Vaccine Rate Coverage Forecast in Brazil: Is It Possible to Keep Polio Eradicated?

Objectives: Brazil's annual vaccination coverage rate (AVCR) for Polio has risen to alarming levels in recent years. Given the imminent possibility of the return of the disease eradicated 32 years ago in Brazil, the objective was to assess the historical data of AVCR and foresee the Brazilian performance in the next five years. Method(s): We apply a classic linear forecasting model Holt Winter (HW), composed of a forecasting equation and three corresponding smoothing equations alpha, beta, and gamma. The Polio AVCR between 1994 and 2022 was collected from the National Immunization Program and was evaluated in two stages using the R software involving (i) analysis of data, (ii) application of the HW using least squares adjustment. Result(s): The AVCR showed a growing trend between 1994 (38%) and 1999 (86%). From 2000 to 2015, the average AVCR was 78.72%, with the best coverage in 2015 (95.07%). Between 2016 and 2022, the AVCR was 66.75%, with a tendency to reduce over time. Between 2020 and 2022, AVCR had its lower result (64.44%), which can be explained by the postponement of Polio vaccination due to the COVID-19 pandemic. The best adjustment of smoothing alpha, beta and gamma was achieved (0.67, 0, 0) by HW. The forecast showed positive results in the average AVCR, with a growth of 16.71% in the next five years and with an AVCR projection of just 75.89%, in the case of no public health action is endowed by the country. To reach the best AVCR achieved in 2015, it is necessary to expand it by 48.5%. Conclusion(s): Forecasts using HW are recommended for public health monitoring, helping managers make decisions with limited resources. The results indicate that it is necessary to develop a strategic plan to expand AVCR to keep Polio eradicated from Brazil, mainly due to both disease gravity and treatment unavailability.Copyright © 2023

Safety and Immunogenicity of Coronavac and Chadox1 Vaccines against Sars-Cov-2 in Patients with Rheumatoid Arthritis: Brazilian Multicentric Study

Objectives: To evaluate the safety and immunogenicity of CoronaVac and ChAdOx1 vaccines against SARS-CoV-2 in patients with Rheumatoid Arthritis (RA). Method(s): These data are from the 'SAFER (Safety and Efficacy on COVID-19 Vaccine in Rheumatic Diseases)' study, a Brazilian multicentric longitudinal phase IV study to evaluate COVID-19 vaccine in immunomediated rheumatic diseases (IMRDs). Adverse events (AEs) in patients with RA were assessed after two doses of ChAdOx1 or CoronaVac. Stratification of postvaccination AEs was performed using a diary, filled out daily. The titers of neutralizing antibodies against the receptor-biding domain of SARS-CoV-2 (anti-RBD) were measured by chemilumine scence test after each dose of immunizers. Proportions between groups were compared using the Chi-square and Fisher's exact tests for categorical variables. Clinical Disease Activity Index (CDAI) before and after vaccination was assessed using the McNemar test. Result(s): A total of 188 patients with RA were included in the study, most of them were female. CoronaVac was used in 109 patients and ChAdOx1 in 79. Only mild AEs were observed. The more common AEs after the first dose were pain at injection site (46,7%), headache (39,4%), arthralgia (39,4%) and myalgia (30,5%), and ChAdOx1 had a higher frequency of pain at the injection site (66% vs 32 %, p alpha 0.001) arthralgia (62% vs 22%, p alpha 0.001) and myalgia (45% vs 20%, p alpha 0.001) compared to CoronaVac. The more common AEs after the second dose were pain at the injection site (37%), arthralgia (31%), myalgia (23%) and headache (21%). Arthralgia (41,42 % vs 25 %, p = 0.02) and pain at injection site (51,43% vs 27%, p = 0.001) were more common with ChAdOx1. No patients had a flare after vaccination. The titers of anti-RBDafter two doses of ChAdOx1 were higher compared to two doses of CoronaVac (6,03 BAU/mL vs 4,67 BAU/mL, p alpha 0,001). Conclusion(s): The frequency of local adverse effects, particularly pain at injection site, was high. AEs were more frequent with ChAdOx1, especially after the first dose. The use of the immunizers dis not change the degree of inflammatory activity of the disease. In patients with RA, ChAdOx1 was more immunogenic than CoronaVac. .

Clinical Features, Laboratory Findings Outcomes in Multisystem Inflammatory Syndrome (Mis-C) Following Covid-19 Infection - a Multicenter, Observational, Ambidirectional Cohort Study in Rio De Janeiro State, Brazil

Objectives: As of March 5th, 2022, around 1.585 cases of MIS-C and 98 deaths (6,4%) were reported in Brazil. The state of Rio de Janeiro State (RJ) having 94 cases (5,9%) and 4 deaths (4,2%)1.Our aim was to evaluate clinical and laboratory features, and management of MIS-C in seven pediatric hospitals in RJ, Brazil. Method(s): Multicenter, observational, ambidirectional cohort study in seven tertiary hospitals in RJ(Brazil), assessing medical charts of pediatric inpatients (0-18 years) diagnosed with MIS-C according to WHO/CDC criteria, from August, 2020 to February, 2022. Descriptive statistics were used to analyze distributions of continuous variables, frequencies, and proportions. Result(s): A total of 112 cases of MIS-C were enrolled. The mean age was 4.2 years and thre was male predominance (59,8%). All cases had a SARS-CoV-2 contact (29.5% close contact;31.3%:positive PCR;serology:43.8%).Only 12.5% had comorbidities. Length of stay (LOS) was 7 days.Median duration of fever was 8 days. Most common symptoms were: rash(67%);gastrointestinal (67%);conjunctivitis (42%);neurological(39.6%);cardiovascular(37.5%);cervical lymphadenopathy (36.6%), and shock/hypotension(28.6%).Co-infection occurred in 3 patients. Forty-four patients fulfilled criteria for Kawasaki disease. Most patients were admitted to PICU(12;62,5%) for amedian of 2 days. Respiratory distress was seen in 18,7%;hypotension:28,6%, and shock in 23,2%. Main laboratory findings were: high C-reactive protein in 95%;D-dimer:77%, anemia:77%, thrombocytosis:63%;transaminitis:43.8%, lymphopenia:38%;hypoalbuminemia:34%;thrombocytopenia: 29%;hypertriglyceridemia:28%, and high pro-BNP in 27%. Echocardiogram was performed in 91/112 patients;abnormal in 70,3%;exhibiting myocardial dysfunction( 25%);pericardial effusion(21%);coronary dilation/aneurysms(11%) and, valvulitis (14.5%). IVIG+corticosteroids (CTC) were administered in 59.8%(67/ 112);18.6%(18/112) IVIG only;10.7%(12/112) CTC only;3.4%(4/112)biologics, and 15(13.3%) received no treatment. ASA low dose in 77.7% (87/112) and moderate/high dose in 34.8%. Oxygen support was needed in 27,7%;vasoactive amines:18,7%;dialysis:5,3%, and transfusion:18,7%.One patient died from a cytokine storm syndrome. Conclusion(s): Our study reports a higher number of MIS-C cases in RJ than the number reported to Brazilian authorities, highlighting underreporting. Our patients were younger, had fewer comorbidities, cardiovascular/gastrointestinal/renal involvement, shortest LOS in ICU, and a higher frequency of myopericarditis.

Safety and Efficacy of Covid-19 Immunization in Systemic Vasculitides - a Multicentric Cohort

Objectives: Patients with immune-mediated rheumatic diseases (IMRDs) develop more severe outcomes of Coronavirus disease 2019 (COVID-19). Recent studies have contributed to understand the safety and efficacy of COVID-19 vaccines in IMRDs, suggesting that different diseases and therapies may interfere on immunization efficacy. In this study we analyze the immunogenicity of COVID-19 vaccines in patients with Systemic Vasculitides (VASC), the rate of COVID-19 and the frequency of disease relapse following immunization. Method(s): We included patients with VASC (n = 73), a subgroup of the SAFER study (Safety and Efficacy on COVID-19 Vaccine in Rheumatic Disease), a longitudinal, multicenter, Brazilian cohort.We analyzed the geometric means of IgG antibody against receptor-biding domain of protein spike of SARS-CoV-2 (anti-RBD) after two shots of CoronaVac (Inactivated vaccine), ChadOx-1 (AstraZeneca) or BNT162b2 (Pfizer-BioNTech). IgG anti-RBD was measured by chemiluminescence test. We assessed new-onset COVID-19 episodes, adverse events (AE) and disease activity for each VASC. Result(s): The sample included Behcet's disease (BD) (n = 41), Takayasu arteritis (TAK) (n = 15), antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) (n = 14), polyarteritis nodosa (n = 7) and other small vessel VASC(n = 6). The majority of patients were female (69%) without comorbidities (49%) and a median age of 37 years. The most common medication was conventional synthetic disease-modifying anti-rheumatic drugs, followed by biologic drugs. No patient received rituximab at baseline. Most patients received CoronaVac (n = 25) or ChadOx-1 (n = 36), while four received BNT162b2. Baseline IgG-RBD means were 1.34 BAU/mL. They increased to 3.89 and 5.29 BAU/mL after the 1st and 2nd vaccine dose, respectively. ChadOx-1 had higher antibody titers than CoronaVac (p = 0.002). There were no differences between different VASC. There were 3 cases of COVID-19 after immunization with CoronaVac. BD patients had a tendency for more cutaneous-articular activity following ChadOx-1. There were no severe relapses and no serious adverse events. Conclusion(s): Our results show the safety of different SARS-CoV-2 vaccines in VASC population. A progressive increase of IgG-RBD antibodies was observed after each dose. ChadOx-1 led to higher IgG-RBDgeometricmeans compared toCoronaVac. Finally, even though ChadOx-1 presented a tendency of triggering mild disease activity, there were no significant disease activity following vaccination in VASC patients. .

Impact of Glucocorticoid on Immunogenicity among Covid-19 Vaccines in Immune-Mediated Diseases

Objectives: The use of glucocorticoids (GC) has been associated with increased risk of hospitalization for coronavirus infection and reduced immunogenicity of SARS-CoV-2 vaccines in immune-mediated diseases (IMD) patients. However, there is still controversy of which dose of GC is correlated with impaired vaccine response on each of the diverse COVID-19 vaccines available, as well as the possible influence of other concurrent immunosuppressants. This study aimed at evaluating the effect of GC on serological response after two doses of BNT162b2 (Pfizer/BioNTech), CoronaVac (inactivated SARS-CoV-2 Vaccine) and ChadOx1 (AstraZeneca) and after the booster dose in patients with IMD. Method(s): The data were extracted from a multicenter longitudinal observational Brazilian cohort (SAFER: Safety and Efficacy on COVID19 Vaccine in Rheumatic Disease). Patients >18 years of age with IMD were evaluated after 2 doses of the same vaccine against COVID-19 and after a booster vaccine, applied according to Brazilian National Immunization Program. All patients underwent clinical examination and collected blood samples for immunogenicity tests. Serological response was evaluated by Anti-RBD titers (IgG) at baseline and 4 weeks after each vaccine dose. Result(s): Among the 1009 patients evaluated, 301 were using GC (196/401 SLE, 52/199 RA and 27/74 vasculitis). Patients using GC were younger (38.2 vs 40,8 years, p = 0,002), had higherBMI (27,6 vs 26,4 p = 0,008), higher prevalence of kidney disease (3,3% vs 0,5%, p = 0,001) and of thrombosis (11,6% vs 5,9%, p = 0,002) than non-users. Regarding the type of vaccine, most of the GC users received CoronaVac (61.7%), while only 31.9%of non-users received this vaccine (p alpha 0.001). Although there were similar rates of pre-vaccination infections among them, patients with GC tended to have a higher incidence of confirmed COVID-19 infection after the 2nd dose of the vaccine compared to non-users (4.5% vs 2.0% p = 0.054). The antibody titers after the 1st dose of COVID-19 vaccines were similar between groups, but there was a worse response in the GC group after the 2nd dose (p = 0.039). However, this difference was not statistically significant after the 3rd dose (Figure). Conclusion(s): GC use may compromise vaccine-induced immunogenicity after a 2-dose regimen;however, this effect does not remain significant after the booster dose. Multivariate analysis is still pending to assess the potential difference in the impact of GC on the immune response depending on GC dose, type of vaccine and associated drugs.

Evaluation of Homologous and Heterologous Vaccine against Sars-Cov-2 in Systemic Lupus Erythematosus Patients: Data from Safer Study

Objectives: To evaluate the immunogenicity of ChAdOx1, Coronavac and BNT162B2 vaccines in SLE patients, including homologous and heterologous immunizations. Method(s): The 'Safety and efficacy on COVID-19 Vaccine in Rheumatic Disease-SAFER study' is a Brazilian multicentric longitudinal phase IV study to evaluate COVID-19 Vaccine in immune-mediated rheumatic diseases (IMRD) in real life, started on May 2021. SLE patients (according to the 2012 SLICC classification criteria), older than 18 years of age were recruited after 2 or 3 doses of vaccine against COVID-19 (ChAdOx1, BNT162b2 and CoronaVac) and were evaluated at baseline and on the 28th day after each dose. Homologous immunization was considered if they received three doses of the same vaccine and heterologous if a different one was applied. IgG antibody against SARS-CoV-2 spike receptor-binding domain were measured by chemiluminescence (SARS-CoV-2-IgG-II Quant assay, Abbott-Laboratories) at baseline and 28 days after the first, 2nd and 3rd doses (Seropositivity IgGSpike>= 7.1BAU/mL). Statistical analysis: ANOVA and pairwise comparisons tests Results: 316 SLE patients were included (255 heterologous and 61 homologous immunization), 89.2% were female and the mean age was 37.6 +/- 11.2 years. The two groups were homogeneous regarding demographical data, disease activity and immunosuppressive treatment. 49.7% used corticosteroids (alpha 5 mg/day in 52.3%), 83.5% antimalarials, 22.8% azathioprine and 20.3% mycophenolate mofetil. 207 patients received the first two doses with CoronaVac, 128 ChadOx-1 and 32 BNT162b2. Regarding the first two doses of the same vaccine, there was no difference in IgG titers over time between CoronaVac or ChadOx-1 (p = 0.313). IgG titers increased in all vaccine groups, with difference only after 2nd dose: 4.96 +/- 1.71BAU/mL CoronaVac vs. 6.00 +/- 1.99BAU/mL ChadOx-1 vs. 7.31 +/- 1.49BAU/mL BNT162b2 (p alpha 0.001). There was no difference in IgG titers over time between homologous or heterologous vaccine schedule (p = 0.872). IgG titers also increased in all groups, with difference only after 2nd dose: 5.49 +/- 1.96BAU/mL heterologous vs. 6.30 +/- 2.10BAU/mL homologous (p = 0.009). Conclusion(s): Induction of immunogenicity occurred in different vaccine regimens in SLE patients. Future research to explore different heterologous schemes in IMRD must be performed.

The Necrobiopolitics of COVID-19 in Brazil: Transitivity Choices in Global Media Representations

Global media have reported widely on the (in)actions of the Brazilian federal government, particularly of president Jair Bolsonaro, in dealing with the COVID-19 pandemic. This paper aims to describe media representations in terms of their transitivity choices (HALLIDAY;MATTHIESSEN, 2004) and to discuss how emerged language patterns may be indicative of particular ways life and death have been controlled in terms of a coupled conceptualization between biopolitics (FOUCAULT, 2008) and necropolitics (MBEMBE, 2019) which we call necrobiopolitics. Overall results indicate how the death of babies and mothers, the collapse of hospital and health service, the spike in hunger, the dismissal of the severity of the pandemic, and the purposeful delay in purchasing vaccines are instrumental in the way president Jair Bolsonaro has implemented a political agenda that defines whose lives are worthy and whose deaths are tolerated. © 2023, Universidade Federal de Minas Gerais, Faculdade de Letras. All rights reserved.

Communication Channels and their Challenges: An Analysis of Sofware Development Teams during the COVID-19 Pandemic

Software development teams depend on the constant and varied use of technological tools that contribute to the fluidity of development activities. The communication channels provided by these tools contribute to the participatory culture of software development, where requirements include getting involved, learning and co-producing the code. However, the choice of channels to support development is still an open question in the scientific community. Through an investigation of closed remote software teams from a large public educational institution in Brazil during the COVID-19 Pandemic, we identified their preferred communication channels and analyzed them to learn how to improve collaboration. We also drew some comparison with social developers and took a look at the challenges that these channels impose and solutions adopted to mitigate these problems. © 2023 ACM.

A Method to Estimate COVID-19 Contamination Risk Based on Social Distancing and Face Mask Detection Using Convolutional Neural Networks

We present a method for evaluating COVID-19 contamination risk based on social distancing between individuals and face mask usage. Our method employs images captured by surveillance cameras as input to a system that computes a health risk indicator in real time. This system can handle real-world situations, performing detections in large public spaces, such as squares and streets, as well as other potentially crowded areas like restaurants and shopping centers. Our system uses the number of people with and without masks and their proximity to evaluate the risk of COVID-19 contamination. We employed deep neural networks to detect people with and without masks, and we used computer vision to measure the distance between them. Both cases presented challenges, including distinguishing face masks at wildly different distances and positions concerning the camera, occlusions, shape variance, etc. We have built and made public a face mask detection dataset (44,402 faces) with images that include these challenging scenarios and used them to train our deep neural networks. Our best deep neural network architecture achieved 91.41% precision, 82.88% accuracy, and 89.88% recall on face mask detection. © 2022 IEEE.

Economic-financial performance of B3-listed meat agribusiness companies before and after the start of Covid-19

This study aimed to analyze the economic and financial performance of the four largest companies in the Meat Agribusiness Sector listed on B3 S.A., before and after the onset of the Coronavirus Pandemic (period from 2018 to 2020). The analysis was carried out by means of financial indicators of capital structure and profitability, focusing in particular on the DuPont Identity, calculated based on values of accounting accounts in the companies' financial statements. The collection was performed through the structured financial statements presented on the B3 S.A. website and with the use of the Economatica database. The research is characterized as descriptive, documentary, and quantitative. Comparing the percentages corresponding to the indicators for each year and the economic scenario of the period, the research used Pearson's Correlation to analyze the relationship between the variations of the indicators with respect to the variation of the Gross Domestic Product (GDP) of the Livestock Branch, in the period studied. Among the main findings, a significant improvement of the Return on Assets and Return on Equity, in medium and strong positive correlations with the sector's GDP growth, is evident. Furthermore, an extremely strong positive correlation was found between the companies' Revenue from Goods and Services and the Livestock Industry GDP. It is concluded that, overall, in addition to the sector's GDP growth, despite the economic crisis resulting from the pandemic, companies raised their revenues and improved profitability and profitability.

The constitution of being a teacher: new challanges in face of a pandeminc scenario

This paper analyzes the constitution of being a teacher in the context of the Covid-19, aiming to: i. characterize the elements present in the process of reframing the teaching professional identity in the context of a pandemic;ii. identify the challenges experienced in professional practice as a teacher in remote education. It is about a descriptive-analytical study of an exploratory nature, related to a more extensive research-intervention, considering the pandemia first year. Focuses on the experience of eight non-remote experienced schoolteachers who act as mentors at referred investigation-intervention. The data comprised written narratives recorded in reflective diaries, virtual activities and, reports by WhatsApp. As a complement, we will consider the deposits of experienced professors registered in virtual synchronous online meetings. It was possible to identify/understand: i. signs of anguish and helplessness when facing the professional effects caused by the pandemic, ii. sense of emptying one's professional identity and iii. challenges in projecting teaching in remote education. It was observed that is this new scenario caused by the pandemic, teachers are going through processes similar to those of beginners who accompany in mentoring, experiencing tensions such as: fear and uncertainty about the future (including the return of regular classroom activities), anxiety, anguish, feeling of incapacity, doubts about the reorganization of school activities (remotely), difficulties in dialogue with the students' family members, concern about children and their families, lack of information and dialogue in schools and education networks, revolt at government actions, among others. It was also observed that new meanings are being attributed to the process of becoming a teacher. The imbalance in the constitution of professional identity was noticed as one of the first effects of the pandemic. Such an imbalance gave way to the empowerment of the teaching identity itself, also causing an expansion of the repertoire of professional knowledge. © 2023, Universidade Estadual de Maringa. All rights reserved.

Vaccine-Induced Immune Thrombotic Thrombocytopenia (Vitt) by a Third Dose of Chadox1 Ncov-19 (Astrazeneca) after Bnt162b2 (Pfizer-Biontech)

An atypical case of VITT was described resulting from a vaccination schedule where the third booster with ChAdOx1 nCoV-19 (AstraZeneca) was administered. The patient received a complete vaccination schedule with two doses of Pfizer-BioNTech (BNT162b2) without any complications before the third dose. However, the patient has developed an infrequent yet extreme prothrombotic;hypercoagulable state caused by platelet-activating anti-Platelet Factor 4 (PF4) antibodies. This phenomenon is typically triggered by the proximate administration of an adenoviral vector vaccine against COVID-19. The patient's symptoms began ten days after taking the third dose of the ChAdOx1 nCoV-19 vaccine (AstraZeneca). His main complaints when hospitalized were severe headaches and right abdominal pain. The blood tests and MRI scan imaging findings were very characteristic of VITT, and a rare cerebral venous sinus thrombosis was found. Also, a markedly elevated D-dimer and strong positive PF4-dependent enzyme-immunoassay test results were documented. Due to discerning clinical suspicion, this patient was rapidly treated with immunoglobulin infusion for two days and oral steroids for three days. Subsequently, he was anticoagulated with the new oral anticoagulant edoxaban after platelet numbers recovery. In a few days, platelets normalized, and D-dimer levels decreased, while anti- PF4-dependent enzyme-immunoassay test results showed a slow decline. He was discharged taking oral edoxaban without any sequeal. Copyright © 2022

Avaliacao Por Citometria De Fluxo De Celulas No Sangue Periferico De Gestantes E Puerperas Com Suspeita De Covid-19

A resposta imune a infeccao por SARS-CoV-2 durante o periodo gravidico puerperal e as alteracoes que podem aumentar o risco de complicacoes maternas, fetais e neonatais ainda nao sao bem caracterizadas. Para isso, foram determinados, atraves de citometria de fluxo, niveis perifericos de linfocitos T-totais (CD3+), T-auxiliar (CD3+/CD4+), T-citotoxico (CD3+/CD8+), linfocitos B (CD19+), celulas NK (CD16+/56+) e NKT (CD3+/CD16-56+) em gestantes e puerperas com suspeita de COVID-19 com o objetivo de identificar potenciais alteracoes imunologicas induzidas pelo coronavirus. Foram utilizadas amostras de sangue periferico de mulheres que realizaram RT-PCR para COVID-19 entre maio de 2021 e marco de 2022. As amostras foram coletadas em tres maternidades publicas do Rio Grande do Norte na admissao para parto e no puerperio imediato nos casos suspeitos. O sangue foi coletado em tubos contendo EDTA para a realizacao da citometria de fluxo, utilizando o analisador de fluorescencia celular ativado (FACScan) e o software Cell Quest. Os linfocitos foram identificados por alta expressao de CD45 e baixa dispersao lateral, utilizando as seguintes combinacoes de 3 cores de anticorpo monoclonal: isotiocianato de uoresceina (FITC), ficoeritrina (PE) e Proteina Clorofila Piridina (PerCP). Cinquenta mulheres precisaram realizar o RT-PCR e 32 (64%) testaram positivo para COVID-19. Gestantes e puerperas infectadas pelo SARS-CoV-2 apresentaram niveis elevados de celulas T citotoxicas, mediana (ME) = 495,0;intervalo interquartil (IIQ) = 391,5, quando comparadas com pacientes nao infectadas, ME=356,2;IIQ=297,8;p=0.032. Com relacao a quantidade das celulas NK, ME=159,1;IIQ=220,4, e dos linfocitos B, ME=126,7;IIQ=186.4, as contagens foram significativamente mais baixas no grupo com menos de 30 dias de infeccao, em comparacao com o grupo em que o RT-PCR foi negativo, ME=280,8;IIQ=214,9;p=0,021 e ME=323,9;IIQ=365,5;p=0,045, respectivamente. Gestantes e puerperas com COVID-19 apresentam maior numero de linfocitos T citotoxicos no sangue periferico e menor numero de celulas NK e linfocitos B. Considerando que gravidez e pos-parto alteram fisiologicamente o sistema imunologico e que esse estudo transversal nao permite analisar causalidade entre infeccao e alteracoes celulares, mais estudos sao necessarios para elucidar as alteracoes causadas pela COVID-19 no sistema imunologico durante o periodo gravidico puerperal, para confirmar se a infeccao viral compromete a imunidade, aumentando o risco de complicacoes para o binomio mae-feto. Declaramos que nao houve apoio financeiro e (ou) material recebido para o desenvolvimento deste trabalho. Copyright © 2022

Estrategias De Enfrentamento Aos Desafios De Captacao Hospitalar Frente a Pandemia De Covid-19

Objetivos: Viabilizar o servico de Captacao Hospitalar em um cenario de incertezas instalado com a Pandemia COVID-19, comprometendo o estoque de Hemocomponentes a nivel critico, atraves da orientacao, treinamento, acompanhamento remoto das equipes multiprofissionais das Agencias e Assistencias para otimizar o comparecimento dos doadores de reposicao. Material e metodos: Foram realizados entre 2020 e 2021: 11 treinamentos de captadores;09 reunioes de orientacao com as Agencias e Assistencias, Servico de Captacao e Coordenacao do Hemocentro de Belo Horizonte;supervisao particularizada para os 03 hospitais com maior demanda transfusional;envio mensal dos relatorios com resultados de reposicao e utilizacao de hemocomponentes para todas as Agencias atendidas;incentivo a criacao de campanhas internas e pecas publicitarias;envio de materiais informativos;participacao em reunioes de comite transfusional;treinamento de captacao por telefone e acompanhamento remoto dos resultados junto as instituicoes. Todas as acoes foram realizadas de modo virtual atraves de e-mails, atendimento por telefone e videoconferencias. Resultados: Diante do novo cenario instaurado com a Pandemia de COVID-19, os captadores hospitalares se depararam com inumeras medidas restritivas no ambiente hospitalar dificultando a atuacao em prol da doacao de reposicao, refletindo no estoque de hemocomponentes. Estes desafios impulsionaram a implementacao de medidas estrategicas alternativas e adequadas ao momento. Atraves do suporte que o Servico de Captacao do HBH ofereceu as instituicoes hospitalares, formou-se um ambiente propicio a troca de ideias e experiencias que culminou na producao de videos;pecas informativas;campanhas voltadas para o publico interno;desenvolvimento da estrategia de captacao hospitalar por telefone;capacitacao de 224 novos captadores;participacao ativa nas reunioes de 204 profissionais de agencias e assistencias transfusionais, que possibilitou a retomada da atividade de captacao de candidatos a DVS para estabilizacao dos estoques. No que se refere ao comparecimento de DVS de reposicao nas unidades HBH e Posto de Coleta Shopping Estacao BH, advinda das instituicoes hospitalares acompanhadas: de 2019 a 2020 registrou-se queda de 18%, em razao da Pandemia de COVID-19;de 2020 a 2021 registrou-se aumento de 11%. Discussao: Em atendimento ao periodo critico de Pandemia COVID-19 e mediante o impacto no estoque de hemocomponentes, foi necessario realizar acoes especificas em conjunto com as Instituicoes hospitalares em prol da melhoria do comparecimento para DVS de reposicao. As praticas corroboraram a corresponsabilidade entre instituicoes e hemocentro, sendo construidas, acompanhadas e, quando necessario, aperfeicoadas. Os encontros realizados foram oportunidades de apresentar novas ideias e replica-las nas demais instituicoes, adequando-as a realidade de cada instituicao hospitalar. Conclusao: O conjunto das praticas desenvolvidas entre a Captacao do HBH em parceria com as instituicoes hospitalares fortaleceu o vinculo entre os profissionais envolvidos no servico de Captacao Hospitalar e possibilitou a adequacao do servico ao momento, se tornando uma estrategia que viabilizou a realizacao do servico de captacao hospitalar e essencial para a manutencao dos estoques de hemocomponentes. Copyright © 2022

Impacto E Importancia Do Atendimento Especifico Dos Doadores Voluntarios De Sangue Caravanistas Para Melhoria Do Estoque De Hemocomponentes

Objetivos: Gerar uma rede de candidatos a doacao voluntaria de sangue (DVS) caravanistas no intuito de ampliar o banco de doadores da Fundacao Hemominas e promover a fidelizacao dos mesmos, com a intencao de majorar o estoque em momentos criticos. Material e metodos: A partir de 2020, em funcao da Pandemia de COVID-19 foi intensificado o acompanhamento dos grupos e caravanas, que passaram a receber atendimento personalizado. Estreitou-se o relacionamento com os organizadores atraves do monitoramento dos grupos que possibilitou o desenvolvimento de acoes estrategicas voltadas para este publico: atendimento por e-mail, telefone e whatsapp;envio de material e producao de videos informativos;criacao de sistema de atendimento com reserva de horarios;monitoramento dos grupos com agradecimento aos parceiros;intervencao junto as caravanas com comparecimento espontaneo e incentivo a producao de material de divulgacao proprio. Resultados: Observou-se o aumento de 265% no comparecimento de candidatos a doacao entre 2020 (1654 candidatos a DVS) e 2021 (4392 candidatos a DVS). Em 2022 ate o mes de julho, compareceram 2708 doadores de caravanas, apontando para um aumento aproximado de 10% no comparecimento, mantendo o cenario atual. Houve diminuicao do comparecimento espontaneo: 2020 a 2021 (27%) e 2021 a 2022 (54%). Em resposta ao processo educativo, constatou-se que os organizadores dos grupos passaram a se referenciar ao servico de captacao como fonte de informacao segura, tornando-se multiplicadores da DVS e retornando com os grupos de doadores com maior frequencia. Discussao: O atendimento especial aos doadores que comparecem em grupos proporciona maior divulgacao da DVS, acesso a informacao de qualidade e humanizacao do processo, possibilitando a conscientizacao da importancia desse ato de cidadania. O suporte ao organizador de caravana e fundamental para desmistificar o senso comum, promovendo uma experiencia de DVS positiva e culminando em um melhor indice de doacoes efetivas. O atendimento personalizado com foco na humanizacao forma um cidadao sensibilizado e consciente, capaz de fomentar a cultura da DVS, aprendida em um grupo organizado, em seu proprio meio social. Conclusao: Em vista da necessidade de manutencao do estoque, o estreitamento do relacionamento com os caravanistas proporciona o fortalecimento da rede de grupos parceiros conscientes de sua responsabilidade social. Estabelece acesso facilitado em momentos de estoque critico, onde e possivel ativar esta rede para impacto imediato no estoque de hemocomponentes. Copyright © 2022

Atendimento a Doadores De Celulas Progenitoras Hematopoieticas Em Centros De Hemoterapia: A Experiencia Do Grupo Gsh No Cuidado Aos Doadores Do Redome

Objetivo: No ano de 2020, em decorrencia da reducao significativa da capacidade de atendimento a doadores alogenicos nao aparentados pelos hospitais parceiros do Registro Brasileiro de Doadores de Medula Ossea (REDOME) e com a restricao de internacoes eletivas para comportar as internacoes dos pacientes para tratamento da COVID-19, surge a oportunidade de um modelo inovador de avaliacao de doadores alogenicos nao aparentados no Brasil, o atendimento exclusivamente realizado por um servico privado de hemoterapia. Nesse cenario, o presente trabalho busca demostrar a seguranca do procedimento de doacao de celulas progenitoras hematopoieticas (CPH) ambulatorial em servicos de hemoterapia. Materiais e metodos: O atendimento a esses doadores e realizado nos Complexos de Hemoterapia do Grupo GSH nas cidades de Sao Paulo, Rio de Janeiro e Brasilia, onde ja havia equipe com experiencia em avaliacao e coleta de CPH por aferese de doadores alogenicos. Os possiveis doadores sao selecionados e encaminhados pelo REDOME para avaliacao e coleta de CPH de acordo com a demanda do registro. Todo o processo de orientacoes, avaliacao clinica e laboratorial, mobilizacao e coleta de CPH por aferese foi realizada no banco de sangue, um ambiente preparado para o atendimento a doadores e sob a coordenacao de um medico hemoterapeuta. Resultados: No periodo de 01/08/2020 a 01/08/2022 foram avaliados 48 doadores encaminhados pelo REDOME sendo 1 deles um doador aparentado que, devido as restricoes de viagem impostas pela pandemia, realizou a doacao no Brasil para que o irmao fosse transplantado no exterior. A idade dos doadores nao aparentados variou de 23 a 49 (mediana 35 anos) e 44% eram do sexo feminino. Vinte e cinco (52%) foram considerados inaptos para a coleta de celulas em regime ambulatorial e desses, 19 (76%) o motivo da inaptidao foi o acesso venoso periferico incompativel com o procedimento de aferese. Esses doadores foram encaminhados pelo REDOME para outros servicos para realizar a coleta em regime hospitalar. Vinte e tres doadores foram aptos e submetidos a 25 procedimento de aferese. O volume sanguineo processado medio foi de 13,3 litros (variando de 7,8 a 17 litros) com tempo maximo de procedimento de 300 minutos. Nenhum doador apresentou reacao adversa moderada ou grave, em 28% dos procedimentos o doador apresentou hematoma no local da puncao venosa e em 25% dos procedimentos houve perda de acesso com necessidade nova puncao para conclusao da coleta. Dois doadores apresentaram sintomas de hipocalcemia durante a coleta de celulas que regrediram com reducao do fluxo de extracao e aumento da velocidade de reposicao do calcio. Conclusao: Assim como em estudos previamente publicados, a analise dos dados demonstra que o procedimento de coleta de CPH alogenica por aferese apresenta baixo risco de eventos adversos quando o doador e adequadamente selecionado o que possibilita a realizacao do procedimento com seguranca no ambiente de banco de sangue, onde o doador encontra maior conforto e e acompanhado por profissionais treinados e habituados com cuidados a doadores, o que reduz a probabilidade de haver sub-identificacao dos riscos para o doador e aumenta a seguranca do procedimento. Copyright © 2022

Study of the sewage from a municipality in southern Minas Gerais, Brazil: correlation of physical and chemical variables, COVID-19 cases, and SARS-CoV-2 RNA concentration

Wastewater-based epidemiology is an important public health tool with great applicability when facing the COVID-19 pandemic, since infected individuals are able to excrete SARS-CoV-2 particles. In this context, this study aimed to correlate the number of cases of COVID-19 with physical and chemical variables and the presence of the virus in raw sewage samples from a sewage treatment plant (SIP) in the municipality of Lavras, Minas Gerais, Brazil, collected between the 19th and 25th epidemiological weeks. The samples were concentrated by electronegative membrane adsorption method and SARS-CoV-2 RNA was extracted, detected, and quantified by RT-qPCR using oligonucleotides and probes for the N gene. Moreover, the variables pH, total suspended solids, and chemical oxygen demand were evaluated. COVID-19 cases were obtained from epidemiological bulletins made available by the municipal government From the 24th epidemiological week on, a reduction in viral concentration (copies L-1) was observed concomitantly with the pandemic response countermeasures initiated by the municipality. A strong and significant positive correlation (p<0.05) between viral load and number of confirmed cases was obtained through Spearman's test. However, there was no correlation between the presence of the virus and the physical and chemical characteristics of the sewage. Therefore, it is suggested that further research be carried out in order to track SARS-CoV-2 concentrations in wastewater, thus corroborating with the fight against the pandemic and the achievement of epidemiological surveillance systems based on sewage monitoring.

Disinformation, public health and immunization in Brazil: the effects of popular health education

Vaccine immunization is considered a true milestone in public health by contributing to the reduction, protection and prevention of numerous communicable diseases and in the context of the COVID-19 pandemic it is no different. However, among the different expressions of the denialism of the coronavirus disease pandemic (COVID-19), are the fake news and information regarding the vaccine, making it difficult to adhere to immunization due to "fake news". Therefore, the present study aimed to present the educational actions that have popular health education as a reference, which were used in favor of adherence to vaccination in Brazil, and that are cited in the scientific literature. For this, a systematic review of scientific literature was carried out, using descriptors and search strategies: "Health Education AND COVID-19 Vaccines" and "Health Education AND Immunization", in the online databases Virtual Health Library (VHL) and Scientific Electronic Library Online (SciELO) - with the filters "Brazil", and publications from 2020, until December 2021, in the languages "Portuguese", "English" and "Spanish" and "article". The results point to different strategies of popular health education (HPS), such as: (i) conversation wheels in public health services;(ii) messages and electronic journals forwarded to SUS users by Primary Health Care;(iii) explanatory videos forwarded by public schools;and (iv) posters made available in public buildings in different municipalities. It is concluded that dialogical HPS contributes to the intellectual emancipation of citizens, making them able to decide about themselves, safely, when facing health situations.

Lessons learned from Clinical Librarian in the pandemic of COVID-19: experience report of the Study Center of Hospital “Felício Rocho”

This paper aims to report the experience of the Clinical Librarian in preparation and response to the pandemic of COVID-19, in the Hospital Library of the Study Center of Hospital “Felício Rocho”, in Belo Horizonte, Minas Gerais, Brazil. This is a qualitative and descriptive research that approaches the role of the Clinical Librarian in the context of the Hospital Library in the Brazilian scenario. For this, the Library is described, the services offered to the medical team, the opportunities and challenges of the Clinical Librarian, the need for training and the partnership with the front-line medical team of COVID-19. The Clinical Librarian played an important role in supporting decision making in facing the pandemic of COVID-19. Thus, the experience report seeks a contribution to Information Science in facing a pandemic and lessons learned from Clinical Librarian. © 2022, Centro Nacional de Informacion de Ciencias Medicas. All rights reserved.

Kinetics of humoral immunodeficiency with bispecific antibody therapy in multiple myeloma

Background: Bispecific antibodies (bsAb) are a promising class of therapeutics in RRMM. While hypogammaglobinemia (HGG) is anticipated due to plasma cell depletion, there is a lack of information about the degree of secondary immunodeficiency and resultant infectious complications. We investigated the kinetics of HGG in patients with RRMM on bsAb therapy. Methods: We identified and followed 42 patients treated on early clinical trials of bsAb at our institution between 2019 and 2021. Serial immunoglobulin levels and infections were obtained from the start of therapy until last follow up or 3 months after study exit. Results: 49 treatment courses were included from 42 individual patients. All patients were triple class exposed with a median of 5 prior lines of therapy. The median age was 67 (44-85) years, with 49% females. African Americans accounted for 18% of patients. 96% of patients had at least one prior ASCT. 90% of patients received bsAb targeting BCMA including 7 patients who received more than one line of BCMA targeting therapies. At a median follow up 9.5 (0.9-28.6) months, 40.8% of patients remained on bsAb therapy. At the start of therapy, the median IgG, IgA, and IgM levels were 560 (44-9436), 15 (5-3886) and 6 (5-64) mg/dL, respectively and 50% of patients had severe HGG (≤400mg/dl). Serum IgG levels reached a nadir at 3 months while, IgA and IgM at 1 month, from the start of therapy. The median nadir levels of IgG were 159 (40-2996) mg/dL, while it was < 5 mg/dL for both IgA and IgM. IgG levels were below the detectable range (< 40 mg/dl) in 28% of patients at some point during therapy. IgA and IgM were also below the detectable range (< 5 mg/dl) in 50% and 60% of patients, respectively. At last follow-up, the median IgG levels were 444 (40-1860) mg/dL and IgA 5 (5-254) mg/dL and IgM 5 (5-44) mg/dL. Additionally, 38% of patients remained severely hypogammaglobinemic. 57% (24/42) of patients received IVIG supplements in the current series. About 71% of patients had at least one infectious event and the cumulative incidence of infections progressively increased with increasing duration of therapy with risk at 3, 6, 9 12, 15 months being 41%, 57%, 64%, 67% and 70%, respectively. Among these, 54% of infection were bacterial. Viral infection accounted for 41% of infections. A third of patients had new infectious events during the first 90 days following stopping bsAb treatment. 57% (8/14) of patients did not mount a response to the primary COVID19 immunization series. Among the five patients with repeat antibody titers after the booster dose, 50% were still not able to mount an antibody response. Conclusions: bsAb therapy in RRMM can be associated with profound and prolonged HGG. The cumulative risk of infection correlated with the degree of HGG and progressively increases with treatment and persisted months after being off therapy. Additionally, an impaired antibody response to the COVID-19 immunization series was also noted.