SAFETY INCIDENTS CLASSIFIED AS CLINICAL PROCESS/ PROCEDURE IN HOSPITALIZED PATIENTS DURING THE COVID-19 PANDEMIC

Objective: Compare reported patient safety incidents related to a clinical process/ procedure among patients with laboratory-confirmed COVID-19 diagnosis and with Severe Acute Respiratory Syndrome (SARS) caused by another infectious or undetermined agent and the other patients. Results and discussion: retrospective, documentary study approved by the ethics committee in a public teaching hospital in southern Brazil. In the study, 2,191 notifications and records of COVID-19 between March and September 2020 were used. The data were submitted to descriptive analysis with frequencies of the variables in the data set, Fisher's test to determine the associations between outcomes (classification/process/ problem) and calculation of relative risk to measure its strength. The incidence of pressure ulcers was almost 3.7 times higher in patients with SARS. In the others, various tube-related incidents and events associated to the surgical process predominated. Conclusion: Intensive nursing care for patients with SARS, risk management and strengthening of good practices for the safety of all patients were relevant. © 2023, Universidade Federal do Parana. All rights reserved.

Reducing the risk of indoor transmission of SARS-CoV-2 using UV-C disinfection

In this work, SARS-CoV-2 infectivity after UV-C exposure of porous and non-porous surfaces was assessed under controlled environment conditions. The irradiance of a setup of UV-C lamps, placed indoors was studied in detail as a function of the geometry and the distance to the surface. In the presence of living beings, the external UV-C lamps are turned off, and the UV-C lamps mounted inside the disinfection chamber are kept active, allowing a continuous air disinfection and a decreased risk of indoor transmission. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.

Portuguese Language Teaching: (Re)Invention of Pedagogical Practice in the Whatsapp App

The research aimed to analyze the curricular practices of literacy in Portuguese language classes adapted for Emergency Remote Teaching (ERT) due to the Covid-19 pandemic scenario. It was guided by the questioning: what are the didactic strategies used by a literacy teacher in the Portuguese language teaching-learning processes during the ERT? It was a case study qualitative research. The research locus was a public school in the municipal network of Maceio-Alagoas whose classes were taking place remotely. For the collection of empirical data, the curricular practices developed in a class of the 2nd year of elementary school were observed. The results showed that the literacy teacher used the WhatsApp application as a "virtual classroom," resorted to the Portuguese language textbook and carried out other complementary parallel activities. Regarding the (re)invention of practices, the teacher produced video classes, explanatory audios, sent texts, digitalized activity proposals and photographs, with the pedagogical intention of mediating children's learning.

Fc RECEPTOR-MEDIATED INFECTION OF MYELOID CELLS BY SARS-CoV-2

Background: The role of myeloid cells in the pathogenesis of SARS-CoV-2 is well established, in particular as drivers of cytokine production and systemic inflammation characteristic of severe COVID-19. However, the potential for myeloid cells to act as bona fide targets of productive SARS-CoV-2 infection remains unclear. Method(s): Using anti-SARS-CoV-2 mAbs with a range of neutralisation potencies and binding specificities, we performed a detailed assessment of mAb-mediated infection of monocytes/macrophages. THP-1 cells were used as a model system, with results confirmed in primary macrophages. Result(s): Infection of THP-1 cells was seen via mAbs targeting the spike RBD, but not with those targeting the NTD or S2 subunit. mAbs with the most consistent potential to mediate infection targeted a conserved region of the RBD (group 1/class IV). No infection was seen with the same quantity of virus but in the absence of antibody, and pre-treating the cells with FcgammaRI and -II blocking antibodies inhibited infection. Thus, antibody-FcR interactions are able to expand the tropism of SARS-CoV-2. Time-course studies demonstrated high-level and productive infection. Studies performed in human iPSC-derived macrophages and primary monocyte-derived macrophages paralleled results seen in THP-1 cells but with lower infection levels. Up to 2% of macrophages were infected, with infected cells appearing multinucleated and syncytial. Addition of ruxolitinib, an inhibitor of JAK1/2 signalling, increased infection up to 10-fold, indicating limitation of infection through innate immune mechanisms. Sera from primary infections (n=80) mediated rare infection events, with a minority of samples (n=3) promoting significant infection. Competition assays confirmed results seen in sera, with the addition of neutralising mAbs diminishing the infection seen with infection-mediating mAbs. Thus, the presence of antibodies with potential to mediate infection is not sufficient to predict myeloid cell infection, rather, the context in which the antibodies are produced is key. Conclusion(s): We hypothesise that a nascent antibody response during peak viral replication in primary infection presents a window of opportunity for myeloid cells to become infected, while establishment of a robust polyclonal response via vaccination or prior infection reduces the likelihood of this occurring. Infection via antibody-FcR interactions could contribute to pathogenesis in primary infection, systemic virus spread or persistent infection.

Aligning the Goals Hybrid Model for the Diagnosis of Mental Health Quality

The social distancing imposed by the COVID-19 pandemic has been described as the "greatest psychological experiment in the world”. It has tested the human capacity to extract meaning from suffering and challenged individuals and society in Brazil and abroad to promote cohesion that cushions the impact of borderline experiences on mental life. In this context, a survey was conducted with teachers, administrative technicians, and outsourced employees at the Federal Institute of Piauí (IFPI). This educational institution offers professional and technological education in Piauí, Brazil. This study proposes a system for the early diagnosis of health quality during social distancing in the years 2020 and 2021, over the COVID-19 pandemic, combining multi-criteria decision support methodology, the Analytic Hierarchy Process (AHP) with machine learning algorithms (Random Forest, logistic regression, and Naïve Bayes). The hybrid approach of the machine learning algorithm with the AHP multi-criteria decision method with geometric mean accurately obtained a classification that stood out the most in the characteristics' performance concerning emotions and feelings. In 2020, the situation was reported as the SAME AS BEFORE, in which the hybrid AHP with Geographical Average with the machine learning Random Forest algorithm stands out, highlighting the atypical situation in the quality of life of the interviewees and the timely manner in which they realized that their mental health remained unchanged. After that, in 2021, the situation was reported as WORSE THAN BEFORE, in which the hybrid AHP with geometric mean with the machine learning Random Forest algorithm provided an absolute result. © 2023 by the authors.

Influenza vaccination strategy in acute coronary syndromes: the VIP-ACS trial.

AIMS: To evaluate whether a strategy of double-dose influenza vaccination during hospitalization for an acute coronary syndrome (ACS) compared with standard-dose outpatient vaccination (as recommended by current guidelines) would further reduce the risk of major cardiopulmonary events. METHODS AND RESULTS: Vaccination against Influenza to Prevent cardiovascular events after Acute Coronary Syndromes (VIP-ACS) was a pragmatic, randomized, multicentre, active-comparator, open-label trial with blinded outcome adjudication comparing two strategies of influenza vaccination following an ACS: double-dose quadrivalent inactivated vaccine before hospital discharge vs. standard-dose quadrivalent inactivated vaccine administered in the outpatient setting 30 days after randomization. The primary outcome was a hierarchical composite of all-cause death, myocardial infarction, stroke, unstable angina, hospitalization for heart failure, urgent coronary revascularization, and hospitalization for respiratory causes, analysed by the win ratio method. Patients were followed for 12 months. During two influenza seasons, 1801 participants were included at 25 centres in Brazil. The primary outcome was not different between groups, with 12.7% wins in-hospital double-dose vaccine group and 12.3% wins in the standard-dose vaccine group {win ratio: 1.02 [95% confidence interval (CI): 0.79-1.32], P = 0.84}. Results were consistent for the key secondary outcome, a hierarchical composite of cardiovascular death, myocardial infarction and stroke [win ratio: 0.94 (95% CI: 0.66-1.33), P = 0.72]. Time-to-first event analysis for the primary outcome showed results similar to those of the main analysis [hazard ratio 0.97 (95% CI: 0.75-1.24), P = 0.79]. Adverse events were infrequent and did not differ between groups. CONCLUSION: Among patients hospitalized with an ACS, double-dose influenza vaccination before discharge did not reduce cardiopulmonary outcomes compared with standard-dose vaccination in the outpatient setting. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov number: NCT04001504.

Impact of COVID19 on work return after 6 months of hospitalization

Post-COVID syndrome has directly affected quality of life, reduced individual health status and it also could bring slow return to work and to routine activities of daily life. Objective(s): The aim of this study was to assess the impact of moderate to severe COVID-19 infection on work return, physical activity, and persistent symptoms 6 months after hospitalization. Method(s): We included 94 patients referred to the post-COVID outpatient clinic, who were hospitalized by COVID-19 with pulmonary involvement and requirement of O2 supplementation. A survey was applied by telephone after 6 months of hospitalization. Result(s): The mean age was 52+/-13yrs and 63% was male. 48% were admitted in the ICU. Among the patients who answered the survey (n=70), 54 patients (77%) reported post-discharge physical activity and 54.2% maintained a training frequency of 2 to 3 times or more per week. Except one, all patients that became asymptomatic performed exercises after discharge (n = 18/19). Regarding job, 62 patients worked before COVID-19 infection and all of them returned to their activities. Although back to work, 64.2% reported low energy or fatigue throughout the workday after 6 months. It was also reported a persistence of other symptoms by 73% of patients, mainly: memory loss (41%), myalgia (40%), fatigue (37%) and dyspnea (24%). Conclusion(s): After COVID19 hospitalization, patients managed to get back to work but two-thirds of them with impairments related particularly to low energy or fatigue during the day. Perform regular exercises could improve symptoms and help to decrease the impact of COVID19 in work activities.

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.

Marcadores De Endoteliopatias Continuamente Elevados Apos a Alta Hospitalar Por Covid-19 Relacionados Ao Tempo De Internacao Dos Pacientes

Objetivo: Avaliar se os marcadores de endoteliopatias continuamente elevados apos a alta hospitalar por COVID-19 possui correlacao com o tempo de internacao dos pacientes. Materiais e Metodos: Foram recrutados 97 pessoas sobreviventes de COVID-19 com a infeccao confirmada pelo ensaio de RT-PCR (PCR real time) de 18 a 65 anos internadas na unidade de terapia intensiva de dois grandes hospitais de referencia regionais. Os voluntarios dos tres grupos estavam curados ha pelo menos 30 dias da convocacao. Todos assinaram o Termo de Consentimento Livre Esclarecido (TCLE) e a pesquisa foi aprovada pelo Comite de Etica da Universidade Federal do Espirito Santo, sob numero CAAE 37094020.6.0000.5060. A infeccao pelo SARS-CoV-2 precedeu a vacinacao completa dos pacientes estudados (considerando 2 doses minimas). Os participantes responderam um formulario no RedCap e os dados relacionados a internacao foram adquiridos junto aos hospitais. Foram analisados dois marcadores que podem indicar a endoteliopatia: Fator de von Willebrand Antigeno (FvW:Ag) e D-dimero (DD). O teste de multipla regressao linear foi usado para estabelecer a diferenca entre o tempo de internacao e os parametros avaliados e foi considerado significativa p < 0,05. Resultados: Pacientes com o FvW:Ag e FVIII >150% apos a alta tiveram a media do tempo de internacao de 12 dias e mediana de 10 dias, em contrapartida, pacientes com niveis normais de FvW:Ag e FVIII internaram em media 10 dias e a mediana foi de 8 dias, p=0,0536 e p=0,1539 respectivamente. Os pacientes com o DD >500 mg/dL apos a alta tiveram a media do tempo de Internacao de 11,6 dias e mediana de 10 dias, os pacientes com niveis normais de DD internaram em media 10,75 dias e a mediana 8 dias, p < 0,0001. Discussao: Os marcadores de endoteliopatias FvW:Ag, FVIII e DD demonstraram em um estudo anterior desse mesmo grupo de pesquisa diferenca significativa quando comparados ao grupo controle de participantes que tambem tiveram COVID-19 a nivel ambulatorial (p < 0,05), indicando que esses marcadores permanecem alterados significantemente em pacientes que internaram na UTI apos a alta hospitalar. Varios estudos apontaram os marcadores avaliados nesse trabalho como possivelmente alterados na fase aguda da COVID-19, predizendo a forma grave da doenca. Nao foi estabelecido apos uma analise multivariada uma correlacao entre o FvW:Ag e FVIII continuamente alterados apos a alta hospitalar e o tempo em que os pacientes ficaram internados. Entretanto, o DD alterado apos a alta demonstrou correlacao positiva com o aumento do tempo de internacao dos pacientes, corroborando com outros estudos. Conclusao: A endoteliopatia por infeccao endotelial direta com SARS-CoV-2 e os danos indiretos causados pela inflamacao desempenham o papel predominante no desenvolvimento e agravamento da COVID-19. As consequencias do desbalanceamento do sistema pro e anti trombotico estao relacionados com o tempo de internacao dos pacientes. A COVID-19 longa, na fase pos-aguda, e uma sindrome caracterizada pela persistencia dos sintomas clinicos alem de quatro semanas do inicio dos sintomas agudos e pode estar associada a resquicios da endoteliopatia causada pela infeccao. Copyright © 2022

Marcadores Inflamatorios Endoteliais E Plasmaticos Apos a Alta Hospitalar Por Covid-19

Objetivo: Avaliar os niveis de marcadores inflamatorios endoteliais e plasmaticos em pacientes apos a alta da internacao por COVID-19. Materiais e Metodos: Foram recrutados 226 pessoas diagnosticadas com a COVID-19 confirmadas pelo ensaio de RT-PCR (PCR real time) de 18 a 65 anos, divididos em tres grupos: controle ambulatorial (Grupo A, n=82), enfermaria (Grupo B, n=47) e UTI (Grupo C, n=97). Os voluntarios dos tres grupos estavam curados ha pelo menos 30 dias da convocacao. Todos assinaram o Termo de Consentimento Livre Esclarecido (TCLE) e a pesquisa foi aprovada pelo Comite de Etica da Universidade Federal do Espirito Santo, sob numero CAAE 37094020.6.0000.5060. A infeccao pelo SARS-CoV-2 precedeu a vacinacao completa dos pacientes estudados (considerando 2 doses minimas). Foram dosados os seguintes marcadores: Fator de von Willebrand Ag (FvWAg), D-dimero (DD), Fator VIII (FVIII), Fibrinogenio (FIB), Hemoglobina glicada (HbA1c), Interleucina-6 (IL-6) e Fator de Necrose Tumoral alfa (TNF-alpha). O teste de multiplas comparacoes Dunn's foi usado para estabelecer a diferenca entre os grupos e foi considerado significativa p<0,05. Resultados: FVIII: Grupo A (Amb) vs. Grupo B (Enf) = p>0,9999 e Grupo A vs. Grupo C (UTI), p=0,0789. FvWAg: Grupo A vs. Grupo B, p=0,8277 e Grupo A vs. Grupo C, p=0,0361. DD: Grupo A vs. Grupo B, p=0,2090 e Grupo A vs. Grupo C, p=0,0010. HbA1c: Grupo A vs. Grupo B, p=0,2680 e Grupo A vs. Grupo C, p<0,0001. FIB: Grupo A vs. Grupo B, p>0,9999 e Grupo A vs. Grupo C, p=0,3363. IL-6: Grupo A vs. Grupo B, p>0,9999 e Grupo A vs. Grupo C, p>0,9999. TNF-alpha: Grupo A vs. Grupo B, p>0,9999 e Grupo A vs. Grupo C, p=0,4149. Discussao: Os Grupos A e B nao obtiveram diferenca significante (p<0,05) nos parametros avaliados. Os pacientes do Grupo C quando comparados ao Grupo A demonstraram uma diferenca significativa apenas nas dosagens de FvWAg, HbA1c e DD. Varios estudos apontaram os marcadores avaliados nesse trabalho como possivelmente alterados na fase aguda da COVID-19, predizendo a forma grave da doenca. Niveis sericos de IL-6 e TNF-alpha apos a alta nao divergiram entre os grupos estudados, indicando nesse trabalho que os niveis pre ou pos COVID-19 desse marcador nao estao relacionados com a resposta adversa obtida no Grupo C. Uma correlacao positiva entre o FvWAg e o DD favorece um mau prognostico, e isso sustenta o desequilibrio entre os processos pro e anticoagulantes diretamente relacionados a disfuncao endotelial em pacientes com COVID-19 que foram internados na UTI. A transformacao da inflamacao em fibrose tecidual, remodelacao vascular envolvida em hipoxia, dano de celulas endoteliais vasculares, estado de hipercoagulabilidade, e mudancas continuas nos marcadores plasmaticos contribuem para a lesao pulmonar pos-alta. Conclusao: Alteracoes vasculares sao preditivos relevantes para a mortalidade hospitalar. O retorno a normalidade dos marcadores depois de no minimo 30 dias apos a infeccao e um bom prognostico para eventos similares futuros. A permanencia das alteracoes apos a alta hospitalar do grupo C (UTI) pode indicar alteracoes pre-existentes nesse grupo (como Doencas cardiovasculares e pulmonares), aumento na quantidade de sequelas pos infeccao pelo SARS-CoV-2, bem como predisposicao a novos agravamentos considerando o estado continuo de lesao vascular. Copyright © 2022

Influenza and schizophrenia: Howcan we shed a light in the new virus from an old association?

Introduction: COVID-19 raises serious concerns regarding its unknown consequences for health, including psychiatric long term outcomes. Historically, influenza virus has been responsible for pandemics associated with schizophrenia. Epidemiological studies showed increased risk for schizophrenia in children of mothers exposed to the 1957 influenza A2 pandemic. Controversy remains concerning the mechanisms of pathogenesis underlying this risk. Objective(s): We aim to review the evidence for the association between influenza infection and schizophrenia risk, the possible pathogenic mechanisms underlying and correlate these findings with the schizophrenia hypothesis of neurodevelopment. Method(s): We reviewed literature regarding evidence from epidemiological, translational animal models and serological studies using medline database. Result(s): The biological mechanisms likely to be relevant account to the effects of infection-induced maternal immune activation, microglial activation, infection-induced neuronal autoimmunity, molecular mimicry of the influenza virus, neuronal surface autoantibodies and psychosis with potential infectious antecedents. Influenza infection may fit into the theory of the neurodevelopment of schizophrenia as a factor that alters the normal maturation processes of the brain (possible second or third hit). Conclusion(s): Influenza infection has multiple pathogenic pathways in both pre and post natal processes that might increase the risk of schizophrenia or psychosis. The existing evidence regarding the relationship between influenza virus and psychosis might help us draw similar long-term concerns of COVID-19.

COVID-19 Outcomes in Kidney Transplant During in the Period of Omicron Predominance

Background: In 2022' first trimester the Omicron SARS-COV-2 variant (OV) was the most prevalent in Portugal. OV is associated to greater transmissibility and less severe disease in immunocompetent patients but less is known about the clinical characteristics of the OV in immunosuppressed patients, namely in kidney transplant recipients (KTR). The authors aim to characterize and compare the clinical characteristics of KTR infected during SARSCOV2 Omicron and Delta wave. Method(s): Single center retrospective cohort study of KTR (n=675) to analyze the clinical outcomes of SARS-COV-2 infection throughout the epidemic waves: June-November 2021 -Delta predominant wave (DPW);January-March 2022 -Omicron predominant Wave (OPW). Data were collected from electronic clinical records. Continuous variables were compared using t student tests and categorical variables with Chi-square tests. Result(s): SARSCOV2 infection incidence in the KTR was significantly higher during the OPW than during the DPW (DPW 10.7% vs OPW 3.7%, p<0.001). Most patients had booster of SARSCOV2 vaccine at the time of the diagnosis of SARSCOV-2 infection (DPW 88.8% vs OPW 91.6%, pns). Patients infected during OPW had lower hospitalization rates (OPW 20.8% vs DPW 44.0%, p0,024), less need for invasive ventilation (OPW 4,1% vs DPW 24% p0.003), lower rates of admission to Intensive Care Unit (ICU) (OPW 4.1% vs DPW 24% p0.003) and lower mortality rates (OPW 5,6% vs DPW 24,0%, p0,009). In hospitalized patients, respiratory failure rates were similar between both waves (OPW 81.9% vs DPW 81.8%, pns) and there was similar percentage of lung parenchyma involvement as determined by computed tomography scan (parenchymal involvement> 50%: OPW 53.4% vs DPW 63.5%, pNS). Although not statistically different, there was a higher prevalence of acute kidney graft injury at hospital admission during the OPW (OPW 53.3% vs DPW 18.2%, pns). Conclusion(s): OV was associated to higher infection rates but less severe respiratory disease, lower admission to the ICU and lower mortality rates than Delta SARSCOV2 in KTR. Nonetheless severe pulmonary involvement occurred in a few cases and mortality seems to be higher than in the general population. Thus, preventive strategies of OV infection in KTR should go beyond vaccination.

Both sides of the Atlantic: the impact of the pandemic on Real Estate Tourist Enterprises in Brazil and on Tourist Complexes (Resorts) in Portugal

This article aims to present a study of Real Estate Tourist Enterprises (ETIs) behavior in Brazil and their equivalents in Portugal, the Tourist Enterprises Resorts (CTR) face to the Covid-19 pandemic. The methodology used involved, in addition to the bibliographic review, a primary survey of ETIs in Brazilian case, consultation and georeferencing of the National Register of Tourist Enterprises (RNET), and information contained in the Geographic Information System of Tourism (SIGTUR), in Portuguese case. The conclusion in Portugal is that Covid-19 pandemic meant an opportunity for residential tourism and for these tourist developments, which registered a very significant increasing amount commercialization of residences integrated in tourist complexes, with a price increasing. In Brazilian case, the ETIs suffered from the impact of the pandemic, resulting in closed hotel units and exchange of flags, which signals a possible product retraction.

Sleeping well project: dissemination of information on sleep health in the COVID 19 pandemic course

Introduction: With the confrontation of the COVID-19 pandemic, there was a drastic change in the daily life routines, with reflexes on the general health and impacts on the sleep quality of many Brazilians. This fact leads to a glimpse of the potential existing in virtual actions with a wide population reach, focused on health promotion and disease prevention as an alternative to minimize damage to quality of life. Objective: To disseminate safe information in a virtual environment to the general population in a simple and illustrative way about sleep health. Methods: The university extension project has been underway since October 2020 and has the participation of 10 undergraduate students from the Speech Therapy course and two advisor professors. The first stage of the project was aimed at training and updating the team, by remote means, on issues involving sleep health;in the second stage, there was the creation of a public profile on the social network and the elaboration/confection/publication of illustrative informative materials and with simple and comprehensive language (videos, posters, comics, leaflets, technical sheets and the like);the third stage featured/relies on live virtual actions focused on health promotion and prevention through lives, seminars and open classes conducted by professionals from different health areas and sleep specialists. Results: Between October 2020 and August 2021 the digital profile published 39 posts, IGTV or Reels with informative content about sleep, in addition to more than 200 stories. More than 3000 “likes or likes” were registered in the publications, 3,507 views on IGTV, 347 comments, 381 shares (of which 150 were saved by followers or visitors), 8,280 visits to the profile and 18,524 people/accounts were reached for a virtual audience of 1,731 people/following accounts located in Sergipe, São Paulo, Pernambuco and Bahia, in addition to a small percentage of Spanish, Portuguese, Colombian and German followers. It is also important to highlight that the project awakens in the students the relevance of disseminating information based on reliable sources. Conclusion: Through the execution of the project, important and safe information can be disseminated in a virtual environment to clarify, inform and popularize science with knowledge about sleep health and the prevention of its disorders to an expressive public.

Assessing Priorities of Transparency During COVID-19 Pandemic in Brazil Special Issue on Corruption, Lack of Transparency and the Misuse of Public Funds in Times of Crisis

This article assesses the level of transparency of epidemiological and financial budgetary information on the COVID-19 pandemic in Brazilian state governments and the Federal District. State government web portals were assessed. A methodological instrument was developed to categorize and collect the data. We also assessed whether socioeconomic and epidemiological variables can explain state government transparency indices on pandemic information. According to our results, half of Brazilian states have advanced transparency, half have moderate transparency, and one has opaque transparency. HDI and monthly income are variables that better explain the level of transparency.

DA SOLIDÃO À COLABORAÇÃO: UMA METODOLOGIA PARA ORIENTAÇÃO DE TRABALHO DE CONCLUSÃO DE CURSO EM TEMPOS DE PANDEMIA

The study aimed to design, implement, and evaluate the application of seminars as a tool to mitigate the difficulties presented by students in the process of guidance and preparation of the Course Conclusion Works (CCW's). Data collection was carried out by observing the students' behavior during the seminars and by questionnaires. The seminars contributed to increase dialogue, collaboration, motivation, provided opportunities for self-assessment and contributed to lessen students' perception of difficulties. Completion of Course Work, Remote guidance, Administration, Professional and Technological Education. 1 INTRODUÇÃO Os trabalhos de conclusão de curso são mecanismos avaliativos importantes na etapa final da vida acadêmica de alunos dos cursos de graduação.

Human immunodeficiency virus pre-exposure prophylaxis: analysis, follow-up and pandemic effect

Background and importanceIn 2019, the National Health System (NHS) approved funding for the indication of pre-exposure prophylaxis (PreP) as an strategy to prevent human immunodeficiency virus (HIV) infection in high-risk populations. The hospital pharmacy (HP), together with the Sexually Transmitted Infection (STI) centre, has created an interdisciplinary circuit where these individuals are closely monitored.Aim and objectivesTo characterise the user population of the HIV PrEP programme and assess the adequacy of the circuit, as well as the impact of the SARS-CoV-2 pandemic.Material and methodsRetrospective observational study of the PrEP programme from November 2019 to April 2021 carried out in the provincial STI treatment centre and the HP.The following were assessed: compliance with inclusion criteria, adherence to treatment and causes of discontinuation, toxicity, acquisition of STIs and interactions. Also variations during confinement and degree of involvement by COVID.Results169 males, aged 39.6±10.0 (range 19–64) years, all met at least one inclusion criterion in the last year: 75.7% (n=128) men who have sex with men (MSM) with more than 10 different sexual partners, 71.6% (n=121) MSM anal sex without condoms, 17.1% (n=29) MSM drug use, 10.7% (n=18) MSM with multiple PreP, 74.0% (n=125) MSM with at least one STI and one engaged in prostitution.30 clients discontinued medication: 33.3% (n=10) stopped risky practices, 20.0% (n=6) digestive toxicity (main adverse effect), 3.3% (n=1) poor adherence, 16.7% (n=5) client choice and 26.7% (n=8) drop out of follow-up. Mean adherence was 94.5±11.4.No patients acquired HIV during treatment, but other STIs were found (several users reported reduced of condom use): 36.7% (n=11) Treponema pallidum, 56.7% (n=17) Chlamydia trachomatis, 63.3% (n=19) Neisseria gonorrhoeae and 36.7% (n=11) Mycoplasma genitalum.This was a young population that does a lot of physical exercise and after the clinical interview it was discovered they were abusing protein shakes and anabolic steroids, therefore they were warned about it.During the confinement, 41 users were in treatment. Of the 37 who continued, 4 suffered from COVID.Conclusion and relevanceThe programme meets the requirements of the NHS, with high adherence to treatment and a good safety profile.Patients continued with PreP during confinement and there was a significant number affected by COVID.Clinical pharmaceutical follow-up has allowed preventive and corrective interventions, but more emphasis should be placed on the use of condoms and avoiding anabolic steroids given the possible renal repercussions.References and/or acknowledgementsConflict of interestNo conflict of interest

CLINICAL AND RADIOLOGICAL FINDINGS IN PEDIATRIC PATIENTS WITH ACUTE LEUKEMIA DURING COVID-19 INFECTION - WHAT HAVE WE LEARNED?

Introduction: While Covid-19 pandemic spreads around the world, there has been described different evolution in individuals according to risk groups. The onset of the disease, which is mainly associated with respiratory distress, has its classic imaging presentation as ground-glass opacities in computer tomography (CT), although there are plenty of other possible findings. In pediatrics, the infection has its own particularities, rarely presenting severe course. Since April 2020, even if uncommon and less prevalent than in adults, cases with worse outcome started being described, mainly associated with multisystem inflammatory syndrome. Oncologic patients have higher mortality rates, and in the hematologic malignancies, this risk factor is even more evident, where severe lymphopenia is frequent. Proportionally, there is still small data about pediatric leukemia patients during Covid-19 disease, as there is also lack of imaging descriptions. Objectives: Evaluation of pediatric patients under leukemia treatment that had Sars Cov 2 infection, correlating clinical and radiologic presentations. Material and methods: Data was collected from patients in the institution. Leukemia patients with molecular confirmation of Covid-19 were considered. Patients that didn't have confirmation of infection on RT-PCR test were excluded from analysis. Results: During the period from March 2020 to May 2021, there were 11 subjects with leukemia that had Sars Cov 2 proved infection. They were from 3 to 17 years old at Covid-19 diagnosis. From those, 6 had B ALL, 1 T ALL and 4 AML. 1 AML patient had previous allogeneic stem cell transplant. 6 patients had lymphocytes count < 550/mL. 6 patients underwent CT (5 with lymphopenia), and all presented radiologic signs. The main presentation was ground-glass opacity (GGO), present on all the 6 CTs. GGO was bilateral in 4 patients. The other findings were nodule (1), consolidation (1), interlobular septal thickening (1). The patient that presented consolidation had it localized, unilateral and perihilar. Regarding clinical evolution, 5 patients were classified as critical and transferred to ICU;all had a CT with GGO. 3 of them needed respiratory support and 1 needed only supplementary oxygen. This one had an atypical presentation, firstly suspected of transfusion-related acute lung injury, supported by clinical history. 2 patients had septic shock, renal failure and myocarditis combined. There was 1 decease (mortality 9% in the group), in a patient with severe respiratory presentation, associated with pulmonary Graft-versus-host disease. Discussion: This study showed that the main imaging finding in the group was GGO, which was present in all patients that had a CT performed. All the subjects that needed intensive care had imaging proof of pulmonary involvement, even if the complications were also due to multisystemic inflammation. CT has been described with a high sensitivity for symptomatic Covid-19, and when it is very typical, can be diagnostic also if a negative RT-PCR. Patients undergoing leukemia treatment are immunocompromised and have low anti-viral defense, which could lead to higher risk of worse onset. The exam was not done for all patients in this study, the choice for indicating CT was based on clinic presentation and laboratory, which could bring a bias on positivity for GGO. Conclusion: GGO is the main finding in CT scan in Covid-19, which was also found in this pediatric leukemia group.

FROM THE RIGHT TO EDUCATION TO THE RIGHT TO PLAY: reflections on public policies for early childhood education

This work is a qualitative biographical research, which aims to reflect the right to education and play of children who are the target audience of Early Childhood Education (El), for this, we resorted to the main educational public policies aimed at implementation of these rights, from which, we highlight the Common National Curriculum Base - BNCC (2017), the National Curriculum Reference for Early Childhood Education - RCNEI (1998), the Child and Adolescent Statute - ECA (1990), the Laws of Guidelines of Bases of National Education - LDB (1961;1971;1996), among other documents, we also rely on the studies of theorists such as Aries (1978), Saviane (2008;2018), Kunz (2015), among other authors. In this work, it is possible to perceive the gradual historical evolution of the conception of the child, currently recognized as a subject of rights, including the right to education and play in El institutions. We also emphasize our considerations about the defense of the child's right to education and to play, even in times of the Covid-19 pandemic and the absence of public policies in this adverse context.

CRIPTOCOCOSE CUTÂNEA SEM ACOMETIMENTO ENCEFÁLICO EM PACIENTE COM SIDA

A criptococose é uma doença fúngica e oportunista, causada pelo fungo da classe Blastomycetes, da família Cryptococcaceae e apresenta duas espécies patogênicas: C. neoformans e C. gattii. A infecção pode ser adquirida por quaisquer indivíduos saudáveis ou não, mas, as pessoas mais suscetíveis são os portadores de SIDA. A infecção no homem acontece por via respiratória;a levedura atinge os pulmões e, dependendo do estado imunológico do paciente, dissemina-se através por vias hematogênica ou linfática, para o sistema nervoso central, globo ocular e tecido cutâneo. O exame direto com coloração de tinta de nanquim é de fácil execução, rápido e barato permitindo a visualização das estruturas características do Cryptococcus spp, porém, o padrão-ouro para o diagnóstico é a associação do exame histopatológico com a cultura. Anfotericina B, é um medicamento fungicida que em associação a 5-flucitosina, constitui primeira opção de tratamento. Descrição do caso: Paciente feminina, 36 anos, venezuelana, com diagnostico de infecção pelo HIV há aproximadamente 2 anos, porém sem tratamento antirretroviral regular. Foi admitida em agosto de 2021 no Hospital de referência de Roraima por alteração neurológica (afasia, hemiparesia direita e alteração da marcha) com achados sugestivos de leucoencefalopatia multifocal progressiva (LEMP) na ressonância magnética do encéfalo;foi diagnosticada também com COVID-19. Durante a internação, evoluiu com surgimento de lesões elevadas, circunscritas, hipercrômicas em face, pescoço, tronco e membros superiores e lesão ulcerada de bordas elevadas de aproximadamente 5 cm na face medial do tornozelo esquerdo. Realizada biópsia das lesões que demonstraram infiltrado inflamatório linfohistiocitário, com esporos fúngicos de variados tamanhos, com cápsula espessa que se coram pela coloração HE e mais nitidamente pelo Grocott sugestivo de infecção por Cryptococcus neoformans. Análise de líquor realizado em 2 oportunidades teve exames diretos e culturas negativas para estruturas fúngicas;não foi possível realizar teste de aglutinação em Latex para Cryptococcus. Fez uso de Anfotericina B lipossomal e Fluconazol por 2 semanas, evoluindo com boa resposta cutânea, porém sem melhora do quadro neurológico. Comentário: A criptococose cutânea localizada uma condição na qual as lesões estão confinadas à pele, não disseminadas sistemicamente e ao mesmo tempo, não estão associadas a fungemia.