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BackgroundSome individuals may have persistent symptoms after COVID-19, a new condition known as long COVID-19. However, these complaints can be misunderstood with disease activity in patients with immune-mediated rheumatic diseases (IMRD), especially fatigue and mental distress.ObjectivesTo evaluate fatigue, depression, anxiety, and stress in IMRD patients after 6 months of COVID-19, compared with IMRD patients without COVID-19.MethodsThe ReumaCoV Brasil is a longitudinal study designed to follow-up IMRD patients for 6 months after COVID-19 diagnosis (cases) compared with IMRD patients no COVID-19 (controls). Clinical data, such as age, sex, comorbidities, as well as disease activity measurements and current treatment regarding IMRD, and COVID-19 outcomes were evaluated in all patients. The FACIT questionnaire (Functional Assessment of Chronic Illness Therapy) and the DASS 21 (Depression, Anxiety and Stress Scale - 21 Items) were applied at 6 months after COVID in both groups.ResultsA total of 606 IMRD patients were included, of whom 322 (53.1%) cases and 284 (46.9%) controls. Most patients were female (85.3%) with mean age 46.1 (13.0) years old. Specific disease activity were similar between cases and controls. There was a significant difference between FACIT scores and 3 domains of DASS-21 comparing cases and controls (Figure 1). The factors associated with FACIT were female gender, diabetes, obesity, no comorbidities, COVID manifestations (skin, joint pain, asthenia, diarrhea, and dyspnea), and chronic oral corticosteroid use. DASS-21 Depression was associated with these same factors. Female gender, COVID manifestations as skin, joint pain, asthenia, cough, dyspnea, and chronic oral corticosteroid use were associated with DASS-21-Anxiety. DASS-21 Stress was associated with female gender, asthenia, diarrhea, dyspnea, cough, chronic oral corticosteroid use, and hospitalization. Table 1 shows the variables that remained in the models after the univariate logistic analysis. A weak correlation between disease activity and FACIT was observed in rheumatoid arthritis (p=0.010;r2 = 0.035) and ankylosing spondylitis patients (p=0.010;r2 = 0.129). No other correlations were observed between the scores results and disease activity (patient's global assessment - PGA), medications or specific IMRD.ConclusionFatigue and mental changes such as depression, anxiety, and stress, occurred more frequently in IMRD patients who had COVID-19 than in those who did not have COVID-19, especially in women, regardless of disease activity score. Fatigue was more related to female gender, diabetes, obesity, and current joint pain. Mental impairment was more associated with severity of COVID-19, including respiratory and non-respiratory symptoms.Figure 1.Comparison between cases and controls of FACIT and DASS-21 depression, anxiety, and stress scoresFACIT (Functional Assessment of Chronic Illness Therapy);DASS-21 (Depression, Anxiety and Stress Scale - 21 Items):Table 1.Final model using binary Logistic Regression analysis to evaluate the preditive factors associated with FACIT and DASS-21 scoresFACIT Score ≤ 37 x score > 37§DASS-21-DEPRESSION Score ≤ 6 (normal/mild) x score > 6 (moderate/severeDASS-21-ANXIETY Score ≤ 5 (normal/mild) x score > 5 (moderate/severe)DASS-21-STRESS Score ≤ 9 (normal/mild) x score > 9 (moderate/severeVariableP-valueOR (CI 95%)VariableP-valueOR (CI 95%)VariableP-valueOR (CI 95%)VariableP-valueOR (CI 95%)Female0.151.83 (1.12-2.98)No comorbidities0.0290.66 (0.46-0.95)Joint pain0.0022.44 (1.39-4.26)Female0.0122.31 (1.20-4.46)Diabetes0.0062.35 (1.28-4.32)Joint pain**0.0012.58 (1.57-4.22)Dyspnea0.0013.61 (2.11-6.19)Dyspnea0.0013.69 (2.09-6.51)Dyspneia0.0012.00 (1.23-3.26)Dyspnea0.0012.82 (1.79-4.44)Oral CE0.0141.55 (1.09-2.21)Joint pain0.0052.20 (1.41-3.43)Oral CE0.0481.41 (1.00-1.99)§Lower scores mean worse fatigue;CE: corticosteroid;OR: odds ratio;CI: confiance intervalAcknowledgementsReumaCoV Brasil researchers, Brazilian Rheumatology Society and National Council for Scientific and Technological Deve opment.Disclosure of InterestsNone Declared.
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Purpose: In December 2019, the Covid-19 pandemic began in the world. To reduce mortality, in addiction to mass vaccination, it is necessary to massify and accelerate clinical diagnosis, as well as creating new ways of monitoring patients that can help in the construction of specific treatments for the disease. Objective: In this work, we propose rapid protocols for clinical diagnosis of COVID-19 through the automatic analysis of hematological parameters using evolutionary computing and machine learning. These hematological parameters are obtained from blood tests common in clinical practice. Method: We investigated the best classifier architectures. Then, we applied the particle swarm optimization algorithm (PSO) to select the most relevant attributes: serum glucose, troponin, partial thromboplastin time, ferritin, D-dimer, lactic dehydrogenase, and indirect bilirubin. Then, we assessed again the best classifier architectures, but now using the reduced set of features. Finally, we used decision trees to build four rapid protocols for Covid-19 clinical diagnosis by assessing the impact of each selected feature. The proposed system was used to support clinical diagnosis and assessment of disease severity in patients admitted to intensive and semi-intensive care units as a case study in the city of Paudalho, Brazil. Results: We developed a web system for Covid-19 diagnosis support. Using a 100-tree random forest, we obtained results for accuracy, sensitivity, and specificity superior to 99%. After feature selection, results were similar. The four empirical clinical protocols returned accuracies, sensitivities and specificities superior to 98%. Conclusion: By using a reduced set of hematological parameters common in clinical practice, it was possible to achieve results of accuracy, sensitivity, and specificity comparable to those obtained with RT-PCR. It was also possible to automatically generate clinical decision protocols, allowing relatively accurate clinical diagnosis even without the aid of the web decision support system. © 2023, The Author(s), under exclusive licence to The Brazilian Society of Biomedical Engineering.
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Introduction The use of fingolimod as a long-term therapy in people with Multiple Sclerosis (PwMS) is associated with a small increase in the risk of herpes virus reactivation and respiratory tract infections. At the moment, the outbreak of the novel coronavirus SARS-CoV-2 brings new challenges to physicians when deciding to continue or stop the treatment with fingolimod. Objective We report one MS patient tested positive for SARS-CoV-2 that has not discontinued fingolimod treatment and developed only mild symptoms from COVID-19. Method(s): Descriptive observational study. Discussion and conclusion The effects of COVID-19 infection on MS patients treated with fingolimod are still uncertain. This case report outlines promising results by demonstrating a patient who didn't stop the fingolimod treatment during COVID-19 infection and developed only mild symptoms. Nevertheless, more studies are necessary to evaluate the risks and benefits of fingolimod in MS patients infected with COVID-19.Copyright © 2022 The Authors
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Brazil produces only 5% of the active pharmaceutical ingredients needed to the manufacture of medicines. Recent changes on regulations and the COVID-19 pandemic could open the Brazilian market to a new window of opportunity where continuous manufacturing can play an important role to secure pharmaceutical supply chain. © 2022 TeknoScienze. All rights reserved.
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Objective: To identify and map strategies to increase vaccine uptake in pregnant and breastfeeding populations with the aim of informing practice and strategies to increase vaccination uptake in this group. Study Design: We conducted a scoping review of the literature wherein we used a comprehensive search algorithm to identify relevant publications indexed in six electronic databases. We included studies that reported on pregnant and breastfeeding individuals, examined an intervention to improve vaccine uptake, and reported outcomes related to change in vaccine attitude, perspective, intention, behaviour, or uptake. Interventions were mapped using a five-level social ecological framework (intrapersonal, interpersonal, institutional, community, and policy level) or as bundled interventions, when strategies targeted multiple levels. Result(s): The search yielded 5458 publications after deduplication, of which 63 were included in the final review. Included studies reported mostly on the uptake of influenza, pertussis, tetanus toxoid and COVID-19 vaccines in 17 high- and middle-income countries. Studies varied in terms of design, sample size, scope and study output (Table 1) and described interventions corresponding to all levels of the social ecological framework (Figure 1). Most studies (33.3%) described using bundled interventions, although intrapersonal (31.7%) and institutional (15.9%) strategies were also widely employed. While the reported uptake (5% to 93%) varied based on comparator group, vaccine type, country and intervention(s), most strategies were deemed effective when implemented in the context of experimental and observational studies. Conclusion(s): The published literature points to several successful strategies for increasing vaccine uptake among pregnant and breastfeeding individuals. Incorporating these strategies into guidelines and protocols could increase the uptake of routinely recommended and new (COVID-19) vaccines in this population. [Formula presented] [Formula presented] Copyright © 2022
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CONTEXT The ongoing coronavirus pandemic required us to quickly adapt and familiarise ourselves with new skills and technologies in the shift to online teaching. Irregular communication due to extended lockdowns has meant that while knowledge on effective online teaching has been developed, this knowledge has not been properly disseminated to our junior teaching staff. As they operate predominantly in student-facing positions, it is essential that our junior staff be equipped with information on best practice in online teaching as well as with an awareness of the resources available to support them. PURPOSE OR GOAL To address the gap outlined above, we developed a new professional development program for our junior teaching staff, focusing mainly on online teaching. The goal was to share our collective knowledge on best practice in online teaching, and to demonstrate how various technologies could aid in promoting active learning in an online setting. The program also aimed to initiate a community of practice around teaching and the online teaching space. APPROACH OR METHODOLOGY/METHODS In designing our program, we considered student feedback from previous semesters, and more recent feedback on the online teaching experience from 2020. The final program covered the following topics: general advice, navigating Zoom and physical setup for online teaching, online tools for active learning, engagement within teaching teams, online feedback, and blended synchronous learning. Tools and technologies showcased in the program were embedded in the delivery to allow first-hand experience. ACTUAL OR ANTICIPATED OUTCOMES An exit survey indicated that in general, participants found the program useful, with an average rating of 8.27 (out of 10). The top areas that participants indicated that they would like more assistance were quizzes and tools for active learning (31%), providing feedback to students (22%), and blended synchronous learning (20%). Zoom (12%) and the physical setup for online teaching (15%) did not rank highly, in line with our observation that a large percentage of participants had some prior experience with online teaching in 2020. CONCLUSIONS/RECOMMENDATIONS/SUMMARY In summary, we piloted a professional development focused mainly on online-teaching for junior staff. The program was well-received, and the collected feedback will used for implementation and improvement of future run. Copyright © Lionel Lam, Raquel de Souza, Catherine Sutton, Eduardo Araujo Oliveira, Glen Currie, Ryan Hoult, Leila Meratian Esfahani, Leigh Canny, Christopher Honig, and Gavin Buskes, 2021.
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Objective: To implement a telerehabilitation prevention, treatment, and follow-up physical therapy protocol for monitoring individuals with Parkinson ' s disease (PD) and to verify its effectiveness in minimizing the deleterious effects of the COVID-19 pandemic. Design: Prospective case series, involving 40 participants with mild to moderate PD recruited from a specialized neurorehabilitation group. The study was divided into four parts: (1) Phone calls to assess the feasibility of participating in remote physical therapy. (2) Social media training. (3) Baseline and post-intervention assessment for functional lower extremity strength, fear of falling, quality of life, depression, anxiety, activities of daily living, verbal fluency. (4) Intervention protocol consisting of 20 remote weekly physical therapy sessions, graphic material for physical and cognitive training, social activities, and education. Conclusion: The telerehabilitation protocol was viable and effective for patients with PD as an alternative to in-person treatment during the COVID-19 pandemic.
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Objective: To describe 2 cases of autoimmune neutropenia (AIN) patients infected with Sars-Cov-2. Design/Method: Two subjects case report. Result(s): Case report 1: A girl with primary AIN since 1 year and 10 months old, maintaining severe neutropenia and mild recurrent infections. Presented to the emergency department in June/2020, at 3 years and 8 months old, with flu-like symptoms, afebrile, in good general condition. Physical examination was normal. The absolute neutrophil count (ANC) was 0.279 x 109/L. At hospital admission, Sars-Cov-2 (RT-PCR) tested positive and filgrastim (G-CSF) 5 mug/kg/day was initiated. Chest X-ray was also normal and blood culture resulted negative. She remained in great general condition, afebrile, and was discharged on the 2nd day of hospitalization, with clarithromycin (15 mg/kg/day). After G-CSF, ANC: 0.494 x 109/L (1st dose), 1.431 x 109/L (2nd dose). On outpatient follow-up, she had no long-term complications from Covid-19. Case Report 2: A man with chronic immune thrombocytopenia purpura (ITP) since 2008, autoimmune hemolytic anemia since 2013, evolved with AIN on May/2020, at 42 years old, with ANC lower than 0.5 x 109/L. On 6/1/2020, he had ANC 0.170 x 109/L. On 6/25/2020, he started flu-like symptoms, had ANC of 5.118 x 109/L, and tested positive for Sars-Cov-2 (RT-PCR). He kept high fever (102,2degreeF) and was hospitalized for 10 days without use of G-CSF. After discharge, on outpatient follow-up, he had no long-term complications from Covid-19, and presented ANC 0.338 x 109/L (Aug/2020). Discussion(s): At beginning of Covid-19 pandemic, severity infection in children was unknown. Today is known that most of them have milder clinical course, regardless of chronic diseases. In adults, in contrast, the inflammatory response tends to exacerbation, with more severe clinical conditions. Furthermore, many case reports of patients infected by SARS-CoV-2 with comorbidities literature are published. However, to date there are no reports on the impact of COVID-19 in AIN patients. Increased neutrophil counts during infectious episodes are common in AIN, which appears to be related to the benign course of most infections. We reported 2 cases of AIN patients diagnosed with Covid-19, both with favorable clinical outcomes despite heterogenic clinical course. On the first case, she presented few symptoms and ANC increased only after using G-CSF. On the second reported patient, there was a spontaneous increase of ANC and greater inflammatory response than the first case. It could suggest a correlation between inflammatory response to COVID-19 and ANC in cases of autoimmune neutropenia. Conclusion(s): In the reported cases, clinical course of disease and neutrophil count were different between adult and pediatric patients. It is not possible to state whether this difference is due to age group, individual response to infection or other variables. It is important to assess other cases of AIN infected by COVID 19 to better understand correlation between severity of infection and neutrophil count response. Copyright © 2022
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This research aimed to identify the perception of parents about changes in their parenting practices and their impact on their children, aged 6 to 12 years, during the Covid-19 pandemic. This is a descriptive and qualitative study developed from the application of a Likert-type questionnaire with 26 items, which were answered by 35 participants who met the inclusion criteria. The results indicate that the most prevalent parenting practices during the pandemic context were positive monitoring and moral behavior, to the detriment of those considered negative, such as negligence, relaxed discipline, inconsistent punishment and negative monitoring. Data analysis also highlighted the predominance of the authoritative parenting style to resolve conflicting situations. It was possible to identify that, even in a challenging scenario, most parents sought dialogue and affection as a means to resolve the conflicts that arose with their children during social isolation and so many other adversities brought about by the pandemic.
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COVID-19 pandemic has resulted in excess mortality globally and presented an unprecedented challenge to people's lives. Despite the benefits of getting a COVID-19 vaccine, there have been arguments against the available vaccines and vaccine hesitancy worldwide. In this work, we analyze the information published by the public on Reddit as a digital forum, using unsupervised natural language processing to discover useful insights from the collected data related to COVID-19 vaccines, and validate the results of our study using Google Trends. Our results show that the government's contributions to the vaccination process, vaccine side-effects, and opposition to vaccine mandate and lock-downs are the main concerns shared by the public on digital forums. Moreover, we provide our collected data publicly available for further infodemiology studies by researchers and practitioners. © 2022 IEEE.
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The coronavirus (Covid-19) pandemic represented a challenge to physical and emotional health for adolescents subjected to almost two years of social isolation, restricted to family life and prevented from being in school. This article presents data from the pandemic associated with emotional distress among adolescents and the impact of restricted school life in this period. This is an exploratory, descriptive research, whose objective was to identify the frequency of situations in which there are signs of emotional distress in adolescents and to compare the scores found between demographic profile issues (race, gender and smartphone use). A total of 1,991 adolescents participated in the sample, students from two directorates of the Sao Paulo state public education network. The investigation instrument was built from a broad literature review in the form of a questionnaire with closed questions, divided into two parts: the first, containing 13 questions about the student's profile and, the second, with 21 questions, about signs of emotional suffering. From the quantitative analysis, the results found highlight a higher score of emotional distress among adolescent girls and black students and point to the urgency of actions that provide welfare and the learning of assertive forms of conflict resolution, as well as the urgency of spaces for expression of feelings by students.
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Background: The COVID-19 pandemic may affect youth's physical and mental well-being, partially because of the countries' rules to contain the virus from spreading. However, there is still uncertainty about the impact of physical distancing on youth's mental health. We aimed to estimate the prevalence of feeling agitated, anxious, down, sad, or low mood (FNF) due to physical distance measures and verify which factors are associated with young Portuguese and Brazilian people. Methods: We used cross-sectional data from the instrument "COVID-19 Barometer: Social Opinion"in Portugal (March 2020 and September 2021) and from "COVID-19 Social Thermometer"in Brazil (August 2020 to April 2021);these surveys included data regarding the health and socioeconomic impact on the population. The health and sociodemographic variables of the two countries were summarized as absolute and relative frequencies. A multivariable logistic regression model was fit by country to estimate the relation between FNF and selected variables of interest. Results: Approximately 36% of the sample studied reported anxiety, agitation, sadness, or low mood almost every day in Portugal and 52% in Brazil due to physical distancing. In Portugal, having more than two comorbidities represented a greater chance of experiencing FNF every day or almost every day (odds ratio [OR] = 1.51 [CI: 1.22-1.87]) than those without comorbidities. In contrast, having a university education level represented a protector factor (OR = 0.76 [CI: 0.67-0.88]). In Brazil, being unemployed increased the chance of FNF compared to students (OR = 11.2). Conclusions: Physical distancing measures have impacted the mental well-being of the young population in Portugal and Brazil. The countries must make a quick effort to attend to and protect young people's well-being and mental health in the changing context of the current pandemic.
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Our world is at a turning point with biological and social pathogens wreaking havoc at the same time that science and technology are exploding with new discoveries. It is a pivotal time for the new report Oral Health in America: Advances and Challenges to be released and a pivotal time for our profession to take action and lead. The art, science, and practice of dentistry is very different from 20 y ago when the original Surgeon General's report was released. We are on the precipice of individualized health care where providers will collaborate to deliver diagnostics and therapeutics that are data driven and inclusive of the social determinants of health. To move forward with alacrity requires a strong scientific foundation, effective educational approaches, an understanding of the upstream determinants of health, and partnerships across the health professions and beyond. Oral health has never been more important, and now is the time for our profession to further develop, elevate, and translate the science into practice and policy to improve the nation's health.
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Oral HealthABSTRACT
O termo DRESS (drug rash with eosinophilia and syste- mic symptoms – erupcao a droga com eosinofilia e sintomas sistemicos) surgiu em 1996, para caracterizar um tipo de reacao de hipersensibilidade a medicamento com caracteristicas sistemicas, que incluia erupcao cutanea grave, febre, linfadenopatia, hepatite e anormalidades hematologicas (hipereosinofilia e linfocitose atipica). Em criancas, esta sindrome e rara, muitas vezes subdiagnosticada, pois seu quadro clinico inespecifico se confunde com muitos outros diagnosticos diferenciais. Em ano de Pandemia em que muitos diagnósticos convergiam para COVID, esse relato de caso faz um diagnóstico diferencial com MIS. Por causa da raridade dessa reacao e da dificuldade e importancia de seu reconhecimento, relata-se o caso de um menino de 13 anos de idade com Síndrome de DRESS secundária a Vancomicina. Relato de caso: Menino admitido na UTI para tratamento de Osteomielite em membro inferior após trauma. Evoluiu com sepse clínica. Durante internação apresentou trombose venosa em sítio de acesso profundo. Iniciado anticoagulação. Persistia febre. Iniciado Vancomicina. Paciente apresentou melhora clínica sendo transferido para enfermaria. Na segunda semana do início da Vancomicina evoluiu com aumento de transaminases, erupção cutanêa importante principalmente em face. Hemograma apresentou eosinofilia e linfocitose atípica. Suspeita de COVID foi feita. Realizado PCR COVID que veio negativo. Suspenso Vancomicina. Trocado esquema antibiótico. Paciente recebeu Imunoglobulina 2g/kg com pouca melhora da lesão de face. ECO mostrava alterações agudas sugestivas de cardite. Paciente recebeu alta fazendo Clexane. No retorno ambulatorial como mantinha lesão em face foi iniciado terapia com corticoide 1mg/kg/dia. Após 30 dias anticoagulação foi suspensa e discutido com Cardiologia uso de AAS. Paciente com 2 meses de corticoide apresentou melhora de lesão cutânea que não retornou após a suspensão do corticoide.Apresentou melhora progressiva da eosinofilia. Realizado sorologia para COVID que demonstrou igG e IgM negativos. A hipótese de Reação a Vancomicina foi feita uma vez que preencheu os critérios para Sindrome de Dress – exposição a medicação, cardite, elevação de enzimas hepáticas, linfocitose atípica, eosinofilia além dos exames para COVID negativo.
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We propose a hierarchical linear method to investigate the effectiveness of social distancing measures. By considering the COVID-19 data as a two-level structure, we are able to demonstrate a significant reduction of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases as a direct consequence of lockdown measures adopted by some states in Brazil. The multilevel modelling is the most appropriate method for the case of Brazil due to the fact that political battles between federal and State government leaders have led to the adoption of lockdown measures with distinct levels of flexibility adopted by each of its 27 states. During the outbreak of such a novel and highly contagious disease, decisions made by policymakers either prevent or increase the number of avoidable deaths. Thus, our results are also potentially useful to convince policymakers to adopt reasonable policy measures to shorten the COVID-19 pandemic in the biggest Latin American country. Copyright © 2022 Inderscience Enterprises Ltd.
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INTRODUCTION: The SARS-CoV-2 (COVID-19) pandemic warranted expanded care via telemedicine across a breath of medical specialties. The aim of the study is to analyze the preferences of caregivers of patients with dementia on the use of telemedicine in monitoring these patients. SUBJECTS AND METHODS: Caregivers and family members responsible for patients with dementia completed an online self-applicable questionnaire, which was distributed in Facebook and WhatsApp groups between April and October 2020. RESULTS: 130 responses were obtained; most caregivers were women (83.8%), of whom 60% were daughters of patients. Most patients were also women (75.3%). Alzheimer's disease caused dementia in 73% of cases. The Internet was accessible to 98% of respondents, yet less than half (33.8%) had used telemedicine at least once. Although 66.9% of caregivers would be willing to use telemedicine if the doctor offered it, 63% believed that the cost of video consultations should be lower than those face-to-face. During the COVID-19 pandemic, 85.3% of caregivers needed to contact the physician: just over half of these consultations were face-to-face (52.2%), but telemedicine was preferred (62.3%) if possible. CONCLUSION: Caregivers accepted and were interested in telemedicine as a tool for monitoring patients with dementia, especially those with walking difficulties.
TITLE: Telemedicina en la monitorización de pacientes con demencia: una perspectiva de cuidadores brasileños.Introducción. La pandemia de SARS-CoV-2 (COVID-19) requirió una atención ampliada a través de la telemedicina en una variedad de especialidades médicas. El objetivo del estudio es analizar las preferencias de los cuidadores de pacientes con demencia sobre el uso de la telemedicina en el seguimiento de estos pacientes. Sujetos y métodos. Los cuidadores y familiares a cargo de pacientes con demencia completaron un cuestionario autoaplicable en línea, que se distribuyó en grupos de Facebook y WhatsApp entre abril y octubre de 2020. Resultados. Se obtuvieron 130 respuestas; la mayoría de los cuidadores eran mujeres (83,8%), de las cuales el 60% eran hijas de pacientes. La mayoría de los pacientes también eran mujeres (75,3%). La enfermedad de Alzheimer causó demencia en el 73% de los casos. Internet era accesible para el 98% de los encuestados, pero menos de la mitad (33,8%) había utilizado la telemedicina al menos una vez. Aunque el 66,9% de los cuidadores estaría dispuesto a utilizar la telemedicina si el médico se la ofreciera, el 63% cree que el coste de las videoconsultas debería ser inferior al de las presenciales. Durante la pandemia de COVID-19, el 85,3% de los cuidadores necesitó contactar con el médico: poco más de la mitad de estas consultas fueron presenciales (52,2%), pero se prefirió la telemedicina (62,3%) si era posible. Conclusión. Los cuidadores aceptaron y se interesaron por la telemedicina como herramienta para el seguimiento de los pacientes con demencia, especialmente los que tenían dificultad para caminar.
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COVID-19 , Dementia , Telemedicine , Brazil , Caregivers , Female , Humans , Male , Pandemics , SARS-CoV-2ABSTRACT
The COVID-19 pandemic has caused a global disruption in society and its healthcare systems. Access to information emerges as an essential tool in combating the pandemic. Technological resources play a central role in providing access to information, for better or worse. They allow almost unlimited and instantaneous access to information. However, false or inaccurate information spreads at high speed, which is especially dangerous in the midst of a pandemic. We have developed and evaluated a chatbot based on selected information from reliable sources to answer questions about COVID-19. We assembled an extensive database of 600 questions about COVID-19 to increase the accuracy, and reliability of the chatbot for Brazilian users. We performed an evaluation of BotCovid regarding its functionality, compatibility and reliability with a group of 52 users, the obtained results indicated high satisfaction with the prototype. Twenty users were randomly selected to evaluate the chatbot's usability, which was analyzed by the System Usability Scale, with an average final score of 83.25, indicating excellent usability. © 2021 IEEE.
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O objetivo desse relato de caso foi demonstrar as particularidades no diagnóstico e possíveis diagnósticos diferenciais em pacientes imunossuprimidos com síndrome febril aguda. Paciente feminina, 37 A, auxiliar administrativo, portadora de artrite reumatoide, imunossuprimida em uso de Simponi associado a Metotrexato 10 mg/semana, com diagnóstico anterior de tumor desmóide em 2016. Após a 2ª dose de Simponi, cursa com quadro agudo de cefaleia de característica persistente, refratária a uso de sintomáticos, acompanhado de náuseas, com queda relativa do estado geral, sudorese de característica noturna, mialgia difusa e episódios recorrentes de febre. Durante esse período foi imunizada com a 2ª dose da vacina para o covid-19. Após a vacinação surgiu nova sintomatologia, disúria isolada. Diante disso, conduzimos com a internação hospitalar para rastreio infeccioso e vigilância clínica. Foi interrogado descompensação infecciosa viral, ITU, reação medicamentosa de suspeição pouco provável e doença hematológica. Foi solicitado laboratório completo, incluindo sorologias virais para citomegalovírus, EBV, parvo vírus, toxoplasmose, leptospirose, hemocultura de 2 amostras de sítios diferentes, EAS e urocultura, ferritina e triglicerídeos devido a febre com alterações de transaminase, aventando um possível quadro viral desencadeado por síndrome hematofágica. Complementando com exames de imagem, como USG de abdome total para avaliar a possibilidade de hepatoesplenomegalia e USG de cervical para avaliar linfonodos. Paciente evolui com piora clínica em vigência de dor abdominal. Solicitada tomografia de abdome, apresentando imagem com vesícula parcialmente distendida, associado à presença de líquido perivesicular, A clínica cirúrgica opta por abordagem invasiva, sendo realizado colecistectomia videolaparoscopia. No pós-operatório, ficando aos cuidados intensivos pela UTI e escalonado para tazocin (D10). Após resultado da sorologia para leptospirose com IgM reagente interrompeu uma longa série de exames negativos e febre prolongada, sem diagnóstico. Apresentou evolução clínica satisfatória, resultando em alta hospitalar. A artrite reumatoide é acompanhada de sintomas constitucionais inespecíficos, principalmente a febre baixa em pacientes imunossuprimidos. O diagnóstico de leptospirose foi concluído mais tardiamente, quando os exames da admissão foram disponibilizados. Um caso de uma enfermidade de alto impacto, contudo negligenciada como problema de saúde pública.
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Introduction Traditional classrooms with limited flexibility in cell phones and social platforms like Twitter and Facebook are typical for most schools and colleges. The coronavirus disease 2019 lockdown scenario opened up a new way and created a wave in purchasing and using android phones, laptops, high-intensity Wi-Fi, which gave an entirely new look to the educational system. Hence, the present study aims to assess the challenges at technology adaption in academic learning faced by nursing students. Methodology A quantitative cross-sectional descriptive survey design was adopted. A total of 708 nursing students were selected using the universal sampling technique in the study. Prior to the study obtained ethical clearance certificate and authority permission from the institutes where the participants were pursuing their nursing course. Demographic Proforma and challenges of technology adoption rating scale were prepared and sent to nursing students online to determine the challenges of technology adoption for academic learning. A second reminder was sent if the participants failed to submit the online forms within 2 days. Results The majority of the students, 557 (78.6%), were between the age group of 18 to 21 years, 658 (92.9%) were females, and 688 (97.2%) of them were pursuing a BSc nursing course. The majority, 188 (26.6%), of the students were pursuing second year BSc. One-third (257;36.3%) of the participants were from Karnataka. Most of the students, (677;95.6%), felt that virtual classes have barriers to learning opportunities. A small proportion of the students felt that technology adoption is an opportunity to learn academics during the lockdown. Mean percentage scores of (394;55.59%) subjects indicate virtual classes made them face many challenges in the form of barriers to learning academics. Conclusion Adequate training on handling technical issues and advanced technology is the need of the hour in higher education institutions. Online teaching and learning should be made an integral part of teaching-learning methodologies to keep the students abreast of advancing technologies.