OR=1.69;95%CI 1.23-2.32). Interestingly, age ≥=65 years (OR=0.20;95%CI 0.11-0.34) was negatively associated. Regarding RD, the risk factors associated with COVID-19 diagnosys were SLE (OR= 2.37;95%CI 1.92-293), SSc (OR=2.25;95%CI 1.05-4.83) and rituximab use (OR=1.92;95%CI 1.13-3.26). In addition, age ≥=65 years (OR=5.47;95%CI 1.7-19.4) and heart disease (OR=2.60;95%CI 1.06-6.38) were associated with hospitalization. Seven female RD patients died, six with SLE and one with pSS, and the presence of two or more comorbidities were associated with higher mortality rate. Conclusion: Chronic HCQ use did not prevent COVID-19 in RD compared to their household cohabitants. Health care profession, presence of comorbidities LES, SSc and rituximab were identified as main risk factors for COVID-19 and aging and heart disease as higher risk for hospitalization. Our data suggest these outcomes could be considered to manage them in clinical practice.

Incidence and risk factors for moderate/severe COVID-19 in rheumatic diseases patients on hydroxychloroquine: a 24-week prospective cohort

OBJECTIVES: To evaluate the incidence of COVID-19 and its main outcomes in rheumatic disease (RD) patients on hydroxychloroquine (HCQ) compared to household cohabitants (HC). METHODS: This is a 24-week nationwide prospective multi-centre cohort with a control group without RD and not using HCQ. All participants were monitored through scheduled phone interviews performed by health professionals. Details regarding COVID-19 symptoms, and epidemiological, clinical, and demographic data were recorded on a specific web-based platform. COVID-19 was defined according to the Brazilian Ministry of Health criteria and classified as mild, moderate or severe. RESULTS: A total of 9,585 participants, 5,164 (53.9%) RD patients on HCQ and 4,421 (46.1%) HC were enrolled from March 29th, 2020 to September 30th, 2020, according to the eligibility criteria. COVID-19 confirmed cases were higher in RD patients than in cohabitants [728 (14.1%) vs. 427 (9.7%), p<0.001] in a 24-week follow-up. However, there was no significant difference regarding outcomes related to moderate/ severe COVID-19 (7.1% and 7.3%, respectively, p=0.896). After multiple adjustments, risk factors associated with hospitalisation were age over 65 (HR=4.5;95%CI 1.35-15.04, p=0.014) and cardiopathy (HR=2.57;95%CI 1.12-5.91, p=0.026). The final survival analysis demonstrated the probability of dying in 180 days after a COVID-19 diagnosis was significantly higher in patients over 65 years (HR=20.8;95%CI 4.5-96.1) and with 2 or more comorbidities (HR=10.8;95%CI 1.1-107.9 and HR=24.8;95%CI 2.5-249.3, p=0.006, respectively). CONCLUSIONS: Although RD patients have had a higher COVID-19 incidence than individuals from the same epidemiological background, the COVID-19 severity was related to traditional risk factors, particularly multiple comorbidities and age, and not to underlying RD and HCQ.

Social Representations and Ideology: Theories of Common Sense About COVID-19 Among Middle-Class Brazilians and Their Ideological Implications

The COVID-19 pandemic has affected the lives of billions of people worldwide. Individuals and groups were compelled to construct theories of common sense about the disease to communicate and guide practices. The theory of social representations provides powerful concepts to analyse the psychosocial construction of COVID-19. This study aimed to understand the social representations of COVID-19 constructed by middle-class Brazilian adults and their ideological implications, providing a social-psychological analysis of these phenomena while the pandemic is still ongoing. We adopted a qualitative approach based on semi-structured in-depth interviews conducted online in April-May 2020. Participants were 13 middle-class Brazilians living in urban areas. We analysed the interviews with thematic analysis and a phenomenological approach. The social representations were organised around three themes: 1) a virus originated in human actions and with anthropocentric meanings (e.g., a punishment for the human-led destruction of the environment);2) a dramatic disease that attacks the lungs and kills people perceived to have "low immunity";and 3) a disturbing pandemic that was also conceived as a correction event with positive consequences. The social representations included beliefs about the individualistic determination of immunity, the attribution of divine causes to the pandemic, and the need for the moral reformation of humankind. The discussion highlights the ideological implications of these theories of common sense. Socially underprivileged groups are at greater COVID-19-related risk, which the investigated social representations may contribute to conceal and naturalise.