A Novel Approach to the Two-Dimensional Cargo Load Problem

The transport and logistics sector, which include freight forwarders companies, constitutes a vast network of entities that are central to a good performance in services. With the COVID-19 pandemic and its effects on the global economy, there was a huge shortage in the number of containers available, thus creating the need to optimize the loading of available equipment to avoid waste and maximize profits from each export. The present work presents a novel approach where a set of restrictions were created that, applied in synergy with the Non-Linear GRG algorithm, aim to allocate the boxes in different consecutive lines until forming a wall, and, therefore, the walls complete the container, in order to maximize the occupancy on it. To validate the proposed approach a prototype was developed and studied in real-world problem where the solutions resulted in occupations around 80% to 90%. Thus, we can foresee the importance of the proposed approach in decision-making regarding container consolidation services. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Covid-19 in lung allograft recipients - better outcomes after vaccination?

Vaccination remains a main weapon against Coronavirus Disease 2019 (Covid-19). Although its efficacy is reduced in the immunocompromised population, we felt empirically that outcomes of Covid-19 in lung transplant recipients (LTRs) were better after widespread vaccination than in earlier phases of the pandemic. We aimed to compare outcomes of unvaccinated and vaccinated LTRs infected with SARS-CoV-2. All LTRs followed in our hospital were reviewed and those with a positive polymerase chain reaction test were included. We analysed disease severity (using World Health Organization criteria) and mortality rates in unvaccinated and fully vaccinated patients (pts). Twenty-four pts were included, two-thirds of which were male, with a mean age of 51 years. Main diagnoses were hypersensitivity pneumonitis (25%), chronic obstructive pulmonary disease (16,7%), idiopathic pulmonary fibrosis (12,5%) and cystic fibrosis (12,5%). Lung transplant was bilateral in 79,2% of pts, unilateral in 16,7% and lobar in one pt (4,1%). The most common immunosuppression regimen was tacrolimus, mycophenolate-mofetil and prednisolone. Thirteen pts were unvaccinated and 11 were vaccinated at time of infection, with a mean time since transplant of 746 and 1641 days, respectively. In the unvaccinated group 69,2% had mild disease, 30,8% had severe disease and mortality was 25%. No deaths occurred among fully vaccinated pts;disease was mild in 72,7%, moderate in 18,2% and severe in 9,1%. Neither the difference in severity (p=0,156) or mortality (p=0,089) reached statistical significance, presumably due to the small sample size. Nevertheless, we confirmed that, in our centre, vaccinated LTRs had better overall outcomes than unvaccinated pts.

Daratumumab (Dara), Cyclophosphamide, Thalidomide and Dexamethasone for Transplant Eligible Newly Diagnosed Multiple Myeloma (Te Ndmm) Patients: Response Rate Impacts on Pfs

Background: The four-drug combo has becoming one of the main induction treatment for TE NDMM patients (pts). We conducted a phase 2 study to assess the safety and preliminary efficacy of Cyclophosphamide (C), thalidomide (T), dexamethasone (d)-(CTd) and Dara combination. MAXDARA study has shown in the primary analysis with 21 included patients (pts), 4 and 8 pts MRD negativity after four induction cycles and two consolidation cycles post transplant, respectively. (Crusoe E et al ASH 2020, 2416 poster presentation). In the present analysis we evaluate the effect of deep response rate on PFS. Method(s): This is a phase II, open-label single-center clinical trial. The main inclusion criteria were: TE NDMM, creatinine clearance > 30 ml/min, normal cardiac, renal and liver function and the ECOG performance status = 0 - 2. The protocol was Dara-CTd for up to four 28-day induction cycles: C-500mg oral (PO) on days 1,8 and 15, T at 100-200mg PO on days 1 to 28, (d) at 40mg PO on days 1,8,15 and 22 and Dara at 16mg/Kg/dose intravenous (IV) on days 1,8,15 and 22 during cycles 1 - 2 and every other week in cycles 3 - 4, followed by ASCT. All pts received up to four 28-day consolidation cycles that was started at D+30 after ASCT: Dara at 16mg/Kg and (d) at 40mg every other week, associated with T at 100mg PO on days 1 - 28. Dara at 16mg/Kg was used monthly as maintenance until progression or limiting toxicity. The MRD was evaluated by next-generation flow (NGF) 10-6 and PET-CT was performed when the patient obtained NGF negativity or finished consolidation. PFS outcome was estimated using Kaplan-Meier method and PFS analysis were performed based on the different response rates. (Data cut-off was April 2022) Results: A total of 24 pts were included. The median age being 58 (range 37- 67 years), 15 (62.5%) pts were female, 22 (92%) were non-white, 6 (25%) had an R-ISS = 1, 12 (50%) had an R-ISS = 2 and 4 (16%), an R-ISS = 3. Sixteen (66.7%) pts were IgG isotype and Six (25%) had high-risk chromosomal abnormalities [1q+, del17p, t(4;14) or t(14;16)]. To date, 23 pts have completed induction, 21 performed transplant and 14 are still in treatment after one year of dara maintenance. By ITT analysis, 22 pts (91.6%) achieved (> PR) after 4 induction cycles. One pts achieved SD, one MR and one sCR. Eleven (39%) pts achieved PR, and 10 (35.7%) VGPR. After two consolidation cycles, ORR was 68%, 8 (28.6%) and 11 (39.3%) pts obtained sCR and VGPR, respectively. The best response during any time of the treatment were PR in 3 (12.5%) pts, VGPR in 12 pts (50%) and sCR in 8 (33.3%) pts. In a ITT analysis, NGF MRD 10-6 negativity were observed in 4(16.6%) after four induction cycles, and in 17 (70.8%) pts after two consolidation cycles post-ASCT. In a ITT analysis, after a median follow up (FU) of 26 months, the PFS was 37months for the entire group. The median PFS comparing sCR vs < VGPR were 37m vs 27m (p = 0.021), respectively, and comparing MRD negative by NGF vs no, had impacted even more on PFS with a median of 37m vs 16m (p = 0.004), respectively. The OS was not yet achieved and 83% of the patients still alive after a median FU of 27m. Four pts died from infection, two of them related with covid infection (one before transplant and one during maintenance). Another case post-transplant, considered not related to the investigational agent and one after consolidation, related to the investigational agent. Summary/Conclusion: The Daratumumab - CTd protocol is an active and safe regimen capable of producing deep and sustainable responses. The deeper response rate impacted on PFS, confirm that MRD negativity is critical to patient outcome. Copyright © 2022

The politicization of Public Administration as an aggravating factor in the Covid-19 pandemic in Brazil

This study demonstrates the negative impact of the politicization of Public Administration in combating the COVID-19 pandemic in Brazil. In order to do so, we discussed the process of State Reform in the period of redemocratization, the changes inaugurated with the Federal Constitution of 1988, the phenomenon of politicization of public institutions and its repercussions on the scope of public interest, especially with regard to health, and facing the emergency caused by COVID-19. To achieve the objective of this article, the nature of basic research was used. As for the research objectives, they were descriptive-explanatory, of bibliographic technical procedure. Thus, it is necessary to implement changes in Public Administration, with a view to making popular demands and expectations viable. In addition, greater rigor in the selection of public office holders is essential, especially those with functions involving health, distancing political party interests and promoting the full effectiveness of the provisions of article 196 of the Charter. © 2022, Instituto de Direito Romeu Felipe Bacellar. All rights reserved.

Drug allergy impact on anaphylaxis risk accessment in COVID-19 vaccination: Experience of an allergy department

Background: COVID-19 vaccination is essential for the pandemic control. Adverse reactions after vaccination are com-mon, although anaphylaxis is rare. Objective(s): To characterize the immunoallergological reactions responsible for pre--vaccination referral by Primary Care (PC), to analyze the impact of drug allergy on this referral, and to evaluate the vaccination outcome after risk stratification. Method(s): Retrospective observational study including patients referred by PC to the Allergy & Clinical Immunology Department of a tertiary hospital to evaluate the risk of severe hypersensitivity reactions (HSR) after COVID-19 vaccination, from January to June 2021. Risk stratification was carried out in accordance with the Allergy & Clinical Immunology Department's protocol. Result(s): From a total of 733 patients referred by the CSP, 510 were admitted, 445 of which were evaluated, 369 (83%) females, mean age 66+/-13 years [20-99 years], 122 (27%) atopic. The majority (n=349, 78%) were referred due to previous drug reactions, of whom 69 (15.5%) due to vaccine reactions. Nonste-roidal anti-inflammatory drugs (n=97, 51%) and antibiotics (n=70, 36%) were the most reported drugs in suspected/confirmed HSRs. Drug reaction profile differed in low-risk (61% with HSR, 39% anaphylaxis) and intermediate/high risk (92% with HSR, 65% anaphylaxis) patients. After risk assessment, 323 patients were referred for vaccination at the vaccination center, of whom 280 received at least one dose of the vaccine. Two patients had chronic urticaria worsening and one patient had a vasovagal reaction after the vaccine. 122 patients were vaccinated at the hospital, of whom 69 received one dose of the vaccine. Only two patients had mild skin reactions. Conclusion(s): Drug allergy was the main cause for pre-vaccination risk assessment. Most patients were vaccinated at the vaccination center with no HSR. Risk assessment protocol was effective, with no significant reactions or cases of anaphylaxis. Copyright © 2022, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved.

Practice of sanitizing the hands of the nursing team to avoid cross-contamination by COVID-19

Introduction: According to ANVISA, hands are the main source of transmission and dissemination of microorganisms, both for patients and for nursing professionals who work. One of the most used precautions as prevention of Covid19 was precisely the hygiene of the hands.

LEPTOSPIROSE EM PACIENTE COM ARTRITE REUMATOIDE: UM DESAFIO DIAGNÓSTICO - RELATO DE CASO

O objetivo desse relato de caso foi demonstrar as particularidades no diagnóstico e possíveis diagnósticos diferenciais em pacientes imunossuprimidos com síndrome febril aguda. Paciente feminina, 37 A, auxiliar administrativo, portadora de artrite reumatoide, imunossuprimida em uso de Simponi associado a Metotrexato 10 mg/semana, com diagnóstico anterior de tumor desmóide em 2016. Após a 2ª dose de Simponi, cursa com quadro agudo de cefaleia de característica persistente, refratária a uso de sintomáticos, acompanhado de náuseas, com queda relativa do estado geral, sudorese de característica noturna, mialgia difusa e episódios recorrentes de febre. Durante esse período foi imunizada com a 2ª dose da vacina para o covid-19. Após a vacinação surgiu nova sintomatologia, disúria isolada. Diante disso, conduzimos com a internação hospitalar para rastreio infeccioso e vigilância clínica. Foi interrogado descompensação infecciosa viral, ITU, reação medicamentosa de suspeição pouco provável e doença hematológica. Foi solicitado laboratório completo, incluindo sorologias virais para citomegalovírus, EBV, parvo vírus, toxoplasmose, leptospirose, hemocultura de 2 amostras de sítios diferentes, EAS e urocultura, ferritina e triglicerídeos devido a febre com alterações de transaminase, aventando um possível quadro viral desencadeado por síndrome hematofágica. Complementando com exames de imagem, como USG de abdome total para avaliar a possibilidade de hepatoesplenomegalia e USG de cervical para avaliar linfonodos. Paciente evolui com piora clínica em vigência de dor abdominal. Solicitada tomografia de abdome, apresentando imagem com vesícula parcialmente distendida, associado à presença de líquido perivesicular, A clínica cirúrgica opta por abordagem invasiva, sendo realizado colecistectomia videolaparoscopia. No pós-operatório, ficando aos cuidados intensivos pela UTI e escalonado para tazocin (D10). Após resultado da sorologia para leptospirose com IgM reagente interrompeu uma longa série de exames negativos e febre prolongada, sem diagnóstico. Apresentou evolução clínica satisfatória, resultando em alta hospitalar. A artrite reumatoide é acompanhada de sintomas constitucionais inespecíficos, principalmente a febre baixa em pacientes imunossuprimidos. O diagnóstico de leptospirose foi concluído mais tardiamente, quando os exames da admissão foram disponibilizados. Um caso de uma enfermidade de alto impacto, contudo negligenciada como problema de saúde pública.

StayAtHome: Active Responsiveness in Institutional Political Propaganda in View of the Covid-19 Pandemic

This research is in line with the postulates of the Bakhtin Circle regarding the dialogism of language, particularly, the active responsiveness assigned to any utterance in response to others. Within the scope of Dialogic Discourse Analysis, we propose an interface with some elements of the Functional Discourse Grammar for linguistic analysis of utterances. Our objective is to evaluate how the responsive attitude is established in the discourse of the Government of Sao Paulo in regard to statements by the Federal Government, in order to build an institutional policy in times of covid-19 pandemic. Through the analysis of two videos, we have found that the responsive attitude which the Government of the State Sao Paulo seeks to demonstrate does not necessarily configure attitudes of responsibility towards the less fortunate. However, it reaches its objective, which is to oppose to the Federal Government's discourse guiding the attitudes of the population in the pandemic scenario. © 2021. All Rights Reserved.

Subcutaneous immunotherapy with aeroallergens in a central hospital in portugal during the covid-19 pandemic

Background: Allergic disease, allergic rhinoconjunctivitis/bronchial asthma, are very prevalent worldwide, and the poten-tially modifying therapy is immunotherapy with aeroallergens. In December 2019 a new coronavirus (SARS-CoV-2) was iden-tified in China, causing a pandemic with devastating effects. For this reason, the State of Emergency (SE) was declared in Portugal for the first time in this pandemic, between 18 March and 2 May 2020, and all non-urgent activity was suspended in our hospital, including the administration of subcutaneous immunotherapy with aeroallergens (SCITA). Objective: Cha-racterize the dose adjustments according to the delay in SCITA administration, verify the safety of the dose administered when resuming SCITA and evaluate the worsening of symptoms of the allergic disease, in patients under SCITA program that inter-rupted it during the SE. Material and methods: An analysis of the SCITA clinical records of the 195 patients who interrupt-ed the maintenance dose during EE was performed. According to the symptoms and the delay interval, the dose was reduced or a new initiation protocol was performed, according to our Allergen Immunotherapy Functional Unit protocol, adapted from international guidelines for this specific time. Results: 7.7% of patients had worsening of allergic symptoms during the interruption period and 6.2% resorted to rescue therapy. 96.4% decreased the dose in SCITA resumption, with a decrease that was mostly greater than predicted, according to our protocol. Immediate local reactions were recorded in 9.2%, with no ana-phylactic reactions. After recovery, 9.7% worsened symptoms and 5.1% resorted to rescue therapy. Conclusions: The pandemic made it very difficult to monitor patients’ chronic pathologies, including allergic diseases. The majority of patients did not report worsening of symptoms and few had adverse reactions in the resumption of SCITA, demonstrating the safety of the dose adjustment protocol. © 2021 Sociedade Portuguesa de Alergologia e Imunologia Clínica. Published by Publicações Ciência & Vida.

Aeroallergen immunotherapy during covid-19 pandemic

Background: Subcutaneous immunotherapy with aeroallergen (SCITA) was stopped in some departments during the lock-down period due to the COVID-19 pandemic. Objectives: To evaluate the impact of SCITA interruption on symptoms, the need for control medication, the quality of life, and the expectations and degree of safety / fear of patients on returning to the hospi-tal. Methods: Self-completion of an anonymous survey for patients over 12 years in the first 5 weeks of SCITA restart. CARAT was used as an instrument to assess rhinitis and asthma control. Results: 77 patients (90% adults, 68% women) were included, all with rhinitis and 40% with asthma. The average time interval between the last administration and the restart of SCITA was 13 ± 2.48 weeks. Seven percent of patients were seen in an emergency / unscheduled appointment due to the exacerbation of respiratory symptoms and only 1 had COVID-19. CARAT-Total scores showed control of rhinitis and asthma, respectively, in 35% and 66% patients. The proportion of uncontrolled patients rised with the increase in the SCITA interruption period (IP). The majority (> 90%) of patients reported no significant impact on their quality of life and maintained the usual control medication (48%), expressed concern about losing the benefits of SCITA with its interruption (62%) and reported feeling safer in the vaccination offices compared to the hospital building or waiting room. Conclusions: An increase in the frequency of uncontrolled patients with an increase in IP was observed. For most patients, the IP did not have a significant impact on quality of life. The frequency of patients who needed to be observed in an emergency / unscheduled appointment was low and only 1 reported having had COVID-19. The perception of safety in the vaccination room is higher than in the hospital’s common spaces. © 2021 Sociedade Portuguesa de Alergologia e Imunologia Clínica. Published by Publicações Ciência & Vida.

Challenges and Strategies for Information Systems in the Decision-Making Process to Face the COVID-19 Pandemic: The São Paulo Case

The State of São Paulo was the epicenter of COVID-19 in Brazil, with a high impact on society, causing many deaths and significant losses to the economy. A milestone in confronting the pandemic was creating an Intelligent Monitoring System, whose mission was to consolidate and integrate data to support the state government in its strategic decisions. Overcoming the challenges of integration, anonymity, and privacy was essential to validate and make governmental actions legal and ethical. We present the technical aspects, the information integration and good practices in disseminating strategic data on mobility, health, and economy to support strategic decision making. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Sars-CoV-2 Infection in Lung Transplant Patients - Single Center Experience in Portugal

Introduction Lung transplant (LT) patients are immunosuppressed and it is yet to be determined if immunosuppression plays a role in SARS-CoV-2 infection. Due to this lack of information about COVID-19 in solid transplant patients, case series are of utmost importance. We report two cases of LT patients with COVID-19 at our LT center. Case Report We report a 60-year-old man submitted to a bilateral LT due to COPD in January 2020. Immunosuppression: basiliximab as induction and prednisolone, mycophenolate mofetil and tacrolimus as maintenance therapy. He was discharged 47 days post-operatively. Six months after LT, as routine screening to an elective endoscopy for previously controlled Barret's esophagus, RT-PCR of naso-pharyngeal swabs detected SARS-CoV-2 RNA, assuming the diagnosis of COVID-19. He was hospitalized for monitoring despite being asymptomatic. Oxygen saturation was always higher than 97% at room air. Leukocyte was 5.730 × 10

Clinical characteristics and outcomes of critically ill covid-19 patients admitted to an infectious diseases intensive care unit in Portugal

Objective: We aimed to describe the characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) admitted to an intensive care unit (ICU) in Portugal. Design: This is an observational retrospective study. Demographic and clinical data were col-lected. Respiratory failure treated with invasive mechanical ventilation (IMV) and death during ICU stay were the main outcomes evaluated. Setting: This study was conducted in the Infectious Diseases ICU of Centro Hospitalar e Uni-versitário de São João, in Porto, Portugal, be-tween March 11 and August 17, 2020. Patients and participants: All consecutive patients with confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infec-tion, admitted to the ICU during the study peri-od were enrolled, and 62 patients were included. Measurements and results: The median age was 71 years (IQR, 54-78) and 39 (62.9%) were male. Thirty-four (54.8%) patients received. IMV in contrast to 28 (45.2%) who were not intubated and the median lowest PaO2/FiO2 was 86 (IQR, 70-113) in IMV and 150 (94-257) in non-IMV patients. Several patients with severe hypoxemic COVID-19 were treated without IMV, especially with high flow nasal cannu-la (HFNC). Overall mortality was 21.8% and older age, male sex, active cancer, lower lym-phocyte count, higher aspartate aminotransfer-ase (AST) level, and higher creatinine level at admission, hematologic dysfunction, and renal dysfunction during ICU stay were all associated with fatal outcome. Mortality was lower than observed in other series of critically ill patients, although comparisons are limited by different ICU admission criteria, management practices, and duration of follow-up. Conclusions: This study provides data regard-ing the characteristics and outcomes of COVID-19 critically ill patients that can be used to op-timize ICU preparedness in the future. © 2021, The Indonesian Foundation of Critical Care Medicine. All rights reserved.

Brazilian scenarios for smart cities deployment from public policies perspectives

Although Information and Communication Technology-ICT solutions have been used for a long time in various sectors of the economy, recent developments in Communications, IoT, Data Science and Artificial Intelligence have brought very attractive possibilities for their wider adoption, especially with regard to cities and its citizens.In this article, some aspects of the international and the Brazilian technical regulations are addressed, with special attention to issues of interest to cities. The General Data Protection Law of Brazil is highlighted.Some specific projects and initiatives related to smart cities are also presented and commented on, such as the National IoT Plan and its consequences, besides other initiatives to address smart cities.Additionally, some aspects of present days combat actions in the Covid-19 pandemic and its relationships with public policies applied to cities are highlighted.Finally, considerations about the need for effective and efficient public policies to reinforce the resilience of cities, including tackling biological hazards, are addressed. © 2020 IEEE.

Best practices in newborn care in COVID-19 times: An integrative review

Objective: to identify scientific evidence on best practices in newborn care, from the delivery room to the home, in COVID-19 times. Method: an integrative review conducted in April 2020 at National Library of Medicine National Institutes of Health (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus, through combinations between the controlled terms “newborn”, “coronavirus infections”, and “COVID-19”. Results: nineteen studies made up the final sample, from which five analytical categories emerged on best practices in newborn care: Pregnant women and puerperal women suspected of having COVID-19;Pregnant and puerperal women with confirmation for COVID-19;Newborns suspected of having COVID-19;Newborns with confirmation for COVID-19;and Horizontal transmission prevention of COVID-19 to newborns. Conclusion: several recommendations were divergent, due to the contemporary pandemic of COVID-19. Therefore, the role of nurses is essential for adherence to best practices, which are proven and recommended nationally and internationally, taking into account the local reality and the constant updating of the theme. Therefore, further research is needed, especially with a strong level of evidence, for formulation of assistance guidelines for this population group that contribute to reducing neonatal morbidity and mortality and healthy and harmonious child development during and post-pandemic. © 2020, Universidade Federal de Santa Catarina. All rights reserved.

ADVERSITIES EXPERIENCED BY NURSING PROFESSIONALS IN INTENSIVE CARE UNITS IN TIMES OF COVID-19

Objective: to describe adversities experienced by nursing professionals in intensive care units in times of COVID-19. Method: descriptive and exploratory research, with a qualitative approach, involving 28 nursing professionals from intensive care units in the state of Rio de Janeiro in April 2020. Data processed in the Interface de R pour Analyses Multidimensionnelles de Textes et de Questionnaires. Results: by the Descending Hierarchical Classification, three classes were obtained: fear of the unknown and lack of personal protective equipment and support to nursing professionals;lack of flows, protocols, information, materials and training of teams to promote safe assistance;and stress in caring for patients with positive COVID-19, risk of contamination and death and constant need for guidance on preventive measures. Final considerations: such adversities influenced the care practice and psychoemotional health of nursing professionals, and public policies and management and care strategies were needed to minimize them. © 2022 Universidade Federal da Bahia. All rights reserved.