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Strengthening institutional resilience is essential for disaster risk governance. This chapter analyzes the principal institutional vulnerabilities exposed by the COVID-19 pandemic crisis in Brazil and the United States. We identify nonconformities that reflected institutional vulnerabilities in these countries' pandemic crisis, based on a survey of professional media coverage. The identification of these failures also led to a discussion of the potential causes of institutional vulnerabilities. The findings were classified according to three levels of analysis, i.e., national governance, international governance, and public-private-third sector governance. Failure modes of institutional vulnerabilities were identified in several sectors (public, private, and third sector), federative entities (Federal Government, States, and Municipalities), and contexts (national and international). The interconnection of these nonconformities contributed to the deepening of the crisis. This chapter could contribute to the development of a political-administrative-operational framework to improve institutional resilience. © Springer Nature Switzerland AG 2022.
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Introduction: Coronaviruses (CoV) is a diverse group of viruses that has been described in the literature since 1960, SARS, MERS, and the most recent SARS-CoV-2. This new virus is causing a worldwide pandemic outbreak in the first half of 2020, thousands of deaths, and a signifi-cant economic crisis. Objective(s): Due to this new context, the present study aimed to conduct a systematic study review of the new Coronavirus's global status (COVID-2019) and its aspects compared to the previous SARS-CoV infections MERS-CoV. Method(s): The study was conducted from January to September 2020, 89 clinical cases were sub-mitted to further analysis, and 77 studies were selected for systematic review under the PRISMA guidelines. Conclusion(s): In some countries, the SARS-CoV-2 pandemic appears to be out of control. In case of suspicion, tests are essential to identify the early stages of infection. If necessary, patients need to go into quarantine, and other public health measures should be taken following the World Health Organization guidelines. Advanced support is needed to identify and isolate infected patients, espe-cially vaccines and medicines that help control the virus and the epidemiological situation in each country. These measures are expected to reduce the rate of new cases of SARS-CoV-2.Copyright © 2021 Bentham Science Publishers.
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Background: The development of depression and anxiety symptoms during long COVID may partly result from the biopsychosocial effects of COVID-19 that impact mental health, rather than from the infection alone. Aim: The present study examined the association of anxiety, depression, stress, and psychological distress levels with sociodemographic factors and symptom severity during and three months after the acute phase of COVID-19. Methods: This cross-sectional study included 119 participants with a positive SARS-CoV-2 qPCR test. Three months after the acute phase of infection, participants completed an online survey to collect clinical information and sociodemographic data, followed by completion of the Impact of Event Scale-Revised, Depression, Anxiety, and Stress scales. Results: During and after infection, fatigue was the most frequently reported symptom. After the acute phase of COVID-19, substantial numbers of participants presented moderate to severe psychological distress (28.5%), severe to extremely severe depression (26.05%), and severe to extremely severe stress (31.09%). Female patients presented higher stress scores than males, while individuals who reported having lost a loved one presented high psychological distress, anxiety, and depression. The presence of physical symptoms after COVID-19 and other factors such as being a woman, being married, having children, or living with someone who suffers from a disease increased vulnerability to depression, stress, and anxiety. Conclusions: There are psychological consequences for survivors of COVID-19 associated with sociodemographic factors. Clinical strategies are needed to provide mental health care for individuals with long COVID symptoms. © 2022 IACFS/ME.
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Background: The development of depression and anxiety symptoms during long COVID may partly result from the biopsychosocial effects of COVID-19 that impact mental health, rather than from the infection alone. Aim(s): The present study examined the association of anxiety, depression, stress, and psychological distress levels with sociodemographic factors and symptom severity during and three months after the acute phase of COVID-19. Method(s): This cross-sectional study included 119 participants with a positive SARS-CoV-2 qPCR test. Three months after the acute phase of infection, participants completed an online survey to collect clinical information and sociodemographic data, followed by completion of the Impact of Event Scale-Revised, Depression, Anxiety, and Stress scales. Result(s): During and after infection, fatigue was the most frequently reported symptom. After the acute phase of COVID-19, substantial numbers of participants presented moderate to severe psychological distress (28.5%), severe to extremely severe depression (26.05%), and severe to extremely severe stress (31.09%). Female patients presented higher stress scores than males, while individuals who reported having lost a loved one presented high psychological distress, anxiety, and depression. The presence of physical symptoms after COVID-19 and other factors such as being a woman, being married, having children, or living with someone who suffers from a disease increased vulnerability to depression, stress, and anxiety. Conclusion(s): There are psychological consequences for survivors of COVID-19 associated with sociodemographic factors. Clinical strategies are needed to provide mental health care for individuals with long COVID symptoms. Copyright © 2022 IACFS/ME.
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Introducao: A Sindrome de embolia gordurosa e uma complicacao rara da doenca falciforme, descrita principalmente na doenca nao homozigotica. Resulta de extensa necrose da medula ossea (MO), durante crise vasoclusiva (CVO), com liberacao de embolos de gordura na circulacao e disfuncao organica multipla. Os criterios diagnosticos sao envolvimento de multiplos/unico orgao histologicamente comprovado por embolia gordurosa e/ou medular necrotica ou desenvolvimento de insuficiencia respiratoria aguda (IRpA) e manifestacoes neurologicas ou falencia de multiplos orgaos com evidencia de necrose medular (laboratorial ou histologica). Objetivos: Descrever caracteristicas clinicas, laboratoriais e de tratamento de 5 pacientes com sindrome de embolia gordurosa atendidos no HCFMUSP entre 10/2021 e 07/2022. Resultados: Os 5 casos eram HbSS (4 mulheres),1 em uso de hidroxiureia (HU), 2 sem HU por hepatotoxicidade e em programa transfusional, 1 interrompeu o tratamento e 1 nunca havia usado. Mediana de idade no evento: 34 (22-52) anos. Fatores desencadeantes provaveis em 3 pacientes: infeccoes por Influenza, Covid19 e S.aureus Oxacilina resistente. A admissao, todos apresentavam dor generalizada e dessaturacao;4 apresentavam confusao mental e rebaixamento do nivel de consciencia com TC de cranio normal;3 com consolidacao pulmonar sendo iniciado antibiotico. Medianas e ranges de exames a admissao: Hb 5,7 (3,6-7,2)g/dL;leucometria 30900 (8620-51600)/mm3, 2 com desvio ate mielocitos, 2 ate metamielocitos e 1 ate bastoes;eritroblastos 38,5 (2,5-53,8) EOC/100 leucocitos;plaquetas 208 (46-507) mil/mm3;DHL 1296 (502->6000)mg/dL;Cr 1,59 (0,94-3,72)mg/dL;BI/BD 2,32 (2,09-4,84)/3,4 (2,57-12,8)mg/dL;TGO 101 (44-289)mg/dL;TGP 19 (18-29)mg/dL;GGT 185 (118-423)mg/dL;FA 369 (142-1060)mg/dL. Durante a internacao, todos evoluiram com reacao leucoeritroblastica (desvio ate mielocitos/promielocitos), aumento de DHL, TGO, TGP, GGT, FA, BI, BD (predominio de BD) e lesao renal aguda, 3 evoluiram com plaquetopenia e 2 com reticulocitopenia. Todos receberam concentrado de hemacias nas primeiras 24h e durante a internacao (mediana 13;range 2-19), 2 iniciaram hemodialise e 2 foram intubados e receberam drogas vasoativas (DVA). Nenhum desenvolveu CIVD. A biopsia de MO de 1 paciente mostrou tecido hematopoietico difusamente necrotico de padrao isquemico. A mediana de internacao foi 11 dias (range 2-22). 1 paciente faleceu em 48h, 1 foi extubado e teve DVA suspensa apos 17 dias, 4 pacientes receberam alta com Hb proxima ao basal e leucometria, plaquetas e funcao renal normais. Discussao: A sindrome de embolia gordurosa e caracterizada por IRpA e manifestacoes neurologicas, podendo haver comprometimento das funcoes renal e hepatica alem de reacao leucoeritroblastica ou pancitopenia, quadro apresentado por nossos pacientes embora nossos casos destoem da literatura quanto ao genotipo, onde apenas 15% sao HbSS. Suspeitar do diagnostico e fundamental para o desfecho dos casos. Na suspeita, a instituicao rapida de terapia transfusional, para reduzir HbS, e determinante para a sobrevida. Uma revisao sistematica descreveu mortalidade de 29, 61 e 91% para quem recebeu troca, reposicao ou nenhuma transfusao, respectivamente. Conclusao: A falta de suspeita diagnostica dificulta o reconhecimento da sindrome, determinando taxas altas de mortalidade. Familiaridade com o quadro clinico e inicio imediato de terapia transfusional tem se mostrado os unicos indicadores de sobrevida. Copyright © 2022
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Introduction During SARS-CoV-2 infection, a severe hypercoagulability state is observed due to the stimulus of multiple mechanisms of hemostasis, such as coagulation, activation of platelets, endothelial cells, monocytes and neutrophils and impaired fibrinolysis. As a consequence, thrombotic complications are common in the course of COVID-19. Microvesicles (MVs) are intracellular transmitters that participate in pathological conditions, such as inflammatory and infectious processes, and are capable of triggering prothrombotic mechanisms. Since MVs release is potentially associated with COVID-19-induced coagulopathy, our aim was to identify during the course of the disease when the stimulus for MVs release occurs and whether this was associated with adverse outcomes. Objective We evaluated changes in the levels of MVs markers during the first month of SARS-CoV-2 infection in patients (pts) with severe disease (hospitalized in an Intensive Care Unit ‒ ICU) as compared to outpatients. We also evaluated the association between MVs markers with: inflammatory biomarkers (C-reactive protein, CRP), hypercoagulability (D-dimer) and death. Methods Blood samples were collected on three occasions: before the 10th day of symptoms, in the 3rd week of symptoms and in the 4th week of symptoms for the quantification of the following MVs markers by flow cytometry: CD41A (platelet activation), CD162 (PSGL-1;leukocyte-platelet interaction), CD31 (endothelium-platelet interaction) and CD142 (tissue factor). Statistical tests of ANOVA with repeated measures, Mann-Whitney and regression methods were used. Results The population studied was 85 pts, being 25 from ICU. Mostly were men (51%), with a median age of 41 years. The concentration of MVs expressing CD31+, CD41+, CD162+ and CD142+ were persistently elevated in pts who required ICU compared to outpatients at the 3 moments studied, except for the levels of MVs-CD31+ and MVs-CD142+ that were similar between ICU and outpatients in the 4th week of symptoms. However, despite the differences between the groups, there were no significant changes in the levels of MVs during the course of the disease within the groups. In subgroup analysis, we observed that increases in the levels of MVs-CD162+ and MVs-CD142+ in the 3rd week of symptoms were associated with the risk of death (p=0.02 and p=0.06, respectively). We also observed that during the course of the disease an association between MVs, coagulability and inflammation was evident. In the 3rd week of symptoms, D-dimer levels were correlated with MV-CD31+ (r=0.52, p<0.0001), MV-CD162+ (r=0.35, p=0.001), MV-CD41A+ (r=0.44, p<0.0001) and MV-CD142+ (r=0.47, p<0.0001) and CRP values were correlated with MV-CD31+ (r=0.56, p=<0.0001), MV-CD162+ (r=0.48, p<0.0001), MV-CD41A+ (r= 0.41, p=0.0001), and MV-CD142+ (r=0.56, p<0.0001). By the 4th week of symptoms, both D-dimers and CRP correlations with the above MVs remained unchanged. Conclusion To conclude, MVs that express antigens related to platelet activation, leukocyte-platelet interaction and endothelium-platelet interaction, as well as those related to tissue factor are released during the course of COVID-19 in pts with severe disease. After the 4th week of symptoms, the release of these MVs was associated with signs of inflammation and hypercoagulability. Additionally, MVs that express tissue factor and leukocyte-platelet interaction antigens were particularly high among non-survivors, suggesting that these MVs may serve as markers of the risk of death. Finally, these findings suggest the participation of innate immunity and tissue factor pathways in the prognosis of COVID-19, and point towards a possible role of MVs as biomarkers of disease prognosis.
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Introduction: Antibiotic resistances are among themost threatening public health issues worldwide, being highly associated with inadequate antibiotic use. To tackle this challenge, it is crucial to educate health professionals to appropriately prescribe and dispense antibiotics. Thus, out team developed eHealthResp, an educational intervention composed by two online courses and a clinical decision support system in the form of a mobile app directed to primary care physicians and community pharmacists, aiming to improve antibiotic prescribing and dispensing in respiratory tract infections. Objectives: The main goal of this pilot study is to validate the eHealthResp online courses and the clinical decision support system (mobile app), involving a small group of health professionals. Methods: Aproximately 15 physicians and 15 pharmacists will be recruited to participate in the study. Participants will have complete autonomy to explore and evaluate the eHealthResp mobile app and online courses, composed by six modules on respiratory tract infections for physicians (i) acute otitis media, ii) acute rhinosinusitis, iii) acute pharyngotonsilitis, iv) acute tracheobronchitis, v) community-acquired pneumonia, and vi) COVID-19), and three modules for pharmacists (i) common cold and flu, ii) acute rhinosinusitis, acute pharyngotonsilitis, and acute tracheobronchitis, and iii) acting protocol). Each online course is also composed by four clinical cases and the most recommended pharmacological therapy. Additionally, for the the global validation of the online course and the mobile app, participants will be invited to complete a questionnaire including three sections of questions. The first part, consisting of five brief questions, will allow the collection of sociodemographic data. The second part contains four groups of closed questions, and the third part consists of four open-answer questions, both aiming to evaluate the online course and mobile app elements. Results: After the assessment made by the physicians and pharmacists who agreed to participate in the pilot study, the data obtained will be duly analyzed and integrated by the research team. The appropriate changes will be incorporated into the e-Health platforms to improve the quality of both the online courses and the eHealthResp mobile app. Conclusions: The findings of this pilot study will provide important information for the next stage of the project, ensuring the feasibility of the educational interventions in a group of primary care physicians and community pharmacists from the Centre region of Portugal, using a randomized controlled trial designed by clusters.
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The worldwide incidence of multiple sclerosis (MS) is estimated at 0.5-10 cases per 100.000 personyears and is probably increasing. Incidence in Uruguay was estimated in 1.2 cases per 100.000 personyears in a 2015 study. Following the EMELAC protocol (MS in Latin America and Caribbean region), we conducted an observational, prospective, population-based study to determine MS incidence in Uruguay. The population under study included people living in Uruguay between 7-1-2019 and 6-30- 2021, with18 years and above. The diagnosis was based on the 2017 McDonald criteria. Multiple data sources were employed. All possible cases of MS were reviewed by the research team. Cases with diagnostic uncertainty were re-reviewed by an outside co-author (D.O.). Results: 155 new MS cases were confirmed after review including 111 females (71.6 %). 99 of them were examined directly by the research team (63.9 %). The sex ratio was 2.5:1 female/male. Age range was 18 to 62. Median age was 33 years and the standard deviation 11.4 years. 111 (71.6 %) cases were relapsing-remitting MS, 9 (5.8 %) primary progressive MS and 2 secondary progressive MS. We have no data in 33 cases (21 %). Global incidence rate was 2.88 cases per 100.000 person-years, 3.95 in females and 1.72 in males. The highest incidence was observed in the group with 35-39 years (5.28 cases per 100.000 personyears). Discussion: According to MS Atlas, Uruguay has a low incidence rate (2.0-3.99). Despite this, the MS incidence in Uruguay is one of the highest in Latin America. Age and gender distribution were similar to other studies. We found a lower proportion of primary progressive MS. COVID19 pandemic raised methodological problems which could have led to an underestimation of the incidence.
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Introduction: The worldwide incidence of multiple sclerosis (MS) is estimated to be 0.5-10 cases per 100.000 person-years and is probably increasing. Incidence in Uruguay was estimated in 1.2 cases per 100.000 person-years in a 2015 study. Objectives: To determine MS incidence in Uruguay Methods: Following the EMELAC protocol (MS in Latin America and Caribbean region), we conducted an observational, prospective, population based study to determine MS incidence in Uruguay. The population studied included people living in Uruguay, older than 18 years of age, between 7-1-2019 and 6-30-2021. The diagnosis was based on the 2017 McDonald criteria. Multiple data sources were employed. All possible cases of MS were reviewed by the research team. Cases with diagnostic uncertainty were re-reviewed by an outside coauthor (D.O.). Results: 137 new MS cases were confirmed after review including 100 females (73%). 65 of them were examined directly by the research team (47%). The sex ratio was 2.7:1 female/male. Age range was 18 to 62 with a median of 35 and an interquartile range of 16.5 (26.5-43). 129 (94%) cases were relapsing-remitting MS, 7 (5%) primary progressive MS and 1 secondary progressive MS. Global incidence rate was 2.55 cases per 100.000 person-years, 3.55 in females and 1.45 in males. The highest incidence was observed in the 35-39 years old group (5.28 cases per 100.000 person-years). Conclusions: According to MS Atlas, Uruguay has a low incidence rate (2.0-3.99). Despite this, the MS incidence in Uruguay is one of the highest in Latin America. Age and gender distribution were similar to other studies. We found a lower proportion of primary progressive MS. COVID19 pandemic raised methodological problems which could have led to an underestimation of the incidence. These preliminary results will be completed in upcoming publications.
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Four decades ago, Hal Broxmeyer demonstrated that umbilical cord blood (CB) contained hematopoietic stem cells (HSC) and hypothesized that CB could be used as a source of donor HSC for rescue of myeloablated bone marrow. In 1988, Gluckman et al reported the first successful cord blood transplant (CBT) of a child with Fanconi Anemia using matched sibling CB. This patient survives and 35 years later still has durable hematopoiesis from the CB donor graft. In 1991, Rubinstein et al established an unrelated donor (UD) CB bank and in 1993 the first UD CBT was using a unit from this bank. Since that time, >40,000 CBTs have been performed worldwide. We hypothesized that changes in cord blood banking (increased size, diversity, and quality of banked units enabling selection of units with higher cell doses and closer HLA matching) and in transplantation (less use of steroids, availability of newer therapies for prophylaxis and treatment of graft versus host disease [GVHD], improved antifungal and antiviral detection and therapeutics) have improved outcomes of CBT today. To address this hypothesis, we performed a retrospective study combining data from Eurocord and Duke University in a large cohort of children transplanted with a single UD CB unit (CBU) from 1993-2019. Standard transplant outcomes (overall survival [OS], disease free survival [DFS], acute and chronic GVHD, treatment related mortality [TRM], and relapse) and changes in outcomes over 3 time periods (1:<2005, n=1297;2:2005-2010, n=1735;and 3:>2010, n=1802) were studied. Relative contributions of cell dose and HLA matching to transplant outcomes over time were assessed. A total of 4834 patients (4015 from Eurocord and 819 from Duke) were analyzed. The majority of patients, (59%, n=2839) had malignant diagnoses including 1422 with ALL, 887 with AML and 167 with MDS. Of the 1995 with non-malignant diagnoses, 761 had inborn errors of metabolism, 644 had primary immunodeficiency, 325 had a bone marrow failure syndrome and 206 had a histiocytic disorder. Half of the patients had positive serologies for CMV prior to transplant. The median age of the cohort fell from 5.2 to 3.25 years over time. In patients with malignancies, use of total body irradiation decreased over time. The median total nucleated cell (TNC) and CD34+ cell doses administered were 8.07x10e7 and 6.17x10e5 cells/kg and increased over time. HLA matching and transplantation of patients in earlier disease states also increased over time, p<0.001 for both. The probability of 5-year OS in the entire cohort was 53.48% and improved over time: 42%;57.4%;and 60.4%, in periods 1,2,3 respectively (p<0.0001). OS improved with closer HLA matching, higher cell dose, myeloablative conditioning, and negative pre-transplant CMV serologies. For patients with malignancies, DFS increased and TRM and acute GVHD decreased over time. In contrast, leukemic relapse did not change throughout the years. OS was higher in patients with inborn errors of metabolism and also improved over time with 57.8% surviving before 2005, 69.4% from 2005-2010, and 71% after 2010 (p=0.0141). Similar results were seen in the cohort with immune deficiencies. In the entire cohort, the median time to neutrophil engraftment decreased from 25 days (period 1) to 19 days (period 3). In multivariate analysis for engraftment, a higher TNC dose (p=0.001) up to but not beyond the median cell dose (8.07x10e7 cells/kg), total body irradiation, and the use of ATG improved engraftment. Acute GVHD decreased from 35% before 2005 to 27.1% after 2010 (p=0.0556) while the incidence of chronic GvHD was stable. The use of ATG reduced the risk of acute GVHD and closer HLA matching reduced the risk of both acute and chronic GVHD. In this population of patients receiving high cell doses, outcomes were predominantly influenced by HLA matching and increasing cell dose did not abrogate HLA mismatching. In conclusion, we analyzed the largest cohort of pediatric patients undergoing CBT over the past 3 decades. OS, DFS and engraftment have improved over time accompanied b decreases in TRM and acute GVHD. Relapse and chronic GVHD were stable and remain low. These improvements are explained by the increased availability of high quality banked CBUs enabling selection of closer HLA matching and units with higher cell doses. The numbers of CBTs have decreased in the past decade, but these results support the ongoing use of CBT in children lacking matched related or unrelated donors. [Formula presented] Disclosures: Kurtzberg: Neurogene: Consultancy;CryoCell: Patents & Royalties: Duke licensed IP, and data and regulatory packages for manufacturing and use of cord blood and cord tissue MSCs in the treatment of patients with hypoxic ischemic encephalopathy, cerebral palsy, autism, acute ischemic stroke, COVID-ARDS, and COVID-MIS-C.;Sinocell: Patents & Royalties: Duke licensed IP, data, and regulatory packages for use of autologous and sibling cord blood to treat children with cerebral palsy.;Celularity: Current holder of stock options in a privately-held company. Troy: SinoCell: Patents & Royalties;CryoCell: Patents & Royalties;Bristol Myers Squibb: Research Funding;Synthetic Biologics: Honoraria;Gamida Cell: Consultancy;The EMMES Corporation: Consultancy;The Community Data Roundtable: Consultancy;AegisCN: Consultancy.
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Background: The COVID-19 disease has spread throughout the world in an unprecedented way. France and Brazil confirmed the first cases in the European and South American regions with high incidence rates at the peak of the first wave of contamination along the year 2020. Patients with hematological disorders, especially malignancies, may be more vulnerable to SARS-CoV-2 infection because of the underlying disease and treatment. Since COVID-19 presentation is heterogeneous, from asymptomatic up to severe life-threatening forms and the patients with malignancies and COVID-19 admitted to the hospital show a wide range of clinical manifestations and laboratory abnormalities, it is still unclear for clinicians which patients, blood tests at admission and disease factors are associated with worse outcomes. Getting further insights into patients with specific diseases is of particular interest. We aimed to identify profiles of hematologic patients hospitalized with COVID-19 that would be associated with survival, and to assess the differences between cohorts. Methods: A binational cohort including all consecutive hematological patients aged 18 years or more with moderate or severe COVID-19, requiring hospitalization until December 2020 at two tertiary centers, from Paris, France and São Paulo, Brazil, was studied. Patients with a hospital stay of less than 24 hours were excluded. All patients were followed until the end of hospitalization;then, after discharge, survival data was recovered on medical charts or outpatient consultations, if data were available. Patient profiles were based on age, comorbidities, blood tests at admission, COVID-19 symptoms, and hematological disease characteristics. A semi-supervised learning method was first used to obtain the prognostic driven profiles;then, a classifier was identified to allow the classification of patients using only admission (baseline) data. Results: A total of 263 patients (135 from Brazil and 128 from France) were enrolled. Male patients (58.2%), elderly (≥ 65 years, 46%), with high comorbidities prevalence were frequent. Non-Hodgkin Lymphoma (29.3%), multiple myeloma (19.4%) and chronic myeloid disorders (12.9%) were the most frequent underlying hematological malignancies and 13.3% of patients had benign diseases. Most of the patients (59.7%) had undergone chemotherapy in the last six months before COVID-19 admission. The clinical presentation of COVID-19 was similar in the two countries. Fever (68.4%), dyspnea (60.1%) and cough (55.9%) were the main symptoms at admission. The ICU admission (56% versus 25%) and invasive ventilation (42% versus 19%) rates were notably higher among Brazilian patients due to scarce ICU beds during the peak of transmission in France. The overall in-hospital mortality rate was 115/263 (43.7% [95%CI 37.6-49.9]) and the median follow-up after admission was 63 days (IQR 40-98). There was no evidence of survival difference between countries after adjusting on age, comorbidities, and diagnosis. Two clusters were identified, segregating young patients with few comorbidities, low CRP, D-dimers, LDH and creatinine levels, with a 30-day survival of 77.1%, versus 46.7% in remainders. The profiles (clusters) were strongly associated with survival (p<0.001), even after adjusting on age (p<0.001) (Figure 1). We identified a set of rules to classify patients into the two profiles, using only information available at hospital admission, with a high accuracy rate (97.7% on the training set and 84.9% on the validation set). The baseline predictors consecutively selected by the model were the number of comorbidities, creatinine, CRP, a continuous regimen of chemotherapy, platelets and lymphocytes counts, a symptom of ageusia, dyspnea, hematological malignancy, high blood pressure, and symptom of myalgia. Conclusions: This analysis allowed to identify two profiles of hospitalized hematological patients with COVID-19 that have a different outcome when infected with SARS-CoV-2. The results showed the importance of CRP, LHD, and creatinine in COVID-19 prese tation and prognosis, whatever the geographic origin of the patients. The identification of patterns and clinical manifestations experienced by hematological patients during moderate or severe SARS-CoV-2 infection might be helpful to medical staff in the care management and in the allocation of scarce resources. [Formula presented] Disclosures: No relevant conflicts of interest to declare.
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The year of 2020 was greatly affected by COVID-19 pandemic, it was necessary to change the work routine, study and social life and adapt to the new world scenario that was suddenly established. The technology, and especially the software, contributed a lot for these changes to be managed and carried out efficiently, mainly in the scope of communication and information. To prevent the pandemic from advancing, protective measures were taken by the state and federal governments, including recommendations for social distancing, wearing masks in a public environment and avoiding people in a feverish state, so the world policed itself and tried to comply with the new guidelines. However, a visually impaired person would not be able to comply with these determinations, how could he know if the person in front of him is wearing a mask or not, or even far enough, not respecting the recommended minimum distance of 1.5 m, or even checking the temperature of someone entering the same environment as him. Motivated by this problem, this research was initiated, with the goal of the development of a case to be coupled to an eyeglass, with processors and sensors, that will detect if the person in front is wearing a face mask, is 1.5 m far and in a possible feverish state, being processed by an Artificial Intelligence software with 95% accuracy. The functional status of the project was successfully executed, the results were satisfactory, with improvements in terms of embedded technology and tests on the impaired resulted in hope and excitement for them. © 2021, Springer Nature Switzerland AG.
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Background: The COVID-19 pandemic had a high burden in Brazil. To date, data on mortality and prognostic factors of COVID-19 infection in Brazilian patients with hematological disorders are scarce. Aims: To describe the characteristics and outcomes of patients with hematological disorders admitted to the hematological COVID care unit of a reference center in Brazil;to analyze the impact of prognostic factors on in-hospital mortality. Methods: This prospective, single-center study,included 118 patients who have been admitted to the hematological COVID care unit of the Hospital das Clínicas da Faculdade de Medicina da USP, S.o Paulo, Brazil, from March to September 2020.All patients had >18 years,an underlying hematological disease and a moderate or severe COVID- 19 infection.For analyses, patients were grouped in:(1)benign or no oncological treatment(n=43),(2) intensive chemotherapy,including induction protocols for acute leukemia and stem cell transplantation conditioning(n=44) or(3) intermediate chemotherapy,including lymphoma regimens,myeloma triple treatment or continuous treatment( n=31).The primary outcome was in-hospital mortality;secondary outcome was overall survival after admission in the COVID-19 unit.Univariate analysis(UVA) used odds ratio(OR) for baseline characteristics and ROC curve analysis for laboratory tests collected at admission.Multivariate analyses(MVA) were adjusted by age and hematological disease status group.The median follow-up and survival time after COVID-19-unit admission were estimated by Kaplan- Meier method.All statistical tests were two-sided;p-values<0.05 were considered significant. Results: Median age was 58(19-90) years and 55% of patients were male. Most patients(83%)had hematological malignancies,- mainly non-Hodgkin lymphoma(29%) and multiple myeloma(19%). The most frequent benign disease was sickle cell disease(5%).12 patients had undergone hematopoietic stem cell transplantation (HSCT),4 allogeneic and 8 autologous.70% had at least one comorbidity, mostly arterial hypertension and diabetes mellitus. Thromboembolic events occurred in 9%. Median hospital stay in the COVID-19 unit was 12(1-63) days;54% needed intensive care and 41% mechanical ventilation.In-hospital mortality rate was 41%[95%CI 32-50];most deaths occurred in patients with malignancies. Median follow-up was 73(95%CI 61-81) and 54(95%CI 39-66) days after admission and discharge from the COVID-19 unit, respectively.UVA showed a risk of death increased by 25% every 10 years old.The risk of in-hospital death was 3-fold and 5-fold higher in groups 2 and 3 compared with group 1.MVA showed higher risk of death in patients from group 2(OR=11.1,95% CI 2.9- 54.8) or group 3(OR=9.7,95%CI 2.4-47.5]),who had lactate dehydrogenase( LDH)>440 U/L(OR=16.8,95%CI 4.9-71.8),C-reactive protein(CRP)>100 mg/L(OR=4.1,95%CI 1.4-13.6) or platelet count<150x10e9/L(OR=3.7,95%CI 1.3-11.7), regardless of age(OR=1.2,95%CI 1.0-1.5).79% of in-hospital deaths were from COVID-19;others were mainly due to hematological disease.The overall median survival time after admission was 92 days(95% CI 34-NA) and the 75-day survival probability was 51%(95%CI 41-60).25% of patients had hospital readmission,mostly due to other infections. Summary/Conclusion: In line with other reports,patients with hematological diseases are at higher risk of mortality from COVID-19 infection, particularly in low and middle income countries.In our cohort, prognostic factors were status of disease,platelets count,LDH and CRP. These findings might help risk stratification and prioritization of vaccines in this setting.
ABSTRACT
Introduction: Hematopoietic Cell Transplant (HCT) is a potential curative treatment for hematological diseases. Patients undergoing HCT are usually immunosuppressed and require frequent outpatient visits. Patients actively enrolled at Hospital das Clínicas, School of Medicine, University of Sao Paulo (HCFMUSP) HCT Outpatient Clinic were already reached via Whatsapp (personal or family members’ cell phones) for clinic appointments and non-medical information before the COVID-19 pandemic. Since the onset of the pandemic, we have faced a challenge: providing medical care for HCT patients while preventing environmental exposure to SARS-CoV-2. Our HCT team started performing telehealth care using a HIPAA-compliant Google Meet-based institutional platform and telephone calls in March/2020. To evaluate this strategy as a permanent tool, we sent out a survey to patients in order to better understand their opinion on and early experience with telehealth. Methods: We sent out a questionnaire on Google Forms containing a few questions regarding barriers to commute to hospital, internet access, feelings about the use of telehealth at our outpatient clinic and their incipient experience with it. Participants were instructed to answer the questions from the patient's perspective, regardless if the survey was filled out by the patients themselves or caregivers. The questionnaire was anonymous, written in Portuguese, and remained open from August 3rd to 9th, 2020. Results: A survey invitation was sent out to 299 patients who had been seen in clinic over the last 12 months. During this period, all patients provided a contact number that could reached through Whatsapp, either on their own or a caregiver's smartphone. Of these, 133 patients answered the survey. The total time to go to and come back from hospital was <30 min for 5%, 30-60 min for 23%, 60-90 min for 20%, 90-120 min for 14% and >120 min for 38%. Total cost to commute to and from hospital (for both the patient and an eventual caregiver) was > US$ 10.00 for 42% (equivalent to 5% of the minimum wage per month). Thirty-two percent of participants reported any degree of mobility disability. Thirty-three and 29% of patients complained of long waiting times for in-person doctor and pharmacy appointments, respectively. In terms of technology, 97% had a personal cell phone or smartphone. Ninety-five percent of patients had access to internet on a smartphone, and 32% through a personal computer (some had both). Sixty-six percent reported no difficulty using a cell phone, 23% some difficulty and 9% significant difficulty. Ninety-five percent regularly used social media apps. Approximately half of the patients had at least one previous interaction via telehealth with our center during the COVID-19 pandemic, of whom 92% considered it a good or very good experience. When inquired if they would like to start receiving or continue to receive telehealth care, 83% answered yes, 10% expressed some interest and 7% declared no interest. When asked about their opinion on widening telehealth use at the HCFMUSP HCT Outpatient Clinic following the pandemic, 43% answered they would certainly use it, 45% thought it could be good, 5% had concerns, 4% were indifferent, and 3% did not approve the idea. Conclusions: In-person appointments seem to be both cost and time-consuming and represent a relevant burden on this limited-resource population. Despite being a public health institution from a middle-income country, most of our patients have personal cell phones with easy internet access. Among those who had an incipient experience with telehealth, the impression was overall positive. We cannot rule out selection bias towards participants who were more familiar with technology and thus more inclined to appreciate telehealth. Taken together, although not always fit for all clinical scenarios, our findings suggest telehealth may be efficient and complementary to in-person interactions with HCT patients, and prompt wider implementation of this health care modality. Disclosures: No relevant conflicts f interest to declare.
ABSTRACT
The COVID-19 pandemic is not only a health crisis but also a crisis for all humanity. In early 2020 and the “Decade of Action” to accelerate progress on the Sustainable Development Goals, humanity needed to change its ways of relating, communicating, consuming, and teaching to reduce the spread of COVID-19. However, this pandemic may mark a transformational period for all society around the world, if the right actions are taken, since behavioral changes have already been forced on humanity, a fundamental requirement for sustainable practical actions. Education for Sustainable Development (ESD) allows students to be empowered to face present and future global challenges, creating more resilient and sustainable societies. This approach signals and emphasizes the transforming role of ESD increasingly in the current global context. The objective of this article is to present the impacts of the COVID-19 pandemic in schools’ ESD, as well as to which extent ESD may prepare resilient citizens to face a future global crisis. The methodology is classified as a descriptive and qualitative critical assessment based on UNESCO reports and government websites. Schools from the Latin America region are the scope of the study. The results show how this region is conducting the primary and secondary education process during the pandemic, how these methods are evaluated, highlighting how quality education, in addition to encouraging students to promote virus prevention, prepares future citizens for the promotion of a society committed to present and future generations. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021.