ABSTRACT
This chapter explores the use of quality statistical tools for the development of diagnostic tests for SARS-CoV-2 and the different metrological parameters recommended to laboratories towards guaranteeing the quality assurance of the tests, according to ISO/IEC 17025. Tools such as validation, uncertainty estimation, and proficiency testing are presented and the importance of their application to the current scenario and their perspectives and scarcity in the tests developed and made available are discussed. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023. All rights reserved.
ABSTRACT
Introduction: Our aim was to characterize new-onset type 1 diabetes mellitus (T1D) cases in a pediatric population referred to a large pediatric diabetic center throughout the first year of the COVID-19 pandemic, comparing it to previous years. Methods: Retrospective study including patients under 18 years with new-onset T1D, from March 12th 2020 to March 11(th) 2021. A control group was defined using data on patients under 18 years with new-onset T1D referred to the same hospital in the 3 previous years (from March 2017 to March 2020). Data was analyzed using SPSS. A p value of 0.05 was used as threshold of significance. Results: Between March 12(th) 2020 and March 12(th) 2021, 44 patients were diagnosed with new-onset T1D. The control group included 96 patients, resulting in an incidence of 32 cases/year (37.5% rise). January 2021 was the month with the higher number of diagnosis, corresponding to the peak of novel SARS-CoV-2 infections. During the pandemic, new-onset T1D cases in children under 2 years-old doubled, when comparing to mean incidence in previous years. Median delay to diagnosis was not significantly different from previous years. Diabetic ketoacidosis (DKA) at presentation was present in 50% of cases that were diagnosed after lockdown, increasing substantially from previous years (38.5%). DKA's severity was also significantly higher (40.9%, p=0.04), as were Intensive Care Unit admission (13.6%, p=0.04). Conclusion: Despite the existance of molecular pathways that could lead to islet cell injury, the role of the new coronavirus in the pathogenesis of DKA and T1D onset is still unclear. Disease severity could also be related to a higher proportion of younger children.
ABSTRACT
Background: Infection with severe acute respiratory syndrome coronavirus 2 has resulted in a global pandemic. The objective of this study was to investigate the prevalence, causes, and clinical implications of magnesium disturbances, including their possible association with treatment outcomes, among patients with COVID-19. Method(s): This cohort study was conducted at the Hospital das Clinicas, a tertiary care academic medical center in the city of Sao Paulo, Brazil. We included only patients diagnosed with COVID-19, and all clinical data were extracted from medical records. The patients were classified as having hypomagnesemia (HypoMg, plasma Mg <= 1.58 mg/dL) or hypermagnesemia (HyperMg, plasma Mg >= 2.55 mg/dL), and the groups were compared in terms of clinical features and outcomes. We analyzed data collected at admission, <= 72 h after admission, or both. Result(s): We analyzed 3,777 patients. Data regarding magnesium levels were available for 3,162 of those patients, and 344 (10.9%) were found to have HyperMg (240 men and 104 women). The mean age of the HyperMg group patients was 62.2 +/- 0.8 years (range, 15-98 years). Of the HyperMg group patients, 54% died during hospitalization, 86% required mechanical ventilation, 13.4% developed AKI, 4% required dialysis, and 4.3% presented cardiac arrhythmia. Comorbidities included COPD (in 6%), diabetes (in 36.6%), hypertension (in 61.5%), and cardiovascular disease (in 17%). Seven patients presented moderately high levels of Mg (> 4.0 mg/dL), and all of those patients died. Of the 344 HyperMg group patients, 97 (28%) had hypernatremia and 27 (8%) had hyponatremia. HypoMg was found in 166 (5.2%) of the patients (84 men and 82 women). The mean age of the HypoMg group patients was 59.0 +/- 1.4 years (range, 18-99 years), and 23% died during hospitalization. Of the 166 HypoMg group patients, 11 (6.6%) had hypernatremia and 11 (6.6%) had hyponatremia. Conclusion(s): Magnesium disturbances, especially HyperMg, appear to be common in COVID 19, increasing the risk of death. Further studies are needed in order to determine the cause of the high rate of hypermagnesemia in patients with COVID-19.
ABSTRACT
Background Maternal experience of labour and delivery is multidimensional and is influenced by a variety of factors. Aim to report maternal childbirth experience as described by the women themselves during the COVID-19 pandemic in Sweden using a WHO Standards-based tool adapted for an online survey (Quality of maternal and newborn care-QMNC). Methods Women ≥ 18 years of age who gave birth from March 1, 2020 to June 30, 2021 were asked to give voluntary consent to participate in an online survey. The survey included 40 questions on four key domains: provision of care, experience of care, availability of human and physical resources and organisational changes due to COVID-19. Results 5003 women were included in the analysis. Among those who underwent labour (n = 4528), 46.7% perceived a reduction in QMNC due to the COVID-19 pandemic, 50.7% were not allowed a companion of choice, 62.5% reported that health workers were not always using protective personal equipment and 36.5% rated the number of health workers as “insufficient”. Fundal pressure was applied in 22.2% of instrumental vaginal births and 36.8% received inadequate breastfeeding support. In addition, 18.4% of women did not feel treated with dignity and 6.9% reported some form of abuse. In general, findings were significantly worse among women who did not undergo labour (n = 475). Conclusions Swedish mothers’ satisfaction of care provided during childbirth was strongly influenced by many variables. Actions to promote high-quality, evidence-based, patient-centered respectful care for all mothers and newborns are urgently needed.
ABSTRACT
Purpose: This paper aims to search measures that unicorn startups have implemented during the pandemic and show what lessons can be learned to help entrepreneurs and small and medium businesses to overcome the crisis. Design/methodology/approach: The method is a multiple case study with five unicorn startups. This study collected data through interviews and analyzed them by the content analysis technique. Findings: The findings show that the pandemic affects negatively unicorns’ businesses;that a digital business model innovation affects them positively;and that innovations moderate positively the negative impact of the crisis. Research limitations/implications: Most interviewees hold operational positions. Practical implications: Three actions stand out to overcome the crisis: adoption of new digital platforms;strategies to increase the network of partners;and adaptations in the provision of payment services. Originality/value: The cases show that entrepreneurs and small and medium enterprises need to develop capabilities to innovate in their business models, and digitalization is a solution to face the crisis and overcome it in the future. © 2021, Cristina Doritta Rodrigues and Matheus Eurico Soares de Noronha.
ABSTRACT
Background &Objective : Multi-Drug Resistant Tuberculosis (MDRTB) and depression act synergistically that magnify the burden of disease. The present study aims to understand the differences in depression scale using Patient Health Questionnaire-9 (PHQ-9) over the time during the COVID-19 pandemic which may cause mental and psychological changes in the patients with MDRTB. Method: A total of 155 treatment naive adults and adolescents MDRTB are enrolled in an ongoing cohort. Each participant completes PHQ-9 to assess depression at baseline, 2 weeks, 1, 2, 3, 4, 5, 6, 12, 18, 24 months of treatment and post treatment 6 and 12 months. Differences in the PHQ9 scores for visits before COVID-19, during 1st lockdown, in unlock phase and 2nd lockdown were assessed by Chi-squared test and t-test and p<0.05 were considered statistically significant. Results: Out of 155 participants with median age of 27 years' 102 (65.8%) were females A significant difference was seen in the overall PHQ-9 scores across each time period (p<0.001). Also, significant changes were seen in overall PHQ-9 scores before COVID-19 and 1st lockdown (p<0.001), during unlock phase, 2nd lockdown (p<0.001) and without lockdown and during 1st and 2nd lockdowns (p<0.001). During 1st lockdown and unlock phase (p=0.165), there were no significant differences seen in the PHQ-9 scores. Conclusion: In this ongoing study, changes in the overall depression scale were significantly associated with COVID-19 lockdown, during unlock phase and 2nd lockdown phase. PHQ-9 screening can be useful for patients who may benefit from additional support and counselling during the treatment during COVID-19 pandemic.
ABSTRACT
Background &Objective : SARS-CoV-2 pandemic is causing high morbidity and mortality burden worldwide with unprecedented strain on health care systems. Data on the prevalence of the SARS-CoV-2 antibody is expanding with growing research. The initial data on antibodies was available for nucleocapsid target proteins however with advancing research and development of vaccines against the Spike RBD domain of the virus, antibody assays are being focussed to the Spike RBD proteins. The current study aims to understand the prevalence of Anti-Spike SARS cov2 antibodies. Method: A commercially available assay targeting the SPIKE RBD domain of the virus using a chemiluminescent microparticle immunoassay was used for the qualitative and quantitative determination of IgG antibodies to SARS-CoV-2 in a total of 260 individuals. Results: A total of 260 individuals were screened which included 147 males and 113 females with a mean age of 51+16 years. A positive seroprevalence was observed in 85.3% (222/260) individuals. Vaccination details were available for 225 individuals wherein 194 were seropositive. Around 12% did not show presence of antibodies (26/211) even after 21 days of vaccination. A few non-vaccinated individuals were seropositive due to prior history of Covid infection. However, 7 individuals with past history of Covid infection and 2 post vaccination were negative for antibodies. Conclusion: Serological testing plays a vital role in understanding and ultimately combating viral outbreaks and can help identifying individuals with an adaptive immune response to SARSCoV-2, indicating recent or prior infection. A high prevalence of positive spike antibodies is observed in most individuals.
ABSTRACT
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.
ABSTRACT
This study presents a research experience with engineering students at undergraduate and graduate levels, during the summer of 2020 at the School of Engineering, University of Minho, Portugal. Following the first pandemic event in Portugal, from March to May 2020, the Foundation for promoting Science and Technology (FCT) has opened a call for research projects among students and researchers at different Universities. The main aim of these projects was to motivate students to return physically to the campus during a summer course, and to promote a research environment among them. i9Masks was one of the projects approved by the University of Minho and its main objective was the development of innovative masks in a silicone elastomer for the protection of COVID-19 with the use of state-of-the-art technologies. The development of masks was at the time a very hot topic as well as a fashionable subject for research. Considering the results obtained, from the final works presented by students, a very positive balance of the experience was achieved. The i9Masks project was a useful learning experience for engineering education, particularly in Portugal, where the opportunity to participate in this type of "learning by doing" experience is very small. Copyright © 2021 by ASME
ABSTRACT
Introduction: The rate of diabetic ketoacidosis (DKA) in new-onset type 1 diabetes mellitus (T1D) is multifactorial. There seems to be an inverse relationship between T1D's incidence and DKA's frequency. DKA has been reported to be more common among young children. Recently, the COVID-19 pandemic has posed additional challenges as to diagnosing T1D. Objectives: We aimed to assess the rate of DKA and associated risk factors in pediatric new-onset T1D in a large pediatric diabetes center in Portugal. Methods: Retrospective analysis of data of patients referred to a level III pediatric hospital between January 1st, 2013 and December 31th, 2020 (8 years). Results: We included 276 children and adolescents with a median age of 9,6 years, 20,1% under 5 years old. A mean incidence of 35 new cases/year was observed, with an upward trend. Newonset T1D cases under 5 years old raised progressively, having more than tripled throughout the study period (n=3 in 2013 vs. n=10 in 2020). In total, 38% children and adolescents presented with DKA, ranging from 23,3% in 2013 to 43,2% in 2020, while remaining stable (37,2%-40,9%) in the period in-between. Overall, DKA was considered severe in 24,8% of cases, ranging from 6% in 2017 to 47% in 2020. 20 (7,2%) patients were admitted to the intensive care unit. DKA at presentation was more frequent in the age group under 2 years old (p=0,016), in which 80% of patients presented with DKA. Non-DKA presentation was associated with family history of T1D (p=0,005). Conclusions: Our study shows an upward trend in T1D's incidence in children under 5 years old and a high DKA rate at disease onset, which was more frequent in patients under 2 years of age. In the first year of COVID-19 pandemic, 43% of DKA was considered severe. It is urgent to implement educational programs to promote earlier diagnosis. Broader studies are required to provide a representative national landscape of the epidemiology of T1D in pediatric population in Portugal.
ABSTRACT
Introduction: On 12th March 2020, a national lockdown was imposed in Portugal, as a response to rising COVID-19 cases. Since then healthcare access patterns were deeply modified. Objectives: In this study, we tried to understand what shifted from prior years in new-onset type 1 diabetes mellitus (T1D). Methods: It was performed a retrospective analysis of patients referred to a level III pediatric hospital from March 2020 until March 2021. Patients admitted during the same period in the 3 previous years were set as control group. Results: Since lockdown imposition, 44 children and adolescents were diagnosed T1D, contrasting with prior mean incidence of 32 cases/ year. Median age was 9,9 years (min. 0,5 - max. 15,8). Children under 2 years-old represented 4,9% of cases, contrasting with only 2,1% in previous years. All subjects were tested for SARS CoV-2 but only 2 were positive. When comparing to prior years, subjects presenting with less than one week of symptoms almost doubled in 2020, (19,5% vs. 10,4%), and a higher rate of diabetic ketoacidosis (DKA) was also observed (53,7%, vs. 38,5%). DKA severity was also higher (40,9% vs. 21,6%;p=0,02 and 14,6% subjects required admission to intensive care unit. Conclusions: Similarly to other reports, a higher number of new-onset T1D was observed, with a comparable increase in severity. In contrast to what might have been expected, DKA prevalence and severity was not necessarily linked to delayed diagnosis. We estimate that such severity may be related to a higher proportion of younger patients. While the role of SARS CoV-2 exposure in pancreatic islet cells destruction is still under investigation, antibody assessment and detailed contact history could help to explain the increased prevalence and severity of new-onset T1D during the pandemic period.
ABSTRACT
The internationalisation of higher education has accelerated in recent years. Internationalisation at most higher education institutions mainly takes the form of study abroad. This immersion in an intercultural environment is believed to foster the development of academic and non-academic skills, thus improving graduates employability. Regardless of the geographical area, higher education institutions (HEI) have therefor put student mobility at the heart of their academic projects. However, the context has changed: the Covid-19 health crisis has led to a freezing of international mobility. Alternative solutions to traditional mobility must be found. With this book, we intend to contribute to reflections on how to develop intercultural sensitivity and intercultural competences among students through Internationalisation at Home. For this purpose, in the eight chapters of the book, we present some pedagogical methods that facilitate the creation of a context conducive to interculturality and the acquisition of plural skills by students at home. Some authors examine how these competences can be assessed. Finally, we propose a framework explaining how a combination of activities within an institution can foster the development of students' intercultural competences. Regardless of the approaches chosen by the teachers observed, they answered similar questions. These questions set a framework for reflections on efficient approaches to supporting the development of students' intercultural skills in an Internationalisation at Home context. © P.I.E. PETER LANG s.a. All rights reserved.