Dois Pacientes Com Sindrome De Guillian-Barre Apos Infeccao Por Sars-Cov-2

Objetivos: Descricao de dois casos de Sindrome de Guillain-Barre (SGB) possivelmente relacionados ao SARS-CoV-2. Materiais e metodos: Avaliacao dos achados clinicos e laboratoriais em pacientes que evoluiram com a SGB apos a infeccao por SARS-CoV-2. Resultados: 1degree. Homem de 56 anos, com lupus eritematoso sistemico e insuficiencia renal cronica, apresentou PCR nasofaringeo positivo para Covid-19, em 7 de setembro de 2021. Evoluiu com insuficiencia respiratoria 10 dias apos a admissao no hospital, porem com evolucao progressive, comprometimento neurologico, com parestesia dos pes/maos e abolicao dos reflexos tendinosos. O liquido cefalorraquidiano deste paciente demonstrou dissociacao albumino-citologica e o padrao eletrofisiologico foi compativel com doenca desmielinizante. O paciente nao apresentou melhora apos tratamento com esteroides e imunoglobulina intravenosa, e vinte dias apos seus primeiros sintomas neurologicos, iniciamos o tratamento com 5 plasmaferese terapetica (PFT), 1 procedimento/dia, com troca de uma volemia plasmatica. Apos 3 sessoes de PFT, houve melhora clinica significativa, inclusive no exame neurologico do paciente. 2degree. Mulher de 22 anos, previamente higida, apresentou infeccao respiratoria superior e PCR nasofaringeo positivo para Covid-19, em 10 de janeiro de 2022. Apos 3 dias do diagnostico, esta paciente apresentou parestesia ascendente progressiva simetrica. A avaliacao eletrofisiologica comprovou uma polineuropatia desmielinizante segmentar e o exame do liquido cefalorraquidiano mostrou dissociacao albumin-citologica. O tratamento com pulsoterapia com corticoides e imunoglobulina endovenosa nao mostrou resultado satisfatorio nesta paciente, que evoluiu com caracteristicas autonomicas e insuficiencia respiratoria aguda. Portanto, foi necessario iniciarmos o protocolo institucional de PFT, 1x/dia, com troca de uma volemia plasmatica. Apos a quarta PFT, o exame clinico neurologico da paciente apresentou melhora significativa, podendo inclusive ser extubada. Finalizamos o tratamento com mais quatro PFTs adicionais ate alta hopsitalar da mesma para reabilitacao. Conclusao: A SGB e uma doenca paralitica flacida aguda com fraqueza progressiva simetrica e arreflexia, geralmente ocorre apos uma infeccao respiratoria ou gastrointestinal, com apresentacao variando entre 3 e 50 dias. O suposto mecanismo fisiopatologico e uma resposta autoimune aberrante que evoca uma reacao cruzada contra os antigenos dos nervos perifericos. Nesses dois casos acima, as caracteristicas epidemiologicas, clinicas e os achados laboratoriais sugerem que a infeccao por SARS-CoV-2 pode ser mais uma infeccao viral causadora de GBS. A resposta ao tratamento com TPE em ambos os pacientes foi positiva e gratificante. Copyright © 2022

BS Team: Finding Competence Gaps

The academy form competences to work in the routine, without worries, without unknown hazards. The rules and objectives in routine activities are clear and require operational discipline to control the cost of production and product quality. The current educational model does not prepare society and groups for an emergency or even for decisions in a crisis, where resources are scarce mainly because the necessary knowledge about danger and its mechanism of action is lacking. What really happens in the chain event scenario when the danger is unknown? What are the typical models of action of the emergency leader and his team? What are the required actions in crisis management required for a BS type event considering the scarce resources, the high level of stress and the direction of the danger energy? Which models are indicated for the situation of unknown danger and its intense energy flow with high impacts during these events? What is the appropriate mind map of those who lead and execute the actions considering the low level of visibility in the events and the dynamic of geopolitics in the BS scenario where, depending on the preparation for emergency, in case of intense demand for attention and action, possible modifications may occur in the map mental for decisions? This work intends to review the discussions already performed about new concepts and tools to be used in the crisis prevention area. Between this works we will understand the effect of the stress level on emergency decisions valuating human error and observing team response using LODA tool. The Human elements designed in the organizational culture, can stop the high danger energy that can flow from some industries. The principal aspects to be constructed and monitored are technology (risk and complexity);management (leadership and stress);and behavior (cooperation, commitment, competence, and communication). By the other hand, human factors are analyzed to avoid situations which hazard energy carriers during top events, as the effect of cultural aspects to chain reaction until the occurrence of disaster. Decision models for the emergency brigade (leader and team) indicate the motor and cognitive gaps that cause lack of control during contingencies. Finally, the analysis of simulation types, by rotating observation of field simulation allow find the deficiencies of the emergency team in a real situation in the future. The methodology divided in following steps are dynamic: first, rescue the discussions about stress and the BS events and, in second step, recognize the intense hazard energy flow through failure events, antecedents, elements and human factors. In third step, we try to locate the gaps and environmental conflicts influencing losses from accidents. Finally, we assess the current event of covid-19 pandemics to suggest correct emergency preparedness actions in the preparation of leaders and their teams regarding cognitive and motor characteristics in situations of high demand. When comparing the characteristics already described by TALEB about BS with the event COVID-19, we intend to carry out a case study to indicate the possible causes this global impact crisis, or even, understand the technological disaster causes where uncontrolled events from chemical, nuclear, and oil industry begins chain reactions until the disaster. Unfortunately, a Crisis situation can be caused from several intricated dimensions, making difficult the contingency and mitigation actions. © 36th Center for Chemical Process Safety International Conference, CCPS 2021 - Topical Conference at the 2021 AIChE Spring Meeting and 17th Global Congress on Process Safety.

BS Team: Finding Competence Gaps

The academy form competences to work in the routine, without worries, without unknown hazards. The rules and objectives in routine activities are clear and require operational discipline to control the cost of production and product quality. The current educational model does not prepare society and groups for an emergency or even for decisions in a crisis, where resources are scarce mainly because the necessary knowledge about danger and its mechanism of action is lacking. What really happens in the chain event scenario when the danger is unknown? What are the typical models of action of the emergency leader and his team? What are the required actions in crisis management required for a BS type event considering the scarce resources, the high level of stress and the direction of the danger energy? Which models are indicated for the situation of unknown danger and its intense energy flow with high impacts during these events? What is the appropriate mind map of those who lead and execute the actions considering the low level of visibility in the events and the dynamic of geopolitics in the BS scenario where, depending on the preparation for emergency, in case of intense demand for attention and action, possible modifications may occur in the map mental for decisions? This work intends to review the discussions already performed about new concepts and tools to be used in the crisis prevention area. Between this works we will understand the effect of the stress level on emergency decisions valuating human error and observing team response using LODA tool. The Human elements designed in the organizational culture, can stop the high danger energy that can flow from some industries. The principal aspects to be constructed and monitored are technology (risk and complexity);management (leadership and stress);and behavior (cooperation, commitment, competence, and communication). By the other hand, human factors are analyzed to avoid situations which hazard energy carriers during top events, as the effect of cultural aspects to chain reaction until the occurrence of disaster. Decision models for the emergency brigade (leader and team) indicate the motor and cognitive gaps that cause lack of control during contingencies. Finally, the analysis of simulation types, by rotating observation of field simulation allow find the deficiencies of the emergency team in a real situation in the future. The methodology divided in following steps are dynamic: first, rescue the discussions about stress and the BS events and, in second step, recognize the intense hazard energy flow through failure events, antecedents, elements and human factors. In third step, we try to locate the gaps and environmental conflicts influencing losses from accidents. Finally, we assess the current event of covid-19 pandemics to suggest correct emergency preparedness actions in the preparation of leaders and their teams regarding cognitive and motor characteristics in situations of high demand. When comparing the characteristics already described by TALEB about BS with the event COVID-19, we intend to carry out a case study to indicate the possible causes this global impact crisis, or even, understand the technological disaster causes where uncontrolled events from chemical, nuclear, and oil industry begins chain reactions until the disaster. Unfortunately, a Crisis situation can be caused from several intricated dimensions, making difficult the contingency and mitigation actions. © 2021 American Institute of Chemical Engineers. All rights reserved.

ASPECTOS EPIDEMIOLÓGICOS DA COVID-19 EM PACIENTES COM DOENÇA ONCO-HEMATOLÓGICA ATENDIDOS EM HOSPITAIS UNIVERSITÁRIOS DA GRANDE VITÓRIA: EXPERIÊNCIA DE 12 MESES

Objetivo: Descrever os dados epidemiológicos da COVID-19 em pacientes onco-hematológicos em dois centros de tratamento do Espírito Santo. Métodos: Estudo retrospectivo utilizando dados de prontuário dos aspectos epidemiológicos da COVID-19 em pacientes onco-hematológico atendidos no Hospital Santa Casa de Misericórdia de Vitória (HSCMV) e Hospital Universitário Cassiano Antônio Moraes (HUCAM), no período de fevereiro/2020 a fevereiro/2021. Resultados: Avaliado, no período de 12 meses, 406 pacientes com neoplasias hematológicas, sendo 195 HSCMV e 211 HUCAM. Identificados 36 pacientes com COVID 19 sendo 44% (16) HUCAM e 56% (20) HSCMV. Quanto ao sexo: 33% (12) feminino e 67% (24) sexo masculino. A média de idade foi 56 anos, menor idade 23 e maior 82. Em relação ao diagnóstico hematológico: 22% (8) leucemia aguda, 14% (5) mieloma múltiplo, 8% (3) SMD, 14% (5) doença mieloproliferativa crônica, 14% (5) linfoma de baixo grau e 28% (10) de alto grau. As comorbidades de risco para COVID estavam presentes em 47% (17), com predomínio da Hipertensão arterial 36% (13). Considerando a linha temporal os meses de maior incidência foram: maio (8), junho (5) e julho (6), agosto (5). A maioria dos diagnósticos foi por RT-PCR,porém16% (6) por sorologia. Em relação à provável fonte de contaminação 39% (14) estavam internados por outros motivos quando desenvolveram sintomas de COVID, 14% (5) relatavam contato com paciente positivo, os outros 47% (17) adquiriram por provável infecção comunitária. Boa parte dos pacientes estavam em quimioterapia 39% (14) ao diagnóstico de COVID. Quadros classificados como COVID grave pelos critérios do MS foram observados em 53% (19), mas 55% (20) necessitou de UTI, destes a maioria (15) precisou de ventilação mecânica. 92% (33) tinham anemia, no entanto, neutropenia foi observada em apenas 16% (6). A taxa de letalidade por COVID-19 e suas complicações foi 39%. Discussão: Informações sobre a incidência de COVID-19 entre pacientes com câncer são variáveis. Sugere-se maior incidência em pacientes com câncer em relação à população geral, mesmo quando ajustado para fatores de risco, como idade avançada e comorbidades. O risco da COVID-19 parece ser maior para aqueles com câncer hematológico e de pulmão. Dados franceses sugerem maior necessidade de UTI em pacientes oncohematológicos (25%) quando comparados a outros tipos de neoplasia. Os dados deste estudo demostram maior gravidade quando comparados a outros centros (São Paulo e França), visto a alta taxa de necessidade de UTI e letalidade. É possível perceber a relação do aumento da incidência com os dados de infeções comunitárias regionais, no entanto ainda é relevante o número de pacientes que adquirem a COVID 19 durante a internação por outros motivos. A minoria apresentava neutropenia o que pode sugerir que outros mecanismos de imunossupressão da doença de base possuem maior impacto além da quimioterapia recente. Conclusão: Os dados corroboram que neoplasias hematológicas possuem piores desfechos comparados a dados de literatura para outros tipos de câncer e para população geral reforçando a necessidade de reavaliar as medidas de prevenção/proteção já adotadas. Estratégias diferenciadas de testagem durante internação podem propiciar diagnóstico precoce prevenindo contaminações nas enfermarias. Estudos de eficácia da vacinação nestes pacientes podem ser importantes para abordagem diferenciada de esquema vacinal permitindo melhor proteção para casos graves de COVID -19.

A Novel Web Platform for COVID-19 diagnosis using X-Ray exams and Deep Learning Techniques

Modern computer vision techniques applied to radiographic studies are presented as an alternative to assist the specialist in screening and diagnosing the respiratory syndrome (SARS-CoV-2), assisting in clinically severe cases, such as acute pneumonia, acute respiratory failure, organ failure, and death. This work proposes a screening method based on the Internet of Medical Things (IoMT) based on deep learning techniques for the classification of COVID-19 from chest X-ray (CXR) exams. The proposed system called Computer-Aided Remote medical diagnostics System (CARMEDSys) applied to the diagnosis of COVID-19 consists of three main stages: 1) segmentation of the lung region in X-ray images, 2) deep extraction of attributes from the filtered pulmonary area and 3) Prediction patient status with machine learning assistance. The performance of CARMEDSys was evaluated considering twelve different deep neural networks, via the transfer of learning. Besides, the performance of this approach is evaluated against recent studies for the classification of healthy patients, with pneumonia, or with COVID-19. The evaluation methodology considered two different sets of radiographic images, reaching Sensitivity (99.97%), F1-Score (99.43%), and Accuracy (98.89%) promising to distinguish patients with pneumonia and COVID-19 combining DenseNet201 as attribute extractor with Support Vector Machine with radial basis function, exceeding up to 12.31% sensitivity for prediction of COVID-19 recent related works.

Crisis Decision Tool, Fighting Against COVID-19

Historically, crises have left consequences increasingly greater and more difficult to control, which can reach socioeconomic, environmental, geopolitical, and cultural relations globally, generating Black Swans. This work intends to discuss the appropriate tools to better manage the pandemic through a critical and inductive observation of the pandemic caused by COVID-19 in Brazil, definition of indicators and protocols and the implementation of a Crisis Committee. In Brazil, this scenario is marked by the denial of the pandemic existence, underreporting and the lack of communication between public governments. This situation shows the unpreparedness of national management to deal with the event, which is reflected in the state of Rio de Janeiro. Then, mechanisms that can prepare managers for the crisis in a dynamic process, in a proactive and preventive manner must be developed, promoting awareness of the barely visible signs that increase the risks of these events and avoiding human errors. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The impact of COVID-19 pandemic in the quality of sleep by Pittsburgh sleep quality index

This article aims to evaluate the sleep quality in individuals during the COVID-19 pandemic by Pittsburgh Sleep Quality Index (PSQI). Searches were conducted in the PubMed, Embase, Web of Science, and PEDro databases, on May 22, 2020. In the publications, 208 articles were found and, considering the eligibility criteria, 10 articles were included at the end, showing the effects on sleep quality during the pandemic, in populations hospitalized, quarantined, and in frontline health professionals. The PSQI measured sleep disorders and a higher score indicated poor sleep quality. Nine articles were classified with evidence level IV and one as level III-2. Eight studies present a "serious" risk of bias and two in "moderate". The studies investigated different populations and described the results as "poor" sleep quality, considering the PSQI on quarantined individuals and frontline health professionals as the most committed. A poor sleep quality was found in the populations evaluated in the selected publications, probably, due to the COVID-19 to contribute as a risk factor for mental health. Psychological interventions must be made to minimize the consequences through social support and social capital.

USE OF THE INTERNET AND SOCIAL NETWORKS IN ORTHOPEDICS AND TRAUMATOLOGY AND PERSPECTIVE OF POST COVID TELEMEDICINE

The internet has been changing the doctor-patient relationship in the orthopedic area, especially in recent months, due to the COVID-19 pandemic. Objective: To gather information on the use of social networks regarding orthopedics and traumatology, as well as patient opinions on telemedicine. Methods: Cross-sectional study with 237 patients discharged from the orthopedics outpatient clinic of the Odilon Behrens Metropolitan Hospital, in service exclusively for the SUS, answered a questionnaire containing questions related to the use of the internet, social networks, and telemedicine in the current context. Results: Most participants never or rarely look for information on the internet before or after the medical appointment;but when they do, the search results are rarely enlightening. There was a lower demand for information among men when compared with women. There were no significant differences regarding the age of the participants who agreed that most appointments will be carried out over the internet in the future. Conclusion: The search for medical information on social networks is a global reality, but it still generates disagreements regarding its effectiveness and scope. More studies are needed in different orthopedic services for further analysis on the use of social networks within this field. Level of Evidence IV, Case Series. © 2022, Acta Ortopedica Brasileira. All Rights Reserved.