ABSTRACT
Background: Telemedicine (TM) has grown substantially worldwide during COVID-19 pandemic, with numerous advantages in healthcare. Specific governmental recommendations and society guidelines are currently stablished to direct a safe and efficient use of TM. The aim of this study was to assess the characteristics of TM practices among Brazilian allergists/immunologists (A/I) doctors and to evaluate their knowledge on the regulatory recommendations. Method(s): An electronic, self-reported survey (27 questions regarding demographic data, TM practices and knowledge about regulatory recommendations) was e-mailed once a week between August and October/2021 to 2600 Brazilian A/I doctors. Result(s): 205 (7.9%) participants fulfill the forms. One form was excluded due to be duplicate. 143/204 (70.2%) are currently using TM in their daily practice, and 184 (89.9%) had never used it before COVID-19 pandemic. 192 A/I doctors (93.8%) used TM for follow-up appointments, 186 (91%) to check complementary tests, and 136 (66.7%) used it in first consultations. 143 A/I doctors (70.2%) felt safe on their diagnostic through TM, and 7 (3.5%) answered that they could not find a correct diagnostic using TM. The main benefits of TM reported were: greater accessibility, mainly in more distant areas 159 (77.6%), reduced traveling costs 158 (77.1%) and safety regarding COVID-19 transmission 145 (71.2%). On the other hand, some disadvantages of TM were listed by participants: absence of physical examination 183 (89.7%), weakened patient-physician relationship 59 (28.8%) and internet issues 45 (22%). Regarding legal/ ethic field, 105 (51.4%) of the specialists applied the consent terms and 34 (16.7%) recorded the teleconsultation, both required steps in a TM appointment, according to local regulatory recommendations. Additionally, inappropriate online platforms for TM, such as social media apps and non-specific online meeting programs, were reported to be used by 131 (64.1%) of participants. Eighty (40%) did not read the official statements and recommendations which regulate TM practice in Brazil. Conclusion(s): An increasing use of TM in Brazil was observed, mainly influenced by COVID-19 pandemic. Its benefits are clear;however, it is primordial to ensure all the correct and recommended practices are being followed when using this modality of healthcare service, in order to avoid ethical, legal and medical issues that may arise.
ABSTRACT
Background: Immunoglobulin replacement has been revolutionized the treatment of inborn errors of immunity (IEI), ensuring greater survival and quality of life for these patients. Most IEI patients need to receive continuous and regular immunoglobulin replacement. In Brazil, unfortunately, there is no production of this biological or policies for plasma reuse and its importation becomes necessary. Immunoglobulin is distributed monthly by the Brazilian Public Health System (SUS), free of charge. Apart from the difficulty in importing, we had to face the worldwide decrease in blood donations related to COVID-19 pandemic. The aim of this study was to report the rate of lack of immunoglobulins and complications related to this event. Method: This is a cross-sectional, retrospective study, based on the analysis of patient's medical charts at an IEI reference center in Brazil, from January to December 2020. Results: During this period, 124 patients received intravenous immunoglobulin (IVIG) replacement, 62 patients are female (50%), 70 adults (18 to 84 years, median age: 38y) and 54 children (0 to 17 years, median 11y). The most prevalent diagnostic were Common Variable Immunodeficiency-CVID (28.2%), Hypogammaglobulinemia (19.3%), Specific Antibody Deficiency-SAD (11.2%), Ataxia-Telangiectasia (8.8%) and other diagnostics (32,5%: SCIDS, leaky SCID, XLP2, XHIGM, VEO-IBD). Indeed, 70 patients (56.4%) were affected by the lack of distribution of IVIG (56.4%) related to COVID-19 pandemic, remaining without IVIG from one to 12 months, 2.9 months on average. Of these, 48 patients (68.5%) had at least one infection (total 125), all of whom needed to use antibiotics for the treatment of infections and 12 patients required hospitalization. Conclusion: In 2020, 70 (56.4%) patients were affected by the lack of distribution of IVIG. It was possible to identify shortage of immunoglobulin replacement in Brazil due to COVID-19 pandemic led to more infections and increase of antibiotics use.
ABSTRACT
Background: The world is facing one of the worst pandemics in history. Its social, economic and psychological consequences will leave profound marks on society. This study evaluated the QoL of patients with IEI at an immunology referral centre, during the SARS-CoV-2 pandemic. Method: A prospective, single-center study with an adapted questionnaire was applied in two moments of the pandemic: from April to June 2020, and again in March 2021. IEI patients over 18 years old and the caregivers of children under this age answered it online. This questionnaire was adapted from the Portuguese version of the shortened WHO QoL-brief QoL assessment instrument (questions 1,2,4,5 e 26) and the 10-item version of the Perceived Stress Scale (questions 1,2 e 3), taking into account the past four weeks. Results: In the first three months analyzed (April to June/2020), 123/160 questionnaires were answered: 44.7% by caregivers and 55.3% by patients themselves. The children were 12-18 years old and adults were 18-45 years old. 91.1% of the patients have been receiving intravenous immunoglobulin replacement. 84.5% of the patients have already been hospitalized, and 38.2% of them in the intensive care unit at least once. All participants have heard of SARS-CoV-2 and 91% were afraid of being infected with the new virus. 81 patients (66%) reported good QoL prior to the pandemic and, after its onset, this percentage dropped to 27%. In March 2021, with the exponential increase in cases and deaths in Brazil, the questionnaire was reapplied, and 99/160 were answered, 52.4% by patients. The majority (72.6%) are between 18-45 years old, and only 8% of the responders reported good QoL. Everyone fears the coronavirus. Conclusion: Currently, Brazil is the epicenter of COVID-19 outbreak on the planet. In recent weeks, the number of new cases and deaths has grown wildly. Furthermore, IEI patients in Brazil had to deal with the lack of immunoglobulin supply throughout 2020, and until now. In the face of so much adversity, there is an urgent need to think about strategies to improve the QoL of these patients. This is one of the alerts of World primary immunodeficiencies (PI) Week 2021.
ABSTRACT
Background: Since 2019, we have experienced a terrible pandemic, COVID-19. Emerging countries, like Brazil, with logistical difficulties and lack of public policies, face a generalized collapse in health system. Rare Diseases Reference Centers are located distant from patients' houses. Thus, patients with lysosomal diseases, unable to travel and need to receive their recombinant enzyme replacement therapy (ERT) close to their homes. Infusion-related reactions (IRR) are uncommon;however, they can impair the treatment. Therefore, due to the impossibility of locomotion and unavailability of teams of allergists, RDD protocol were accomplished. The study aimed to describe remote points of training and protocols execution. Method: After appointments from treating lysosomal centers (TLC) diseases about adverse reactions, the following strategy was adopted: three online meetings between metabolic team and allergists to present the clinical case;lectures about adverse reactions to medications and RDD: video demonstrations off how to perform skin tests and nursing training for the use of. Two meetings were held with the families, terms of consent were applied, and a communication group was created on WhatsApp® with team leaders. Afterwards, the RDD was formulated and applied remotely, by Google Meet®. Finally, three infusions were followed up under the supervision of our center. Results:: Six patients presented immediate IRR to different recombinant enzymes: three patients with Fabry disease, one with MPS I, one with MPS II and one with MPS IV. The Allergy Center located in São Paulo, was composed of a team of allergology and health professionals with expertise in inborn errors of metabolism. The (TLC) were in the interior of São Paulo, Bahia, Pernambuco and Piauí, 300 to 1,800 miles apart. The protocols were carried out respecting the Standard 12-16 steps according to risk stratification. One of the patients, developed urticaria on the 11th step, despite the addition of premedication. Conclusion: The new Coronavirus' pandemic imposed a new reality, which include much more telecommunication. Barriers have been overcome, such as offering remote alternatives to the treatment of incurable diseases in countries with continental dimensions.
ABSTRACT
Background: Inborn Errors of Immunity (IEI) are a heterogeneous group of diseases which immune defect may be related to a complications by COVID 19. Although there are few studies on the evolution and the real clinical impact of infection by SARS-CoV 2 in this group of patients. The aim of the study was to describe the clinical evolution of COVID-19 in patients with different IEI, in a reference center in Brazil. Method: Retrospective and longitudinal study, with analysis of electronic medical charts of patients with IEI and diagnosis of suspected/ confirmed COVID-19 from March 2020 until now. Results: Eighteen patients (61% male), with a median age of 26.6 years (range 12,3-53,4 y), were included in the study. Four X-linked agammaglobulinemia (XLA), 7 common variable immunodeficiency (CVID), 1 specific antibody deficiency, one Good Syndrome-GS, 2 STAT1-GOF, 2 MSMD and one AT. Ten patients (55,5%) had mild flu syndrome and only one patient was asymptomatic. Hospitalization was necessary for 7 patients (38,8%) due to respiratory complications and 3 (16.6%) deceased (2 XLA and 1 GS). Two patients were reinfected (STAT1-GOF and MSMD), with no need for hospitalizations or long-term complications. One of the XLA patients remains hospitalized, with fever for more than 90 days. Five patients experience coughing and tiredness after more than three months of the disease, one also persists with anosmia. Conclusion: Almost 40% of our sample required hospitalization and 16% died. This rate is worrying and reveals how much immunological competence is required by SARS-CoV-2 as well as the fact that Brazil has increasing death rates from COVID-19. Post-acute COVID-19 syndrome (PASC) has presented in more than 25% of IEI patients infected with SARS-CoV-2.
ABSTRACT
In late 2019, a new infectious disease (COVID-19) was identified in Wuhan, China, which has now turned into a global pandemic. Countries around the world have implemented some type of blockade to lessen their infection and mitigate it. The blockade due to COVID-19 has drastic effects on the social and economic fronts. However, recent data released by the National Aeronautics and Space Administration (NASA), European Space Agency (ESA), Copernicus Sentinel-5P Tropomi Instrument and Center for Research on Energy and Clean Air (CREA) indicate that the pollution in some of the epicenters of COVID-19, such as Wuhan, Italy, Spain, USA, and Brazil, reduced by up to 30%. This study compiled the environmental data released by these centers and discussed the impact of the COVID-19 pandemic on environmental pollution.