Family grief during the COVID-19 pandemic: a meta-synthesis of qualitative studies

The COVID-19 pandemic has led to a public health crisis, with increases in the number of deaths. As a result, the number of bereaved people has increased significantly. In addition, the measures adopted to control the spread of virus have triggered changes in the subjective and collective bereavement experiences. This systematic literature review aims to summarize and reinterpret the results of qualitative studies on the experience of losing family members during the pandemic by a thematic synthesis. The searches were performed in the Web of Science, Scopus, PubMed/MEDLINE, CINAHL, PsycINFO, and LILACS databases. Among 602 articles identified, 14 were included. Evidence was assessed using the Critical Appraisal Skills Programme tool. Two descriptive themes related to the objective were elaborated in addition to one analytical theme, namely: "Pandemic grief: lonely and unresolved". These themes proved to be interrelated and indicate that experiences of loss in this context were negatively impacted by the imperatives of physical distance, restriction of hospital visits, technology-mediated communication, and prohibition or restriction of funerals. These changes resulted in experiences marked by feelings of loneliness and helplessness, which should be considered when planning intervention strategies that favor communication between family members with the afflicted loved one and with the health care team, enabling welcoming and creating alternatives for farewell rituals. The findings may support further research to test intervention protocols, especially to guide public policies and promote psychological support to bereaved family members after their loss.

Rupturas a partir de la "política de la boiada”: Un análisis según los Objetivos del Desarrollo Sostenible

Brasil experimenta, a partir del gobierno de Jair Bolsonaro, un notable debilitamiento de la institucionalidad en lo relativo a la implementación de una agenda hacia la sustentabilidad. Apuntando a identificar tendencias y rupturas, el presente trabajo explora cuatro ejes de la actual gobernanza ambiental brasileña, tomando como herramienta de análisis cuatro Objetivos del Desarrollo Sostenible (ODS): Género (ODS 5), Energía (ODS 7), Residuos Sólidos (ODS 12) y Vida Terrestre (ODS 15). El trabajo está estructurado como un ensayo crítico, subsidiado por la evaluación histórica de los indicadores asociados a los ODS analizados. Se concluye que hay un debilitamiento de la gobernanza ambiental, en lo que refiere a la importancia de una articulación multiactores y de la gobernanza participativa. Se verifica que existen fracturas a partir del 2019 en el nivel federal, con una discontinuidad en varias políticas importantes, pero en los niveles territoriales existen tendencias históricas que ya mostraban injusticias en el ámbito socioambiental, que luego se agravan dada la crisis de la pandemia del COVID-19. © All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Atribution License.

Effects of a psychomotor program developed in the COVID pandemic on risk factors for falls in nursing home older adults

Objective: This study aimed to determine the effects of a psychomotor program performed during the COVID pandemic on risk factors for falls in nursing home older adults. Method(s): The study involved 10 nursing home older adults (aged 67-91 years old) who integrated two periods without intervention (control: pre-lockdown;and lockdown) and an experimental period (attending the program). Cognitive, emotional and physical functioning risk factors for falling were measured before and after each period. Result(s): Friedman's Test followed by Pairwise Comparison post-test showed that the program induced significant improvements with an effect size (EF) ranging from large to small in the follow risk factors: fear of falling (EF=3.22), depressive states (EF=1.49), static balance (EF=0.83), lower strength (EF=0.76), upper strength (EF=0.73), cognitive status (EF=0.58), upper flexibility (0.52), perception of affordances - real (EF=0.51) and estimated (EF=0.45), agility and balance (EF=0.37), balance and mobility (EF=0.36), lower flexibility (EF=0.24) and aerobic resistance (EF=0.21), (p<0.05). On the other hand, in the no-intervention periods, lower and upper strength, upper flexibility and perception of affordances - estimated significantly decreased (p<0.05). Conclusion(s): Results from the study showed that the psychomotor program was effective in falls prevention by improving cognitive, emotional and physical functioning risk factors for falling. These findings suggest that for older adults' good quality of life, psychomotor programs should be implemented in nursing homes.

Uso Da Saliva Como Amostra Biologica No Diagnostico Da Covid-19 Por Rt-Pcr

Introducao: O padrao-ouro para o diagnostico de COVID-19 e o teste molecular que permite a deteccao de acidos nucleicos de SARS-CoV-2 em amostras de swab Nasofaringeo (NPS). A deteccao precoce seguida do isolamento dos individuos infectados desempenha um papel crucial para impedir a propagacao da infeccao e o controle da pandemia. No entanto, a coleta de NPS e invasiva e desconfortavel para os pacientes, requer profissionais de saude especializados e pode ser um risco de infeccao cruzada para esses profissionais. Desta forma, avaliar outras fontes de material biologico, tal como a saliva, e fundamental para facilitar o diagnostico de COVID-19. Objetivo: O objetivo deste trabalho foi avaliar o uso da saliva como amostra biologica para a deteccao do RNA do SARS-CoV-2 e sua estabilidade pos coleta. Material e Metodos: Foram coletadas 954 amostras de saliva (5 mL) e de swab nasofaringeo (NPS) de individuos entre dezembro de 2020 e fevereiro de 2021 e analisadas em diferentes tempos (24h, 48h, 72h, 5 dias e 10 dias) apos a coleta. As amostras de saliva foram armazenadas em temperatura de 2degree a 8degreeC e extraidas puras e diluidas em solucao salina na proporcao 1:1. A extracao do RNA foi realizada em extrator automatico de acidos nucleicos (Extracta, Loccus) e o diagnostico molecular do SARS-CoV-2 foi realizado com o kit Gene FinderTM COVID-19 Plus RealAmp (OSang Healthcare). A idade media dos participantes foi de 37 anos (8 a 83 anos de idade) e a maioria dos individuos 738 (77,3%) foram nao-detectaveis e apenas 216 (22,7%) foram detectaveis para SARS-CoV-2. Entre os detectaveis, 96 (44,4%%) eram do sexo masculino e 120 (55,6%) do sexo feminino. A positividade na saliva foi posteriormente comparada com os resultados do NPS bem como a carga viral ou ciclo de limiar de amplificacao (Ct). Resultados e Discussao: A analise dos testes com a saliva e NPS demonstrou concordancia nos resultados de 210 (97%) pacientes detectaveis para COVID, em apenas 2,7 % (6/216) dos casos o SARS-CoV-2 foi detectado somente no NPS. Todos os participantes com resultado positivo para a RT-PCR apresentaram sintomas relacionados a COVID-19, sendo os mais comuns: tosse seca (19%), dor de cabeca (16%), coriza e dor de garganta (11%) e diarreia (8%). As amostras de salivas apresentaram estabilidade ate o decimo dia apos a coleta do material biologico, sem diferenca de deteccao do RNA viral entre a amostra de saliva pura e saliva diluida. Esses resultados demonstram que as amostras de saliva podem ser transportadas e armazenadas em temperatura de 2degree a 8degreeC, e processadas em ate 10 dias apos a coleta. Conclusao: Os resultados mostraram que a saliva e uma alternativa para a deteccao de SARS-CoV-2. E uma amostra biologica confiavel, nao invasiva, de facil coleta e com resultados similares aos obtidos com amostras de NPS. E uma alternativa que facilitaria a coleta em lugares com baixo suprimento de swabs nasofaringeos e regioes distantes de laboratorios especializados, uma vez que pode ser analisada ate 10 dias apos a coleta. Dessa forma, podemos concluir que a saliva pode ser utilizada com seguranca para o diagnostico de COVID-19. Copyright © 2022

Avaliacao Do Perfil De Doadores De Sangue Do Hospital Marcio Cunha Durante O Periodo Critico Da Pandemia De Covid-19

Introducao: Todos os servicos de saude foram impactados durante a pandemia de COVID-19, os servicos de hemoterapia, que dependem de doadores voluntarios, sofreram com a necessidade de isolamento da populacao e pelo medo do contagio ao vir doar, tambem por doadores infectados e maior numero de transfusoes em pacientes com complicacoes da COVID-19. As outras patologias com necessidade de transfusao ainda existiam e os bancos de sangue tiveram que se reorganizar para buscar ativamente os doadores e atender as medidas necessarias para evitar o contagio, como nao causar aglomeracoes, distanciamento entre as cadeiras do doador e uso de mascara e alcool gel. Objetivos: Avaliar o perfil do doador de sangue do servico de hemoterapia do Hospital Marcio Cunha durante o periodo critico da pandemia de COVID-19. Materiais e Metodos: estudo descritivo, retrospectivo e quantitativo, realizado no servico de hemoterapia atraves de avaliacao do relatorio de producao Hemoterapica - Hemoprod, dos meses de maio 2020 a julho 2021, periodo com elevado numero de obitos por COVID-19 no Brasil. Resultados e Discussao: Nos meses de maio/20 a julho/21 foram entrevistados 12.154 candidatos, sendo 9.449 aptos para doacao de sangue total, media de 629 doadores/mes. A maior parte das doacoes foi espontanea (55,6%), seguida de reposicao e apenas uma doacao autologa no periodo. Em relacao ao tipo de doador;69,7% doaram pela primeira vez;29,5% de forma esporadica e apenas 0,7% de repeticao. A maioria dos doadores foi do genero masculino (58,2%) com idade acima de 29 anos (67,7%). A principal causa da inaptidao na triagem foi descrito como outras (20%), sendo mais comum o uso de medicamentos que impedem a doacao e procedimentos endoscopicos nos ultimos seis meses;3,65% apresentavam hematocrito abaixo do necessario;2,8% hipotensao e 1,04% comportamento de risco para doenca sexualmente transmissivel. No que se refere a triagem sorologica, 221 doadores apresentaram sorologia positiva (2,3%) sendo 47% anti-HBc total reagente, 45.8% sifilis;2,7% anti-HCV;1,8% HBsAg e HTLV e 0,9% HIV. Quanto ao perfil imunohematologico 41,8% foram do grupo O positivo e 28,7% A positivo, sendo os mais frequentes e 9,9% foram O negativo. No periodo foram produzidos 9.323 concentrados de hemacias e transfundidos 6.826 e produzidos 8.948 concentrados de plaquetas e transfundidos 3.983. Conclusao: Nao ha substituto para sangue humano, por isso os servicos de hemoterapia dependem dos doadores voluntarios para manter o estoque de hemocomponentes. No periodo da pandemia houve menor numero de doacoes e maior necessidade de transfusoes em decorrencias das complicacoes da COVID-19. O banco de sangue do Hospital Marcio Cunha atendeu as medidas sanitarias para evitar o contagio e utilizou de estrategias de captacao de doares para tentar diminuir o impacto para o setor assistencial, no periodo analisado o numero de doacoes foi suficiente para atender a demanda transfusional, fato tambem relacionado a reducao de cirurgias eletivas. Copyright © 2022

Rural sanitation: scenarios and public policies for the Brazilian semi-arid region

Brazil's primary sanitation sector has been neglected, especially concerning rural sanitation. Population dispersion and the difficulty of access in many rural communities bring more significant challenges to the universalization of the service and, consequently, vulnerabilities for the population. The present work builds a theoretical framework about the context of rural sanitation in Brazil, with history, weaknesses in the sector, the impact of COVID-19 and new technologies, and central public policies in the State of Pernambuco. It is known that COVID-19 has caused considerable challenges that, added to the obstacles to national sanitation, result in greater vulnerability to the population, especially for indigenous peoples, quilombolas, and diffuse rural communities. In the State of Pernambuco, certain policies, such as the One Million Rural Cisterns Program (P1MC), One Land and Two Waters Program (P1 + 2), Agua Doce Program and Operacao Pipa Program, significantly improved the quality of life of the rural population. However, these measures are not enough to remedy the sector's shortcomings. Although alternative sanitation technologies bring hope to the sector, there is a long way to go towards the universalization of sanitation.

Effectiveness of Eculizumab Treatment for Generalized Myasthenia Gravis in Us Clinical Practice: GMG Registry Data

INTRODUCTION: Clinical trial data have demonstrated that eculizumab improves clinical outcomes in individuals with refractory generalized myasthenia gravis (gMG). Data from clinical practice on treatment patterns and effectiveness of eculizumab in gMG are being collected by the Alexion-sponsored gMG Registry. OBJECTIVE: To describe treatment outcomes and safety (serious adverse events [SAEs]) in current gMG Registry participants during eculizumab therapy in clinical practice in the USA. METHODS: Starting in December 2019, adults with gMG who had ever received eculizumab enrolled in the gMG Registry (NCT04202341). After obtaining consent, demographic data, myasthenia gravis activities of daily living (MG-ADL) total score and Myasthenia Gravis Foundation of America (MGFA) classification were collected from medical records at two time points: In the 6 months before eculizumab initiation and at first gMG Registry assessment after eculizumab treatment initiation (at Registry enrollment). SAEs in patients receiving eculizumab during Registry participation were recorded. RESULTS: As of November 29, 2021, in total, 111 adults with gMG had enrolled in the gMG Registry (male, 52.3%;mean [range] age at MG diagnosis, 56.1 [16.0-92.0] years). The mean (range) time from eculizumab initiation to gMG Registry enrollment was 2.0 (0.0-6.7) years. Mean (standard deviation) MG-ADL total score decreased from 8.3 (3.6) before eculizumab initiation to 3.1 (3.6) after eculizumab treatment. MGFA classification improved with eculizumab treatment: Class I, 0.0% of patients before eculizumab initiation versus 28.9% after eculizumab treatment;class II, 36.8% versus 55.3%;class III, 52.6% versus 15.8%;class IV, 10.5% versus 0.0%. The median MGFA class was III before eculizumab initiation and II after eculizumab treatment. One SAE (invasive pulmonary aspergillosis) considered by the investigator to be related to eculizumab was reported in a patient who died, and two serious infections considered unrelated to eculizumab were reported (COVID-19/pneumonia and urinary tract infection);there were no meningococcal infections. Two patients died of causes considered to be unrelated to eculizumab (lung adenocarcinoma and acute congestive heart failure/myocardial infarction). CONCLUSION: These data from the gMG Registry provide evidence of the effectiveness of eculizumab for the treatment of gMG in clinical practice across the USA, demonstrating a benefit/risk profile consistent with that observed in clinical trials.

Real-world experience of eculizumab treatment for generalized myasthenia gravis: initial data from a registry of patients with generalized myasthenia gravis in the USA

Objective: To describe the baseline characteristics and interim treatment outcomes of registry participants with generalized myasthenia gravis (gMG) treated with eculizumab in real-world clinical practice in the USA. Background: Clinical trials have shown that eculizumab improves clinical outcomes in individuals with refractory gMG. The Alexion-sponsored gMG Registry collects real-world data on treatment patterns and effectiveness of eculizumab in gMG. Design/Methods: Adults with gMG who had ever received eculizumab enrolled in the Alexion-sponsored gMG Registry (NCT04202341) from December 2019. After consent, demographic data, Myasthenia Gravis (MG) activities of daily living (ADL) total scores, MG Foundation of America (MGFA) classification and serious adverse events (SAEs) were collected from medical records at two time points: before eculizumab initiation (within prior 6 months) and at Registry enrollment (first Registry assessment during eculizumab treatment). Results: As of February 28, 2021, 59 adults with gMG had enrolled in the Registry (male, 54.2%;mean [range] age at MG diagnosis, 58.3 [16.0-84.0] years). Mean (range) time from eculizumab initiation to Registry enrollment was 697.1 (7.0-2435.0) days. Mean (standard deviation) MG-ADL total score decreased with eculizumab, from 8.3 (3.71) before eculizumab to 3.1 (3.43) at first Registry assessment during treatment (n=38). MGFA classification improved with eculizumab (n=32): before eculizumab, MG was class I (0.0% of patients), II (40.6%), III (53.1%) or IV (6.3%);at first Registry assessment during treatment, MG was class I (25.0%), II (62.5%), III (12.5%) or IV (0.0%). SAEs (lung adenocarcinoma, respiratory failure, atrial fibrillation, heart failure, colostomy closure, COVID-19, death) were reported in six patients. There were two deaths (unrelated to eculizumab). No meningococcal infections were reported. Conclusions: Initial analyses of Registry data showed that MG-ADL total score and MGFA classification improved with eculizumab, and that eculizumab was generally well tolerated. These findings provide additional evidence of the effectiveness of eculizumab for treating gMG in real-world clinical practice.

Plasmapheresis as a fundamental treatment in acute transverse myelitis

Background: Acute Transverse Myelitis (ATM) is a very uncommon neurological syndrome, characterized by acute or subacute spinal cord dysfunction that can lead to paresthesias, sensory/autonomic impairment and paralysis. The aetiology is often unclear, but infectious, para-infectious, systemic autoimmune diseases, paraneoplastic, ischemic diseases and drugs are potential causes. Vaccine administration can also trigger an immune response and induce an autoimmune response;however, ATM has rarely been reported as a complication of COVID-19 infections or vaccination. The treatment mainly consists of steroids and plasmapheresis, which often reverses any neurologic symptoms. The therapeutic plasmapheresis is a highly complex procedure. It separates the patient's blood components replacing the plasma removed by solution that can be fresh frozen plasma or albumin, allowing the removal of the autoantibody, immune complex, lipoprotein or endotoxin that's causing the pathology. Aims: Clinical case report. Methods: A 46-year-old male patient, with personal history of hypertension and obesity, 3 weeks after COVID-19 vaccination, presented to the emergency department due to urinary complaints (urgency and pollakiuria), progressive numbness, paresthesias and decreased muscle strength in the lower limbs and decreased sensibility in the perineal region. Physical examination revealed total gait disability, decreased sensation and strength in the right lower limb, loss of sensation and plegia in the left lower limb and urinary incontinence. Initial laboratory workup and CT imaging of the brain, cervical, dorsal and lumbar spine were normal. The patient was admitted to Neurology internment for further study and treatment. During hospitalization, lumbar puncture and MRI of the dorsal and lumbosacral neuraxis were performed, but only allowed us to exclude infectious and compressive etiologies. The inflammatory aetiology was assumed as the most probable, so acute therapy with pulses of methylprednisolone was initiated. In the remaining study, weakly positive anti-MOG (Myelin Oligodendrocyte Glycoprotein) antibodies were detected in the serum. Therapeutic plasmapheresis using a cell separator (which use centrifugal force to separate components according to their density) was proposed as additional therapy. Seven sessions were performed without intercurrences. Results: During acute therapy, there was a partial improvement in sensitivity and strength in lower limbs. The patient started a rehabilitation program with favourable neurological recovery. At the time of hospital discharge, he still needed crutch support for walking and had muscle strength grade 4-/5 bilaterally. Summary/Conclusions: Although the patient maintained some functional limitation and there was not a complete resolution of the neurological symptoms, he showed a good response to acute therapy. The plasmapheresis, by permitting the antibody to be removed faster than would occur by its endogenous clearance, proved to be fundamental in the clinical recovery of the patient. No relationship between COVID-19 vaccination and the event was established.

Difficulties experienced by managers in the coordination of teams working from home: an exploratory study considering the COVID-19 pandemic

Purpose This research aims to analyse difficulties experienced by Brazilian managers in coordinating teams working from home during the coronavirus disease (2019) COVID-19 pandemic. Design/methodology/approach The methodological strategy used was a survey with 39 managers who led teams working from home during the COVID-19 pandemic. Seven difficulties indicated by current literature were analysed using a fuzzy scale. First, a hierarchical cluster analysis (HCA) approach was used to group managers according to managers' similarities and capacity to infer the difficulties. Responses of each group identified were weighted considering the capacity to assess the theme. In the sequence, data were analysed via frequencies and the fuzzy technique for order of preference by similarity to ideal solution (TOPSIS) approach and difficulties were ordered. Findings Comparatively, the main difficulties evidenced are (1) to reconcile personal and professional life tasks in the same place;(2) to motivate collaborators in a period when social isolation affect employee's mental health and (3) to keep team members integrated and working within the activities scope in a virtual environment. Originality/value The findings present in this paper contribute to theory and practice. For theory, this article contributes to the knowledge on WFH and leadership, evidencing in a comparatively way the difficulties that are experienced by managers during the COVID-19 pandemic. Researchers in future studies can better analyse these difficulties. For practice, managers who conduct managers' teams remotely can use the information to analyse teams' practices and improve performance critically. This was an atypical moment of humanity, and different aspects need to be considered by managers compared with previous periods.

CARACTERÍSTICAS EPIDEMIOLÓGICAS DA HANSENÍASE NO BRASIL ENTRE OS ANOS DE 2015 E 2020

Introdução/Objetivos: A hanseníase é uma doença infecciosa causada pelo Mycobacterium leprae. No Brasil, é um importante problema de saúde pública, sendo de notificação compulsória e investigação obrigatória. O objetivo deste trabalho é analisar os casos de hanseníase notificados e relacionar a prevalência com características sócio-econômicas. Metodologia: Dados referentes às notificações de hanseníase, publicados no SINAN-DATASUS (Doenças e Agravos de Notificação), entre 2015 a 2020, foram tabulados, analisados, e comparados com os publicados em trabalhos científicos relacionados ao tema. Resultados: Entre os anos de 2015 e 2020 foram notificados 195.429 casos de hanseníase no Brasil. As maiores notificações ocorreram em 2018 (20,45%). As regiões Nordeste (42,3%), Centro-Oeste (21,2%), e Norte (14,4%) se destacam. As maiores prevalências foram observadas nas regiões Centro-Oeste (52,3/100.000 hab) e Norte (41,8/100.000 hab), em 2018. A região Sul apresentou o menor número de notificações (3,24%), bem como, a menor prevalência (2,1/100.000 hab, em 2020). A análise da distribuição dos casos por ano demonstra uma importante queda em 2020. A região Norte, por exemplo, apresentou queda de 46% entre 2019 e 2020, passando de 38,1/100.000 hab para 20/100.000 hab. A pandemia de COVID-19, bem como, as medidas de isolamento implantadas para seu controle, podem ter refletido na menor busca por atendimentos em saúde. Análise de casos por sexo demostra predominância do sexo masculino em todos as regiões e anos analisados. A hanseníase é considerada uma doença negligenciada, sendo esse conceito atribuído às doenças de maior ocorrência em países em desenvolvimento. Condições de vida precárias, pobreza, baixa escolaridade e fome são fatores de risco. Além disso, diferentes trabalhos associam a endemicidade de hanseníase à migração populacional. A baixa renda per capita das regiões Norte e Nordeste, bem como, dados referentes à pobreza podem explicar a alta prevalência de hanseníase nessas regiões. Movimentos migratórios associados ao crescimento econômico, ocorrido em cidades da região Centro Oeste, nos últimos anos, também são responsáveis pela sua endemicidade. Conclusão: Podemos concluir que, embora o tratamento preconizado para hanseníase seja disponibilizado no SUS e, o mesmo seja eficaz, sua prevalência ainda não apresenta uma queda satisfatória. Regiões com baixa renda per capita e cidades que apresentaram alterações demográficas importantes, são endêmicas.

Sympathetic neural overdrive, endothelial dysfunction and aortic stiffness in coronavirus disease 2019 survivors: A short-term study of cardiovascular sequelae

Introduction: Coronavirus disease 2019 (COVID-19) has become one of the more dramatic health problems in the century. This disease has enormous consequence for the health care worldwide. In addition to high mortality rate, patients recovered from COVID-19 present short and long-term cardiovascular sequelae including chest pain, myocardial dysfunction, arrhythmia, dyspnea, breathlessness, postural tachycardia syndrome, and thrombotic complications. The explanations for these clinical manifestations are still uncertain but can involve a constellation of physiological alterations. Hypothesis: To test if COVID-19 survivors have augmented sympathetic outflow, diminished endothelial function, elevated aortic stiffness, and reduced physical capacity compared to healthy individuals. Methods: Nineteen COVID-19 survivors [age: 47.0±2.3 years, BMI: 30.1±1.2 Kg/m2] and eighteen well-matched healthy controls (age: 44.0±2.0 years, BMI: 28.4 ±1.2 Kg.m2] were included in study. COVID-19 survivors were evaluated within 6 months of original diagnosis by RT-PCR. Muscle sympathetic nerve activity (MSNA) from fibular nerve (Microneurography), brachial artery flowmediated dilation (BAFMD;Doppler-Ultrasound), carotid-femoral pulse wave velocity (cf-PWV;Complior), beat-to-beat blood pressure (Peripheral BP;Finometer), heart rate (HR;Electrocardiography) and peak oxygen uptake (VO2peak, Cardiopulmonary exercise testing) were measured in both groups. Results: MSNA was higher in COVID-19 survivors compared to controls (33.0±1.0 vs. 22.0±1.0 bursts/min, p=0.001). Both BAFMD and VO2peakwere lower in COVID-19 survivors compared to controls (4.6±0.7 vs. 8.2 ±0.8%, p=0.005 and 22.2±1.5 vs. 29.7±1.6 mL/Kg/min p=0.001, respectively). Although COVID-19 survivors had greater cf-PWV than controls (8.6±0.5 m/s vs. 7.4±0.4 m/s, p=0.03), BP and HR were not different between groups. Conclusions: Our study revealed that patients recently recovered from COVID-19 have abnormal neurovascular control, vascular alterations and reduced physical capacity. These findings strongly indicate the need of further long-term investigations to uncover cardiovascular sequelae provoked by COVID-19.

Allergy to COVID19 vaccine: The role of an allergist

Background: COVID-19 vaccines are being administered all over the world, but information is lacking about the frequency and type of allergic reactions associated to these new vaccines. Method: Retrospective study of health care professionals (HCP) from our hospital who received COVID 19 vaccine Comirnaty, between 29/12/2020 and 20/2/2021. We reviewed clinical data, particularly the immediate reactions after the administration (<6h), skin tests (ST) and graded vaccine administration. Following national guidelines, all HCP with previous history of food, drug or hymenoptera venom allergy or idiopathic anaphylaxis (IA) were first evaluated by an allergist. Vaccination was postponed if HCP had previous history of IA and/or recurrent anaphylaxis (RA), severe allergic reactions to vaccines and mast cell activation syndromes. ST to the vaccine (prick and intradermal) were performed in HCP with IA and/ or RA, severe allergic reactions to vaccines and HCP with immediate reactions to the 1st dose. Graded administration of the vaccine (0.1+0.2cc after 30') was performed in the postponed HCP and the ones with immediate reactions to the 1st dose. Results: From 3073 HCP who received the vaccine, 74.2% were female, mean age 40.2 years-old ± 13.4, 316 (10.3%) were evaluated by an allergist and 4 (1.3%) postponed the administration and performed allergy investigation. 2955 HCP (97%) were able to receive the 2 doses of the vaccine. 118 employees received only one dose: 98 had COVID-19 meanwhile, 7 got pregnant, 13 due to other conditions. Adverse reactions to the vaccine with possible hypersensitivity mechanisms, occurred in 17 (0.6%) HCP, 12 on the 1st dose and 5 on the 2nd dose. Observed reactions were 6 (0.2%) urticaria, 5 (0.16%) pruritus with or without flushing, 2 (0.07%) anaphylaxis (mild), 2 (0.07%) flushing and hoarseness, 1 (0.03%) flushing and nausea and 1 (0.03%) asthma exacerbation. ST with the vaccine were performed in 4 HCP, all negative in the immediate reading and 1 positive in non-immediate reading. 7 HCP undertook the graded administration with the vaccine: 6 tolerated, but one reproduced the immediate urticaria with 0.1cc of the vaccine (0.03% vaccine allergy). Conclusion: In the evaluated sample, suspicious allergic reactions to COVID19 vaccine Commirnaty were rare and allergy was only confirmed in one HCP. The allergist initial evaluation was essential for a safe risk stratification and permitted the non-exclusion of a considerable number of HCP from the vaccination program.