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Objective: To analyze the scientific evidence regarding the effectiveness of using ozone to disinfect surfaces based on an integrative literature review.Methods: A search was carried out in the SciELO, MEDLINE, LILACS, PubMed, Science Direct databases. Eleven articles published January 2010 to August 2021 were analyzed. All employed the experimental laboratory research model and achieved different levels of disinfection by O3, however, with varied surfaces and products tested, in addition to different methodological procedures.Results: The majority had an inhibition rate by O3 equal to or greater than 90%, thus proving the effectiveness of this agent as a surface disinfectant, even with variations in parameter values such as concentration and exposure time, in all selected articles, even those that did not prove the effectiveness of O3.Conclusion: This review shows the inhibitory power that O3 has on different pathogens, even if there are variables in the factors used for this purpose, highlighting it in front of other disinfectants. Thus, it corroborates the composition of surface disinfection protocols and decision-making among managers and committees about sanitizing technologies.
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This study aimed to evaluate the feasibility of using low-cost solutions to monitor and mitigate PM2.5 and PM10 concentrations in nursery and primary schools in Porto (Portugal). Three periods were considered: i) early 2020 (before COVID-19 pandemic), ii) early 2021 (during COVID-19 pandemic, with mitigation measures to prevent SARS-CoV-2 spread);and iii) in the middle of 2021 (additionally using a low-cost portable air cleaner). PM2.5 and PM10 were continuously monitored with a low-cost sensing device for at least two consecutive days in five classrooms. In general, the lowest PM concentrations were observed in the third period. Concentrations reduced up to 63% from the second to the third period. The application of low-cost solutions for monitoring and mitigating PM levels seems to be an effective tool for managing indoor air in schools. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.
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The COVID-19 pandemic crisis, among so many social, economic and health problems, also brought new opportunities. The potential of telemedicine to improve health outcomes had already been recognised in the last decades, but the pandemic crisis has accelerated the digital revolution. In 2020, a rapid increase in the use of remote consultations occurred due to the need to reduce attendance and overcrowding in outpatient clinics. However, the benefit of their use extends beyond the pandemic crisis, as an important tool to improve both the efficiency and capacity of future healthcare systems. This article reviews the literature regarding telemedicine and teleconsultation standards and recommendations, collects opinions of Portuguese experts in respiratory medicine and provides guidance in teleconsultation practices for Pulmonologists.
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Due to the COVID-19 pandemic, governments imposed several mobility restrictions which can be used to evaluate their impact on air quality and generate better-targeted policies to improve it. Therefore, this study aimed to define sustainable mitigation measures to reduce air pollution based on quantifying the impacts of the restrictions imposed during the COVID-19 pandemic on air quality in Portugal. Thus, hourly concentrations of PM10, PM2.5, NO2, O3, CO and SO2 were obtained from the Portuguese Air Quality Monitoring Network. Data was then divided into six periods (2020–2021) and compared with the corresponding historical periods (2015–2019). Furthermore, the satellite data of NO2, CO, and absorbing aerosol index (AAI) from the sentinel-5P TROPOMI was collected to complement the analysis conducted for the monitoring data. Overall, air quality improved in all study periods and areas, except in industrial sites. The satellite data corroborated the results herein achieved and thus validated the real effect of the measures adopted in the country during the pandemic on air quality. Sustainable policies to improve air quality could include remote (or hybrid) work whenever possible as a long-term measure and prohibition of travelling between municipalities when an extraordinary event of high air pollution is predicted or occurs. Other policies should be adopted for industrial areas. Given this, and as the restrictive mobility measures had a strong effect on reducing air pollution, the post-COVID era represents an opportunity for society to rethink future mobility and other emerging policies, that should favour softer and cleaner means of transportation. © 2022 The Authors. Sustainable Development published by ERP Environment and John Wiley & Sons Ltd.
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Background/aims: At the Odette Cancer Centre in Toronto, Canada, almost 1 in 5 ambulatory palliative oncology patients presents to our local Emergency Department (ED) every month. Of these visits, approximately 50% are potentially avoidable as they result in a direct discharge home, or in an acute care admission of < 48 hours. For a palliative cancer patient, ED visits are frustrating, costly and are considered an indicator of poor-quality end-of-life care. To improve end-of-life care for this vulnerable population, reducing ED visits is imperative. Methods: We conducted an interrupted time series following the Model for Improvement with an aim to reduce the monthly ED visit rate for the patients of our oncology palliative care clinic by 20% over 1 year. A patient-informed root cause analysis was performed to guide the implementation of a bundle of three change concepts: (1) improving patients' after-hours access to hospital and home care (2) increasing video virtual visits;and (3) enabling early identification of caregiver burnout. Results: Monthly ED visit rates declined by 24% (p < 0.001) with evidence of sustained improvement. The percentage of ED visits that resulted in a hospital admission of < 48 hours remained unchanged. Fidelity was attained by the interventions associated with the first change concept. Conclusions: Improving patients' after-hours access to hospital and home care was associated with a clinically and statistically significant reduction in ED visits. This is the first study in the palliative oncology population to implement patient-informed interventions to reduce ED use. The study occurred during the COVID-19 pandemic which constitutes a significant confounding factor. Continued evaluation post-pandemic will serve to better understand ongoing trends in ED use.
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The ongoing COVID-19 pandemic is the first epidemic in human history in which digital contact tracing has been deployed at a global scale. Tracking and quarantining all the contacts of individuals who test positive for a virus can help slow down an epidemic, but the impact of contact tracing is severely limited by the generally low adoption of contact-tracing apps in the population. We derive here an analytical expression for the effectiveness of contact-tracing app installation strategies in a susceptible-infected-recovered (SIR) model on a given contact graph. We propose a decentralized heuristic to improve the effectiveness of contact tracing under fixed adoption rates, which targets a set of individuals to install contact-tracing apps and can be easily implemented. Simulations on a large number of real-world contact networks confirm that this heuristic represents a feasible alternative to the current state of the art. © 2022 authors. Published by the American Physical Society. Published by the American Physical Society under the terms of the Creative Commons Attribution 4.0 International license. Further distribution of this work must maintain attribution to the author(s) and the published article's title, journal citation, and DOI.
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Objectives: Ensuring the continuing of care is an imperative need, therefore throughout COVID-19 outbreak, the Portuguese Government released directives to guarantee hospital-only medicines' dispensing through the community pharmacy, reducing contacts between patients and Hospitals. This study aims to measure the value generated by the intervention of the community pharmacy in the dispensing of hospital medicines. Methods: A single-arm, before-and-after study with 3-month follow-up, was carried out in Portugal, enrolling a randomly selected sample of patients with at least one dispensation of a hospital-only medicine through the community pharmacy. Data was collected through a structured questionnaire applied by telephone interview from May 15th to October 10th, 2020. Main outcomes were access to medicines, therapeutic adherence (MAT-7), health-related quality-of-life (EQ-5D-3L), satisfaction with the service, travel and waiting time, and related costs to patients. Results: A total of 603 patients/caregivers accepted to participate in the study. The mean age was 55 years old (SD=16) and 50.6% were male. On average, the estimated time gained with the community pharmacy service was 115.1 minutes/visit compared to hospital. Annual savings derived from travel expenses (€237.6) and absenteeism (€67.4) reduction account for 271.6€/patient. There was an increase in the mean score of adherence to therapy (p<0.05) and no statistically significant changes in the mean EQ-5D-3L score. Overall, 91% of respondents would choose to continue to have access to their medication at the community pharmacy, in post-pandemic scenario. Participants reported an increase of satisfaction levels in all evaluated domains – pharmacist’s availability, opening hours, waiting time, privacy conditions and overall experience. Conclusions: Changing the dispense setting to the community pharmacies seems to promote better access, health outcomes and satisfaction for patients. Moreover, it ensures the persistence of treatments, promotes savings for patients and society, and reduces the burden of health care services, representing a crucial public health measure.
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Background and aims: Presenting as a complication of paranasal fungal sinusitis, due to continuous spread of an invasive agent to adjacent tissues, the rhino-orbito-cerebral syndrome is frequently associated with Aspergillus or Mucor infections. Methods: A case of a 66-year-old patient with rapidly progressive cranial neuropathies in the context of an invasive Aspergillosis is presented. Results: A 66-year-old male patient, with a myelodysplastic syndrome and history of recent severe COVID19 infection, was admitted to the Emergency Department due to periorbital pain and fever. On physical examination, the patient displayed III, IV and VI left cranial neuropathies, decreased visual acuity and left hearing loss. A septic thrombosis of the cavernous sinuses was initially admitted and antibiotic therapy started. However, on the following day, peripheral facial diplegia, V2 paresthesia and dysarthria were identified. An MRI was conducted, revealing bilateral ethmoiditis and post-septal left orbital cellulitis, and PAS staining of a nasal biopsy identified spores and hyphae. After admission to an Infectious Diseases unit, the patient clinically deteriorated, with pre- and post-septal cellulitis and progression of periorbital edema to the contralateral eye. A positive PCR test for Aspergillus spp. was detected in the CSF and nasal mucosa. Thirty-one days later, after antifungal therapy (anfotericin B, isavuconazole), clinical improvement was registered. Conclusions: Patients with severe COVID-19, subjected to corticosteroids, are particularly prone to develop fungal infections due to immune system dysfunction. This clinical case highlights the relevance of fungal etiology in the differential diagnosis of ophthalmoplegia in immunosuppressed patients, whose early diagnosis and treatment is essential, excluding potentially fatal infectious.
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BACKGROUND AND AIMS: Coronavirus disease 2019 (COVID-19) has affected the care of patients on chronic hemodialysis (HD). It has been reported that older adults and those with comorbidities, such as diabetes mellitus, hypertension, cardiovascular disease and chronic kidney disease are prone to develop severe disease and poorer outcomes. By virtue of their average old age, multiple comorbidities, immunosuppression and frequent contact with other patients in dialysis facilities, chronic HD patients are at particular risk for severe COVID-19 infection. The aim of this study was to compare clinical presentation, laboratory and radiologic data and outcomes between HD and non-HD COVID-19 patients and find possible risk factors for mortality on HD patients. METHOD: A single center retrospective cohort study including patients on HD hospitalized with a laboratory confirmed COVID-19 infection, from March 1st to December 31st of 2020 and matched them to non-dialysis patients (non-HD) (1:1). Data regarding patient baseline characteristics, symptoms, laboratory and radiologic results at presentation were collected, as well as their outcomes. Categorical variables are presented as frequencies and percentages, and continuous variables as means or medians for variables with skewed distributions. A paired Student's t-test was performed on parametric continuous values or Mann-Whitney for non-parametric continuous variables. Chi-squared test was performed for comparing categorical variables. Logistic regression was used to identify risk factors for mortality on HD patients. A p-value of less than 0,05 indicated statistical significance. RESULTS: A total of 34 patients HD patients were included, 70,6% male, mean age of 76,5 years, median time of dialysis of 3,0 years. Among them 85,3% were hypertensive, 47,1% diabetic, 47,1% had cardiovascular disease, 30,6% pulmonary chronic disease and 23,5% cancer. The most frequent symptoms were fever (67,6%), shortness of breath (61,8%) and cough (52,9%). At admission, 55,9% of patients needed oxygen supply, one required mechanic ventilation and was admitted to intensive care unit. Regarding laboratory data, the most common features were lymphopenia in 58,9% (median-795/uL), elevated LDH in 64,7% (median-255 U/L), raised C-reactive protein in 97,1% (median-6,3 mg/dlL, raised D-dimer in 95,8% (median 1,7 ng/mL), and all patients presented high ferritin (median 1658 ng/mL) and elevated Troponin T (median 130ng/mL). The majority presented with radiologic changes, particularly bilateral infiltrates in 29,4%. Concerning clinical outcomes, the median hospitalization time was 11 days and 13 patients (38,2%) developed bacterial superinfection. Mortality rate was 32,4%. When matched to 34 non-HD patients there was no statistical significant differences in sex, age and comorbidities. The HD group had a tendency to more ventilator support need (p=0,051), higher ferritin and troponin levels (p=<0,001 for both), whereas the non-HD group presented with greater levels of transaminases (p= 0,017). There was o significant difference in hospitalization time (median of 11 vs 7 days, p=0,222) neither in mortality (median of 32,4 vs 35,3%, p=0,798). When the logistic regression was performed, only bacterial superinfection was a predictor for mortality on hemodialysis patients (p=0,004). CONCLUSION: Our study compared outcomes for COVID-19 patients on chronic HD to non-dialysis patients and showed no difference in hospitalization time nor in death rate. In spite of these results, the mortality in patients on chronic HD is still not negligible, with up to 32% of in-hospital mortality. Bacterial superinfection is a predictive risk factor for mortality. Hence the importance of interventions to mitigate the burden of COVID-19 in these patients, by preventing its spread, particularly in hemodialysis centers.
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Solid information on exposure and how to treat COVID-19 in pediatric patients is not yet conclusive in the literature, because of this it is necessary to make a critical analysis of the available data in order to provide common points on the theme in question. This systematic review protocol is registered in PROSPERO (ID: CRD42020181835) and aims through searches in the Databases PubMed, Google Scholar, LILACS and CINAHL, to group the studies published with the theme COVID-19 and pediatric between 2019 and 2020. The MeSH descriptors: COVID-19, child and children will be used in English and Chinese. Observational research, clinical trials and literature reviews will be included, where the study sample was composed of pediatric patients of both sexes aged between 6 and 17 years. The Rayyan QCRI tool® will be used to manage revision data. The analysis of the feasibilities of observational studies will be done by the Loney scale, clinical trials by the Cocharne scale and review studies by the Overview Quality Assessment Questionnaire (OQAQ). The authors intend that the study is completed in the second semester of 2021. The choice of the theme is justified because the results of the future research are useful for the elaboration of public health measures that offer the promotion of effective treatment during the recovery of pediatric patients infected with COVID-19.
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Organizations have been using performance indicators to, amongst others, support decision-making. However, as reported in the literature, there are obstacles to its design and use. This work analysis the Portuguese COVID-19 daily situation report and identifies the 18 performance indicators present in the four page report. Then, it recognizes the more relevant problems associated with its definition and communication, such as, uncertainty of data quality, too many indicators, lack of human resources attached to performance measurement, time and difficulty doing data analysis and lack of time to do data collection, which may limit its use to support decision-making. It ends presenting the requirements that should be fulfilled to reduce the identified problems. © 2020 IEEE.
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Background: Early studies suggested that co-infections were rare in the COVID-19 (CV19) pandemic which might have led to initial misdiagnosis. Despite their importance in the respiratory diseases' severity, co-infections are understudied and their role in the course of the disease needs to be characterized. Aim: To study co-infections between novel coronavirus (nCoV) and other pathogens. Methods: The authors performed a retrospective analysis (using Mann-Whitney U and Fisher Exact test) of CV19 patients (pts) admitted to a Portuguese community hospital ward between 15/03 and 15/05/2020. Most of these pts were also tested for other pathogens. Results: 203 CV19 suspected pts were admitted, 11,33% (n=23) were confirmed. The mean age was 72.09 ± 16.8 years and most patients were male (56.5%). The mortality rate was 21.7% (n=5). Co-infection was present in 39% (n=9) pts. One third had other virus identified on the nasal swab (two Rhinovirus/Enterovirus and one Metapneumovirus), one third had a positive urine antigen for Pneumococcus, and one third had positive blood cultures for other bacteria. The age of co-infected pts was significantly higher than non-co-infected (p=0.046). Cardiovascular disease (heart failure and arrythmia) and obesity were associated with the presence of co-infection (p=0.009 and 0.019, respectively). Mortality rate tended to be higher in co-infected pts although this finding was not statistically significant (p=0.056). Discussion: In this study, co-infections between nCOV and other pathogens were influenced by age and the presence of comorbidities. Co-infections might have a noteworthy impact in the course of COVID-19 and future studies are needed to accurately assess its burden.
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Objective: To describe the impact of the COVID-19 pandemic on dental care provided to pediatric cancer patients assisted in a referral hospital. Material and Methods: This is an observational, retrospective study based on secondary data extracted from worksheets of dental procedures for patients aged between 0 and 19 years assisted in the pediatric oncology sector of a hospital in João Pessoa, PB, Brazil. Dental procedures performed by the interdisciplinary team of researchers from August 2018 to February 2020 (19 months prior to the pandemic) and from April 2020 to October 2021 (19 months during the pandemic) were totaled and compared. A descriptive analysis of the data was performed. Results: There was a reduction of 80.2% in dental interventions implemented in the sector during the pandemic, with the number of procedures decreasing from 6,210 (the period before the pandemic) to 1,229 (during the pandemic). Most procedures in both periods were performed for patients assisted in beds, for whom there was a reduction of care provided for 81.2% from 5,275 to 994 procedures. Dental procedures in the outpatient clinic decreased by 74.9%, from 935 to 235. Conclusion: The COVID-19 pandemic negatively impacted dental care provided to pediatric oncology patients by restricting dental procedures to emergency demands, compromising performance prevention and health promotion actions.