Incisional Hernia with Loss of Domain as a Consequence of Botulinum Toxin a and the Covid-19 Pandemic

Introduction: Abdominal wall surgery has been one of the major victims of the COVID-19 pandemic, with a large number of patients who have seen their surgery delayed and many are still waiting to be operated on today. On the other hand, botulinum toxin is one of the main protagonists in optimizing abdominal wall surgery, especially important in complex hernia, but we must not forget that it can have adverse effects. Case report: We present the case of a 54-year-old man with a history of obesity, diabetes, hypertension, chronic renal failure and kidney transplant in 2000, who presented a midline incisional hernia as a result of an epigastric hernia operated on in 2006 and subsequently two onlay permanent synthetic mesh in 2010 and 2015. In February 2020 he presented an incisional hernia M2-4W3R3 with a volume of 35%, botox was infiltrated as optimization for surgery and while awaiting placement of a pneumoperitoneum catheter, the surgery was suspended due to the COVID-19 situation. He returns to our clinics in 2022 with a growth of the hernia and a volume of 95%. Weight loss, botulinum toxin and preoperative pneumoperitoneum were indicated. We performed a reconstruction of the abdominal wall with bilateral transversus abdominal release and preperitoneal 45x60cm polyvinylidene fluoride mesh and abdominoplasty. Discussion(s): Botulinum toxin can facilitate abdominal surgery, especially in complex hernias, but we must not forget that blocking the abdominal muscles can have adverse effects. The COVID-19 pandemic has been especially hard on surgical waiting lists, delaying surgeries and aggravating pathologies.

Effect of Early Treatment with Pegylated Interferon Lambda for Covid-19

Background: We assessed the efficacy of a single dose of peginterferon lambda in preventing clinical events among acutely symptomatic COVID-19 outpatients. Method(s): We conducted a placebo-controlled, randomized, adaptive platform trial among predominantly vaccinated SARS-CoV-2-positive adults in Brazil and Canada receiving either one subcutaneous injection of peginterferon lambda or placebo. The primary composite endpoint was medical admission to hospital, defined as either observation in a COVID-19 emergency setting for > 6 hours, or transfer to a tertiary hospital due to symptomatic COVID-19 within 28 days post-randomization. Result(s): For this evaluation, 931 patients received peginterferon lambda and 1018 received placebo. 84% of the population were vaccinated and the trial occurred across multiple COVID-19 variants. In the primary analysis of patients, the primary outcome was reduced by 51% in the peginterferon lambda vs. placebo groups (relative risk 0.49 [25/916 vs 57/1003], 95% Bayesian credible interval 0.30-0.76, posterior probability >99.9%). This effect was maintained in subgroup analyses including COVID-19-related hospitalization alone (relative risk 0.57, 95% Bayesian credible intervals 0.33-0.95, ) and COVID-19-related hospitalization or death (Hazard ratio 0.59, 95% Bayesian credible interval 0.35- 0.97). The effects were consistent across dominant variants and vaccination status. Among individuals with a high viral level at baseline, peginterferon lambda resulted in lower viral loads by Day 7, compared to placebo. The incidence of adverse events was similar in the two groups. Conclusion(s): Among predominantly vaccinated outpatients with COVID-19, single-dose of peginterferon lambda resulted in significantly decreased clinical events.

Intelligent COVID Risk Aversion System

The lack of an in-depth system for determining exposure to COVID-19 has left people with a need for an autonomous method of tracking/monitoring user habits and active COVID-19 cases. The COVID Risk Aversion System (CRS) was created to track users and how often they encounter these risks around them. This project currently uses Ontario as a testbed. The CRS system consists of two main components: an in-house server and user application. Using internal and external technologies, CRS logs how often users interact with other users who have the application and the locations they visit. A server was developed to store every location that each user encounters and then categorizes a quantified risk to that specific location based on multiple factors. Risk is determined by COVID-19 cases in the area, risk values of people at given locations, and regional per capita cases of COVID-19. The server alters area risk based on decreasing or increasing cases within a specific region. Every hour, the server checks Ontario's COVID-19 statistics and updates the database's values, and then recalculates the dynamic values for all locations stored in the system. The client-side application reports the user's location every 5 minutes and requests information on all users geographically close to that person using Vincenty's formula. Twice a day, the application updates the user's risk based on the interactions the user has had throughout the day. Users can also view a map of Ontario that displays regional risk and can check the risk of specific locations. CRS aims to be an effective method at reducing the user's exposure to COVID-19.

IoT-enabled Contactless Doorbell with Facial Recognition

The COVID-19 epidemic has altered lifestyles all across the globe, causing people to take additional safety precautions and make using a face mask a requirement. Face masks are becoming more popular, making it occasionally challenging for people to recognize other people. Children and the elderly in particular would have trouble identifying their masked guests, which poses a serious hazard because thieves or burglars would take advantage of the situation. In this study, a system was created using IoT and deep learning technologies that works as a unit to offer a contactless solution to the ongoing COVID-19 pandemic while also enabling home owners to keep track of their visitors and receive notifications when someone comes over. The contactless doorbell was created with the help of a Raspberry Pi and a modified ResNet-50 model using ArcFace loss as the feature extractor to efficiently extract visible features from a masked face and support very accurate recognition. Due to the lack of a real masked face dataset with sufficient data, this study used a data augmentation method to add masks to face images from a dataset. The model was able to achieve a recognition accuracy of 98.27% when evaluated using a masked LFW dataset. Furthermore, testing the face recognition model in real-Time with limited users, each with and without a mask yielded an accuracy of 100% in unmasked facial recognition and 90% on masked facial recognition. © 2023 IEEE.

Referral patterns of metastatic breast cancer patients to Palliative Care team at a Cancer Center in Brazil

Introduction: Breast cancer is the most common cancer in women and the leading cause of cancerrelated death in women worldwide. The high prevalence of physical and psychosocial suffering among breast cancer patients and their families justifies the need for an early interdisciplinary approach by a palliative care team. The effectiveness of early palliative care for patients with advanced cancer has been demonstrated in many studies. Early referral to outpatient palliative care services improves symptom control, reduces suffering and improves quality of end-of-life care. Aim(s): Evaluation of referral patterns of metastatic breast cancer patients to the outpatient embedded palliative care team. Method(s): We retrospectively retrieved data from electronic medical records of patients who were treated at a private community oncology practice in Brazil who died from metastatic breast cancer during the years of 2018 until 2021.We evaluated the patient's follow-up time by the palliative care team (follow-up > 12 weeks or not) and the year of referral to the service (pre-2020 vs 2020 and later) associated to the service referral type: Late referral (more than 8 weeks of metastatic diagnosis) or early referral. Each group was followed-up by cancer physicians and after referral was also followed-up by a palliative care multidisciplinary team who regularly evaluated cancer patients during their treatments at outpatient setting. During COVID-19 pandemic, some patients were evaluated by telemedicine appointments. We performed univariate comparisons analysis by Fisher's Exact Test. p < 0.1 was deemed as statistically significant. Result(s): Of the 211 patients whose data were assessed, 99 patients were referred to Palliative Care team before 2020 and 112 patients after 2020. 13.1% of patients pre-2020 received early palliative care versus 33.9% of patients in the post-2020 referral group, resulting in a 3.37-fold odds of an early palliative care integration after 2020 (OR 3.37, CI95: 1.61 - 7.45;p< 0.001). Overall, 30.4% of longer follow-up patients were an early referral versus 19.3% of the shorter follow-up, resulting in an 82% greater chance (OR 1.82, CI: 0.92-3.63;p< 0.1) of prolonged assistance with early referral. Conclusion(s): In this analysis, early palliative care integration for patients with metastatic breast cancer has increased after 2019 despite the COVID-19 pandemic, leading to prolonged time of accompaniment by the multidisciplinary palliative care team. This suggests that even in the face of this challenging moment, a mature and consolidated service is offered by the palliative care team. Also, according to previous data in literature, prematurely integration show signs of correlation with better quality of life and death, supporting early palliative care for this group of patients. However, further work is needed to examine the effect of this care model in our cohort.

Super effective antimicrobial silver-sputtered coatings on poly(lactic acid) against bacteria and omicron SARS-CoV-2

Poly(lactic acid) (PLA) is a biopolymer with properties potentially suitable for fabricating packaging, medical devices, and healthcare products in a more friendly environmental way because this polymer presents biodegradability, compostability, low carbon footprint, and recyclability. However, PLA does not present intrinsic antimicrobial properties. Antimicrobial materials are highly desirable for manufacturing smart packaging and personal protective equipment to secure food and health professionals against pathogenic microorganisms. In this work, we evaluated the antimicrobial performance of (Ag)-coated PLA against Escherichia coli, Bacillus subtilis, and Omicron severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). PLA was rapidly coated with metallic Ag by pulsed direct current magnetron sputtering (pDCMS) for 5, 10, and 20 s. Atomic force microscopy indicates that the Ag coating grows predominantly on the PLA surface via a bulk diffusion mechanism. According to bactericidal and quantitative reverse transcription polymerase chain reaction assays, Ag-coated PLA was capable of inhibiting bacterial biofilm formation and disrupting the genetic material of the Omicron SARS-CoV-2. X-ray high-resolution photoelectron and nuclear magnetic resonance results suggest no polymer chain scission in the PLA bulk due to plasma thermal stress effects during Ag sputtering. © 2023 Elsevier Ltd

Humoral immune responses to SARS-CoV-2 vaccines in an ozanimod open-label extension study

Background: Ozanimod, an oral sphingosine 1-phosphate receptor modulator, is approved in the European Union and United States for the treatment of moderately to severely active ulcerative colitis (UC) and relapsing multiple sclerosis (RMS). A previous analysis of data from UC and multiple sclerosis (MS) open-label extension (OLE) studies showed that most patients with confirmed coronavirus infection (COVID-19) had nonserious infections, recovered, and did not require ozanimod discontinuation. Some immunomodulators and biologics may attenuate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine response;therefore, this analysis evaluated humoral immune responses and predictors of response to SARS-CoV-2 vaccination in patients with RMS treated with ozanimod. Method(s): RMS participants who completed a phase 1-3 ozanimod trial could enter an OLE trial (DAYBREAK;NCT02576717) of ozanimod 0.92 mg/d. This analysis (January 2020-October 2021) included DAYBREAK participants receiving mRNA or non-mRNA SARS-CoV-2 vaccines (1-2 doses, vaccine-dependent) with no evidence of recent infection (ie, nucleocapsid antibody negative). Receptor binding domain (RBD) antibody titers were analysed (Elecsys Anti-SARS-CoV-2 assay;Roche Diagnostics, Basel, Switzerland) prevaccination, after 1 dose, and <4, 4-8, 8-12, and >12 weeks after full vaccination. Fisher's exact tests and regression models determined association with seroconversion and log2 antibody levels. Result(s): Demographics were similar between the mRNA and nonmRNA vaccine recipients (Table). Seroconversion (>=0.8 U/mL spike RBD antibody) occurred in 100% (80/80) of fully vaccinated mRNA recipients and 62% (18/29) of fully vaccinated non-mRNA vaccine recipients. Higher spike RBD antibody levels were seen with mRNA (grand mean: 512.6 U/mL, range: 1.3-4572.0) vs non-mRNA (grand mean: 39.3 U/mL, range: 0.4-368.5) vaccines at all time points studied. Vaccination with a non-mRNA vaccine predicted lower antibody levels (beta: -5.90 [95% CI: -6.99 to -4.82];P<0.0001) and less seroconversion (Fisher's exact: P<0.0001), whereas age, sex, body mass index, and absolute lymphocyte count (ALC) did not. Conclusion(s): Participants receiving ozanimod developed humoral immune response to SARS-CoV-2 vaccines, with 100% seroconversion after mRNA vaccination;this was independent of demographic characteristics and ALC levels at time of vaccination. However, some participants developed lower antibody concentrations and may benefit from booster doses. These findings provide important information for physicians managing ozanimod-treated patients with UC or MS.

Long-term home oxygen therapy as a strategy to reduce hospitalization time in patients affected by COVID-19 with persistent hypoxemia

Introduction: Some patients affected by COVID-19 remain hospitalized due exclusively to persistent hypoxemia. The indication of long-term home oxygen therapy (LTOT) has become a strategy adopted to reduce the length of hospital stay. The influence of the degree of severity of disease involvement on the effectiveness of the strategy is unknown. Objective(s): To evaluate the clinical characteristics of patients with LTOT indication according to the type of hospitalization in COVID-19 patients. Method(s): An exploratory cross-sectional study of associated factors in stable discharged COVID-19 patients using LTOT were consecutively included. Result(s): Between April and December 2021, a total of 62 patients with LTOT indication were evaluated 15 days after hospital discharge. Of these, 32 of them required intensive care unit (ICU) at some point during their hospitalization. When we compared the ICU and ward care groups, we observed differences in age (55.84 +/-13.5 vs 68.42 +/- 14.8, p=0.001) and time of hospitalization (31.63 +/- 21.8 v 17.65 +/-9, p=0.002). However, we did not identify statistical differences between groups on gender and degree of pulmonary involvement on tomography during hospitalization. After 15 days of discharge, there was no statistically significant difference between the two groups in terms of the number of patients who needed to maintain LTOT for more period (8 vs 11). Conclusion(s): Regardless of the severity of hospitalization, most patients did not need to maintain LTOT for more than 15 days. LTOT proved to be a temporary and effective strategy to shorten the length of stay in both groups in stable COVID-19 patients.

A different kind of branding: Bolsonaro's handling of the Covid-19 pandemic and a brand-new Brazil

This article argues that Jair Bolsonaro's handling of Covid-19 in Brazil was consistent with his ‘different kind of branding.' Contrary to the expectations of marketing experts and place branding scholars, Bolsonaro's branding tactics were predicated not on por-traying Brazil positively to commoditize it to (trans)national audiences but on produc-ing the image of Brazil as a white conservative Christian country through maintaining epistemic and informational crises, delegitimizing expert systems, and engaging in nec-ropolitical calculation. Methodologically, to describe the ‘brand-new' Brazil projected in Bolsonaro's presidency (2019–2022), I build three case studies centering on the boycott of Covid-19 vaccines, his strategy of letting the virus spread freely in favor of a supposed herd immunity, and the ‘shadow board' that helped him build a necropolitical strategy. I suggest that Bolsonaro's ‘chaotic' branding project harnessed features of currently exist-ing neoliberalism, including informational entropy, the digital production of ‘alternative facts', entrepreneurial ethos, the delegitimization of expert systems, and the association between free market and political conservatism. © 2023, EQUINOX PUBLISHING.

The prevalence of diabetes and thyroid related autoantibodies in Sri Lankan children with type 1 diabetes and their unaffected siblings - The utility of a new screening assay.

Background: There is limited information about diabetes and thyroid related autoantibodies in children with type 1 diabetes (T1D) or their siblings in Sri Lanka. Objectives: To assess in T1D children and their unaffected siblings the prevalence of autoantibodies to (1) glutamic acid decarboxylase (GADA), insulinoma associated antigen-2 (IA-2A) and zinc transporter 8 (ZnT8A) using 3 Screen ICA™ (3-Screen) and individual ELISA assays; (2) insulin (IAA); and (3) thyroid peroxidase (TPOA), thyroglobulin (TgA) and the TSH receptor (TSHRA). Methods: We selected - (a) consecutive T1D children, and (b) their unaffected siblings of both sexes, from the T1D Registry at Lady Ridgeway Hospital, Colombo. Results: The median age (IQR) of 235 T1D children and 252 unaffected siblings was 11 (8.4, 13.2) and 9 (5.4, 14.9) years respectively, and the duration of T1D was 23 (7, 54) months. (1) T1D children (a) 79.1% were 3-Screen positive; (b) all 3-Screen positives were individual antibody positive (GADA in 74%; IA-2A 31.1%; ZnT8A 38.7%); (c) and were younger (p=0.01 vs 3-Screen negatives); (d) multiple autoantibodies were present in 45.1%; (e) IA-2A (p=0.002) and ZnT8A (p=0.006) prevalence decreased with T1D duration. (f) TPOA and TgA prevalence was higher in T1D children compared to unaffected siblings (28%, p=0.001 and 31%, p=0.004, respectively). (2) Unaffected siblings (a) 6.3% were 3-Screen positive (p=0.001 vs T1D), and 2.4% were positive for IAA; (b) four subjects had two diabetes related autoantibodies, one of whom developed dysglycaemia during follow-up. Conclusions: The 3-Screen assay, used for the first time in Sri Lankan T1D children and their siblings as a screening tool, shows a high prevalence of T1D related Abs with a high correlation with individual assays, and is also a helpful tool in screening unaffected siblings for future T1D risk. The higher prevalence of thyroid autoantibodies in T1D children is consistent with polyglandular autoimmunity.

Impacts of Covid-19 interventions on air quality: evidence from Brazilian metropolitan regions.

The Covid-19 pandemic has negatively disrupted the way our economy and society functions. Nonetheless, there have also been some positive externalities of the pandemic on the environment. This paper aims to evaluate the concentration of nitrogen dioxide in Brazilian metropolitan regions after the policies adopted to confront Covid-19. In terms of methodological approach, the study employs cross-sectional quantitative analyses to compare the period of 36 days, i.e., 12 March to 16 April-before (in 2019) and after (in 2020) the pandemic declaration. The data were obtained from the Sentinel 5-P low-Earth polar satellite concerning Brazilian metropolitan regions (n = 24). Thorough spatial and statistical analyses were undertaken to identify the pre- and during pandemic nitrogen dioxide concentrations. Complementarily, Spearman's correlation test was performed with variables that impact air quality. The study results a fall in nitrogen dioxide concentration levels in 21 of the 24 metropolitan regions which was observed. The Spearman's correlation coefficient between the nitrogen dioxide variation and the vehicle density was 0.485, at a significance level of 0.05. With these findings in mind, the paper advocates that while the pandemic has a significant negative consequence on the health of population globally, a series of measures that result in a new social organization directly interfere in the reduction of air pollution that contributes to the quality of the air we breathe.

Relationship between subjective well-being and self-care among caregivers in pandemic times

Self-care refers to disease prevention and health maintenance practices. Self-care capacity can be an important factor in different conditions and contexts and when associated with aspects of an individual's health it can provide direct benefits to this person. During the Pandemic (COVID-19) this ability may be diminished or impaired, and even hindered with affective aspects, influencing their subjective well-being, that is, affecting their assessment of their own well-being. Thus, this study aimed to evaluate the relationship between self-care capacity and the affective attribution (positive or negative) of male and female adults who act as caregivers. The instruments used were a sociodemographic questionnaire, the Positive and Negative Affect Schedule and the Scale to Assess Self-Care Capabilities. After analyzing the frequency of the variables, Pearson's correlation analysis was performed and through it, moderate associations (medium high) were revealed between the measure of positive affect and self-care (r=0.62;p=0.000) and negative affect and self-care, in this case, with a negative coefficient (r=-0.42;p=0.000);thus, this indicates that people tend to have more self-care, have better positive affects and less negative affects, respectively. It was possible to infer the idea that well-being and quality of life are intertwined with the affective attribution of the individual. © 2022 Centro Universitario Sao Camilo. All rights reserved.

An overweight/obesity survey among dogs and cats attended at a veterinary teaching hospital during the second year of the COVID-19 pandemic

Anecdotal reports suggest that the new coronavirus SARS-CoV-2 pandemic (COVID-19) has increased overweight and obesity prevalence in dogs and cats. The present report aimed to perform a retrospective overweight/obesity survey on 1,001 consecutive cases attended in the Veterinary Clinics Hospital from the Federal University of Rio Grande do Sul during its reopening to the public after months closed due to the pandemic. The overall overweight or obesity observed prevalence was 36.63%;being the frequency in cats slightly greater (38.37%) than compared to dogs (35.76%). No local increase in these frequencies was detected. Neutering (dogs and cats), age greater than 10 years (dogs), and male gender (cats) were factors associated with overweight/obesity. Bodyweight was not registered in about 30% of the medical records, while the body condition score was not registered in about 50% of the cases. These flaws were more often observed in feline medical records and efforts to improve these data records are warranted. Copyright © 2022,Arquivo Brasileiro de Medicina Veterinaria e Zootecnia. All Rights Reserved.

A Mobile Based Garbage Collection System

Garbage disposal and collection is an ongoing global crisis amplified by the increasing world population, lack of funds and public awareness, and recently because of the Covid-19 pandemic. Information Technology can be utilized as a solution for the existing garbage collection methods that are old-fashioned, time-consuming, and energy-consuming due to the lack of a unified and consistent system that incorporates all the parties involved in garbage production and collection. A mobile-based garbage collection system is proposed to overcome the issues aforementioned through route and schedule optimization, AI chatbot, and optimized GPS tracking. The route and schedule optimization is achieved through vehicle routing problem with time windows(VRPTW) with synchronization and precedence that was optimized using LNS;the total travel cost went from 172 minutes to 144 minutes. The AI chatbot feature facilitates reporting garbage collection issues and complaints and enquiring about waste management tips (reduce, recycle, and reuse tips) to be used at home. The most prominent role of developing this AI chatbot is replacing the manual process of reporting garbage collection issues in Sri Lanka with an efficient and interactive way. The chatbot has waste management tips Q and A. In Optimized GPS Tracking, the user can use the map to find the nearest garbage disposal place based on the type of rubbish they generate. The truck driver can find the optimal path to the closest current garbage disposal centres and public trash bins and view the location of Homeowners on the map. The optimized path between two points is displayed based on distance, time, and fuel consumption. The main goal of the component is to show the location of garbage disposal bins and the optimal paths for truck drivers using Linear regression and the Node2vec algorithm. © 2022 IEEE.

Plastic pollution in the Brazilian coast: perceptions from hotel managers on the consumption of disposables

This article identified the perceptions of coast-based accommodation facilities managers regarding single-use plastics (SUPS). The research was predominantly qualitative, exploratory, and transversal applied in 41 companies of 8 accommodation categories located in 11 beach destinations within 6 Brazilian states. As the data collection technique, a semi-structured script was applied, and for interpretation, content analysis. The results indicate that economic-driven decisions take precedence over environmental decisions, and there is not an existing common view around a direct relationship between plastic pollution and the reduction in tourist flows. All companies use SUPS, especially cups, bottles, and bags. Among strategies to manage their use and waste, actions of replacement, reduction, environmental education and staff training stand out. Reducing/replacing items such as packaging and amenities require changes in the industry and consumer's consumption behaviour. The absence of plastic products alternatives while keeping quality and price, resistance from consumers and limited support from investors and leaders appear as obstacles to expanding and improving the management of SUPS. Conclusions indicate that the linear logic of continuous use and disposal prevails against the circular economy. Significant perception variations among the categories of accommodation companies were not noticed, as these are predominantly connected to their management. Finally, the context of the COVID-19 pandemic worsens the problem of plastic pollution, requiring greater attention to the topic.

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