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The novelty and uncertainty of the pandemic nourished a gener-alized fear of the COVID-19, which seems to have exacerbated the pan-demic's negative impact. It is thus relevant to monitor fear of COVID-19 and its association with individuals' mental health, well-being, and behav-iors. Valid and reliable measures of fear of COVID-19 are necessary for that purpose. This study aimed at assessing the psychometric properties of a European Portuguese version of the Fear of COVID-19 scale (FCV-19S-P). A secondary aim was to assess FCV-19S-P's multigroup measurement invariance (female vs. male). A sample of 572 Portuguese adults (72 % fe-male) completed the FCV-19S-P and measures of depression, anxiety, and stress. The study results supported this version validity and reliability (Cronbach's alpha = .84;Composite Reliability = .83), and a factorial struc-ture similar to the original version. Fear of COVID-19 was positively asso-ciated (.23 < r < .31) with depression, anxiety, and stress. Results of the multigroup invariance analysis supported the FCV-19S-P total scalar invar-iance and its partial residual invariance, suggesting that this measure may be used to reach valid conclusions in respect to gender comparisons in samples of Portuguese adults in regard to group observed composite means. © 2023, Universidad de Murcia Servicio de Publicaciones. All rights reserved.
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Summary: Background. Due to similarities between the pathophysiological mechanisms of hereditary angioedema (HAE) and COVID-19, it has been hypothesized that SARS-CoV-2 infection may trigger HAE attacks or, alternatively, that HAE patients may experience different of COVID-19 disease severity. Furthermore, the potential for COVID-19 vaccination to trigger angioedema attacks in patients with HAE is still not completely defined. The objective is to characterize the exacerbations and clinical manifestations associated with COVID-19 infection and describe the adverse effects of COVID-19 vaccination in patients with HAE.Methods. Retrospective observational, descriptive, non-interventional, multicenter study conducted in four Allergy Units and Departments in Central Portugal between March 2020 and July 2022. HAE patient data were obtained from electronic medical records. Results. The study included 34 patients (67.6% female): 26 with HAE type 1, 5 with HAE type 2, and 3 with HAE with normal C1 inhibitor. Most patients with HAE type 1 and 2 were receiving long-term prophylaxis. Among the 32 patients who received COVID-19 vaccination, 86 doses, were administered with one angioedema attack (1.2%) associated with vaccination. A small increase in the average number of attacks was observed in the year following COVID vaccination (7.1 versus 6.2 in the previous year, p = 0.029), however, this difference is unlikely to be clinically significant, as the context of the COVID-19 pandemic likely introduced numerous confounders. During the study period, 16 HAE patients had COVID-19, all presenting with mild disease. Four out of 16 patients (25%) reported angioedema attacks during COVID-19, and 43.8% during the convalescence period (3 months after infection). Conclusions. Patients with HAE can safely receive COVID-19 vaccination. The severity of COVID-19 infection does not appear to be increased in HAE patients.
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Hematological problems are associated with Coronavirus disease 2019 (COVID-19). Respiratory impairment is the higher point studied, although without experimental studies related to the oxygen transport performed by erythrocytes. Therefore, we decided to investigate if erythrocytes from COVID-19 patients have their functionality changed. The case-control study included hospitalized patients with a positive real-time polymerase chain reaction (RT-PCR) result admitted to University Hospital. Volunteers (negative RT-PCR results) were recruited as a control group. Thus, we assessed different erythrocytes parameters, oxidative stress markers, and biophysical studies using whole blood and isolated hemoglobin. We found a decrease of 51% in oxygen uptake and reduced antioxidant enzyme activity in COVID-19 patients compared to controls. Raman spectrometry showed structural changes in the hemoglobin and lipids of the erythrocytes from COVID-19 patients;thus, these results were consolidated with an increase in Young's modulus in erythrocytes followed by morphology changes. Besides, isolated hemoglobin from COVID-19 patients has a distinct interaction profile using a ligand model compared to the control. COVID-19 leads to structural, functional, and morphological damage to human erythrocytes. Our data showed structural and molecular changes and induction of oxidative stress in erythrocytes by COVID-19, a new perspective on the contribution of erythrocytes to a respiratory commitment in COVID-19.
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Background: SARS-Cov- 2 is a new respiratory virus that causes COVID-19 disease. It is a new infectious agent and knowledge is still very limited, particularly its interaction with allergic disease. The aim of this study was to assess the effect of allergic disease on the risk of hospitalization for COVID-19. Method(s): A total of 7542 SARS-CoV- 2 infections were diagnosed from 1 March to 31 December 2020 at the Centro Hospitalar Universitario de Sao Joao. A total of 1727 (22.9%) patients were hospitalized (31% in intensive care) and 5815 were followed up by an outpatient clinic. Of this group, 3479 (65%) answered a telephone questionnaire, 3 to 6 months after acute infection, about sociodemographic, clinical, behavioral and psychological characteristics. They were also asked about a previous diagnosis of allergic disease. Individuals aged < 18 years and those with asymptomatic infection were excluded. Result(s): A sample of 2702 participants was analyzed, 33.5% reported allergic disease prior to the diagnosis of COVID-19: 215 (8%) asthma, 517 (19.2%) rhinitis, 138 (5.1%) drug allergy, 36 (1.3%) food allergy, 22 (0.8%) atopic dermatitis and 2 (0.1%) hymenoptera venom allergy. The proportion of participants with asthma is not statistically different across age groups, but when grouping other allergic diseases other than asthma, a reduction was observed with age (21.5% of 18-29 years old vs. 4.9 % with >=80 years, p > 0.001). Allergic disease was significantly more prevalent in women (asthma 9.8% vs. 5.2%;other allergies: 17.9% vs. 12.7%, p < 0.001). In a univariate analysis, the risk of hospitalization of patient with COVID-19 was significantly lower in those with allergic disease (OR = 0.7;95% CI: 0.55-0.92), but for asthma the effect was not significant. Gender was an interaction factor in this association, so in a separate multivariate model for women and men and adjusted for the other significant risk factors -age, obesity and comorbidities -the effect on risk reduction remained only in the men (adjusted OR = 0.6;95% CI:0.33-1.07). Conclusion(s): In this study, allergic disease, excluding asthma, was associated with a decrease in the severity of COVID-19, especially in men. However, further studies, namely prospective studies, are needed to better characterize this effect and the underlying mechanisms.
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Infectious diseases may be the result of either pathogen increasing frequency of transmission within a given population or expansion of pathogen host range alongside with the increasing of its geographical distribution. Vector transmitted new pathogens may emerge driven by environmental factors and hazards such as droughts, floods, wildfires, or heatwaves, which are foreseen to become more frequent due to climate change. Environmental factors and hazards may be the cause in the change of vectors' geographical distribution or its increase within a particular geographical area. Infectious agents that may cross species and environmental barriers are climate sensitive therefore, its study is important. Human health is tightly connected to the health of animals and the environment. Animal feed, human nutrition, animal and human health are closely linked with water contamination, air pollution and the loss of biodiversity. The way climate change, as well as other health determinants, affects host defences and viral pathogenesis deserves scientific research and governments and stakeholders' attention to support preparedness plans and capacity of health systems to face emergence infection diseases. This chapter presents a state-of-the-art of the interactions of climate change effects on transmissible diseases based on (1) authors previous experience and knowledge on the subjects hereby addressed;(2) information from several institutional sources such as the World Health Organization, the United Nations Framework Convention for Climate Change, the Intergovernmental Panel on Climate Change, the United Nations Economic and Social Council, the European Commission of the European Union and The Lancet Countdown;and (3) an oriented search for scientific publications using the criteria described below. Authors analysed publications in Web of Science and PubMed databases choosing title//keywords screening (and full-text when necessary) and using the keywords: "Climate changes”;"Infectious diseases”, "SARS-CoV-2”, "Transmissible diseases”. Detailed information was extracted from the selected papers and the institutional sources based on full-text screening. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Introduction: Since the emergence of COVID19, a broad spectrum of presentation has been described, from the absence of symptoms to critical illness. Some studies show that increased levels of interleukin-6 (IL-6) are correlated with increased mortality and disease severity. Objective(s): To establish the value of IL-6 as an early predictor of severity in SARS-CoV2 infection. Method(s): Prospective study with IL-6 assay as part of the initial study of patients with SARS-CoV2 infection, between 20/10/2021 and 31/01/2022. Two groups were created (I: without hospitalization;II: with hospitalization). Exclusion criteria: chronic respiratory disease, rheumatologic disease and/or inflammatory bowel disease;time between dosing and hospitalization >=72h. Statistics (SPSS v28): Mann Whitney test, AUROC, Spearman correlation. Result(s): Sample of 117 patients (after excluding 10). Group I: 80 patients, 38 (47.5%) were male;mean age of 46.40 +/- 18.85 years old (18-88). Group II: 37 patients, 24 (64.9%) were male;mean age of 72.35 +/- 15.39 years old (29-96). Mean hospital stay of 19.49 +/- 17.02 days;9 (24.3%) were admitted to the ICU. Significantly higher IL-6 values in group II (p<0.001), showing good discriminating power regarding the probability of hospitalization (AUC=0.888;p<0.001) and a statistically significant (p=0.02) positive correlation (0.380) with the length of stay. The optimal cut-off value of IL-6 to establish the need for hospitalization, in our sample, was 12.4 pg/mL (Sensitivity: 97%;Specificity: 69%;Youden index: 0.66). Conclusion(s): IL-6 levels were significantly higher in patients requiring hospitalization and correlated with length of hospital stay. Larger studies are needed to validate its use in risk stratification.
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About a third of COVID-19 patients experience ongoing symptoms that have been referred to as long-COVID. In cooperation with Rehabilitation Medicine and Psychology departments, we developed a protocol for evaluation and further referral of the long-COVID patients that sought our Emerging Infectious Diseases (EID) consultation. The aim was to characterize the symptoms according to their frequency and to develop a screening tool that allows referral to intervention programs. Long-COVID was defined as persistent or new-onset symptoms 12 or more weeks after initial infection. In our EID consultation all patients answered a questionnaire regarding the evolution and impact on daily activities of the persistent symptoms, using a 6-point Likert scale. Participants (n=42) had a mean age of 44.8 years (IQR 18.8) and 76% were female. Ninety-five percent of the patients had a mild to moderate course of acute infection. Fatigue (78.6%), physical capacity impairment (74%), brain fog (62%), anxiety and sleep disorders (52% each) were the most frequently reported symptoms. Regarding the impact of persistent symptoms, 50% of the patients with anxiety disorders, 69% of the ones reporting brain fog and 71% of those with physical capacity impairment reported being moderately or more affected on their daily activities by that symptom. When asked "Did you recover your previous health status?" all patients answered no. As the number of new infections continues to rise worldwide, long-COVID will be a challenging burden to healthcare systems and societies. Establishing a follow-up protocol and a reliable screening tool will allow us to reach a wider population and also promote a better and patient-centered use of medical resources.
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Early evidence on the pandemic's effects pointed to women's employment falling disproportionately, leading observers to call a "she-cession.” This paper documents the extent and persistence of this phenomenon in a sample of 38 advanced and emerging market economies. We show that there is a large degree of heterogeneity across countries, with about two-thirds exhibiting larger declines in women's than men's employment rates. These gender differences in COVID-19′s effects were typically short-lived, lasting a quarter or two on average. We also show that she-cessions are strongly related to COVID-19′s impacts on gender shares in employment within sectors. © 2022
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Introducao: A Leucemia Mieloide Aguda (LMA) e uma doenca agressiva, e em geral, de prognostico reservado. O tratamento com intuito curativo e realizado com altas doses de quimioterapia, seguido ou nao por transplante de medula ossea (TMO) alogenico. Porem, a recidiva ainda representa um desafio a ser superado, levando a busca de novas opcoes terapeuticas, como o inibidor de bcl-2, Venetoclax. Objetivo: Relatar o caso de um paciente jovem com LMA recidivada com resposta ao tratamento baseado em Venetoclax, seguido por TMO alogenico. Metodo: Levantamento de dados do prontuario e revisao da literatura. Relato do caso: VSV, sexo masculino, 21 anos, diagnosticado com LMA em 18/02/2020, mielograma com 60,4% blastos, com fenotipo CD45+ intermediario;CD34+;CD13+;CD33 parcial;CD64 parcial;HLA-DR parcial;MPO parcial e cariotipo 46, XY [20]. Sem possibilidade de avaliacao molecular da doenca. O paciente recebeu tratamento de inducao padrao (D3A7) atingindo remissao completa apos um ciclo e seguindo com consolidacao com 3 ciclos de ARA-C 3g/m2 ate maio de 2020 (optou-se por nao realizar o 4ciclo devido a pandemia por COVID19). Apresentava doenca residual minima (DRM) negativa em reavaliacao medular de agosto de 2020, mantendo-se ate junho de 2021, quando apresentou recidiva com 33,8% de blastos em imunofenotipagem de reavaliacao. Internado em julho de 2021 para QT de resgate com FLAG, evoluiu com choque septico e insuficiencia respiratoria, sendo necessario suporte em unidade de terapia intensiva. Apos recuperacao clinica, obteve novamente DRM negativa, sendo encaminhado para TMO alogenico aparentado (irma "full match"). Entretanto, enquanto aguardava o transplante, apresentou nova recidiva (IF com 5,4% de blastos), sendo optado por tratamento com Venetoclax + Azacitidina, com reducao de DRM para 1,5%. Recebeu o segundo ciclo de Venetoclax combinado com citarabina, devido a indisponibilidade da Azacitidina, seguido por DRM negativa. O paciente foi submetido ao TMO alogenico em 31/03/22, com avaliacao medular no D+60 com quimerismo de 100%, mantendo DRM negativa no D+120. Discussao: O uso do inibidor de BCL-2 (Venetoclax), em combinacao com agentes hipometilantes ou doses baixas de citarabina, foi aprovado para pacientes recem-diagnosticados com LMA inelegiveis para quimioterapia intensiva, revolucionando o tratamento da doenca. Publicacoes recentes vem demonstrando novos beneficios dessa associacao, tanto previamente ao TMO (em primeira linha ou com doenca recidivada), como na terapia de resgate para recidiva pos-TMO. Tambem tendo sido evidenciado sucesso terapeutico em faixas etarias menores (incluindo criancas). Esses novos estudos motivaram o uso de terapia baseada em venetoclax nesse paciente jovem, com doenca recidivada, conseguindo atingir e manter DRM negativa. Conclusao: O caso relatado demonstra eficacia do Venetoclax (em combinacao com hipometilante ou citarabina) em promover remissao profunda da doenca, tornando o paciente habil para o transplante e aumentando a probabilidade de sobrevida a longo prazo. Copyright © 2022
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The present study aimed to analyze the patrimonialization in the historic center of Belem, of 04 intangible assets, Chiquita party, Pre-carnival, Carimbo and Arraial do Pavulagem. In addition to understanding how it was experienced, regarding public policies and impacts, during the pandemic period (2020-2021). The method used consists of qualitative research, direct observation, and monitoring of the social networks of the heritage assets examined by the study. Finally, the results showed that one of the strategies adopted for the dissemination of culture was the practice of lives
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This paper aims to analyze the profile of the tourist living in the state of Para in Brazil, who travelled on leisure during pandemic. This is a bibliographical and descriptive study by using quantitative data through an electronic Google forms questionnaire with 25 closed-ended questions aimed at people living in the state of Para who travelled during the pandemic period of the COVID-19. The electronic questionnaire was made available on the social media of the researchers'contacts members of the "Tourism in Times of Pandemic" Research Networking. in the period March-May 2021. The sampling is a non-stratified and non-probabilistic one for those who answered only needed to have internet, WhatsApp and an e-mail. Anyone aged 18 or over could answer the form, thus divided: socio-demographic profile, did not travel on leisure, travel on other grounds, for leisure travelers, their leisure travel characteristics and other questions. In this article, we have chosen to work with data relating to those who travelled on leisure and the characteristics of the trips for leisure purposes. The data was processed using descriptive statistics considering a sample of 472 people with 95% reliability level and sample error of 4.51%. The key results show that for the people of Paraeven with the fear of contamination, the desire for rest, leisure and entertainment were determining factor for more than half of those interviewed to make the decision to visit other places.
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The current pandemic scenario, which has affected the entire world since the beginning of 2020, has had important and significant impacts in all areas of society, with particular emphasis on education. It is about some of these impacts that we will reflect in this text. The proposed study aims to reflect on the effects of the pandemic on higher education, with specificity in Brazil and as a research question: “what are the opinions of students of a Pedagogy course on emergency remote teaching”? We will make some reflections based on the literature published in 2020-2021 and we will complete this reflection based on empirical data collected through a questionnaire applied to students of a Pedagogy course at a particular HEI. Uncertainty, perplexity, volatility, complexity and ambiguity are an integral part of the daily lives of students, their families and teachers and administrators. The virtual has become the only reality in which choices and decisions have to be made. The need for adaptations in education systems with the use of new technologies had the effect of adopting a simple path, that is, by the mere use of technologies, the effects on student learning/training are not yet known. This path, which consists of the mere replacement of in-person classes with online classes, does not guarantee, a priori, the quality of teaching. As there is no known empirical data that allow us to reflect on the effects on students of replacing face-to-face classes with online classes, we intend to know, from the data collected, what are the negative and positive impacts of the on going changes. © 2021, Edicoes Universitarias Lusofonas. All rights reserved.
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Pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS) is a novel condition with persistent fever, inflammation, and single or multiorgan dysfunction. We aimed to describe the characteristics of children more severely affected and our clinical approach. We retrospectively collected clinical, treatment, and early outcomes data during a 3-month period in a pediatric intensive care unit (PICU) of a tertiary university hospital in Portugal. Twelve children who fulfilled the Royal College of Pediatrics and Child Health case definition were hospitalized, seven needed PICU admission. Median age was 13 years and three were overweight, with no other comorbidity. All had positive immunoglobulin G antibodies for SARS-CoV-2. All presented with prolonged fever, asthenia, hypotension, and shock. Other prominent symptoms were abdominal complaints and rash. All patients had leukocytosis, neutrophilia, and marked elevation of inflammatory markers. Cardiac involvement was observed in all patients with elevated levels of troponin and B-type natriuretic peptide along with left ventricular hypokinesis. Depressed left ventricular function was observed in four patients. All patients received broad-spectrum antibiotics, intravenous immunoglobulin, methylprednisolone, low-dose aspirin, and vasoactive medications. Four patients received prophylactic enoxaparin. All patients needed supplementary oxygen;however, high-flow oxygen therapy and noninvasive ventilatory support with positive end-expiratory pressure were required in three and two patients, respectively. Five patients required invasive mechanical ventilation. The mean duration of PICU stay was 7.1 days. The median Pediatric Risk of Mortality-III score was 9 and no mortality was observed. PIMS-TS demands a prompt and multidisciplinary approach. Risk factors, best clinical pathway, and long-term complications are still unknown.
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Background: Leukotriene receptor antagonists might have a role in viral infections, either by improving lung injury and inflammation, or by acting on 3CL proteinase of the HCoV-19. Thus, we hypothesised that montelukast may be an adjuvant drug in HCoV-19 infection treatment. This study aims to evaluate the efficacy and safety of montelukast in the adjuvant treatment of COVID-19 pneumonia. Method: We are conducting a randomized, controlled, parallel, open-label trial involving hospitalized adult patients with confirmed COVID-19. Patients were randomly assigned in a 1:1 ratio to receive either montelukast 10 mg, once a day for 14 days, in addition to standard of care (SoC), or SoC alone. SoC follows the best practice for treating these patients, according to updated recommendations. The primary outcome is time to recovery. Participants are assessed using diary cards to capture data on treatment-related improvements in an 8-point ordinal scale (COVID-19 scale). Secondary endpoints include changes in NEWS (National Early Warning Score), respiratory and inflammatory parameters. Mann-Whitney U test for continuous variables and Ficher's exact test for categorical variables were used to compare differences between groups. This phase IV clinical trial takes place at the University Hospital of São João, Porto. EudraCT number: 2020-001747-21. Results: Eighteen patients (11 males, mean age 60 years, age range 42-89, table 1) enrolled and completed the trial. The trial is still open for the recruitment of participants. The participants from the active group spent less time hospitalized than control group [median (P25-75): 3.0 (3-6) vs 7.5 (4.75-17.75) days, p = 0.03]. The number of days to achieve 7 (not hospitalized, limitation on activities) or 8 points (not hospitalized, no limitations) in the COVID-19 scale was also statistically significant. The number of patients in need of supplemental high flux oxygen and the NEWS score followed the same trend (table 1). Conclusion: In conclusion, early efficacy results from this ongoing clinical trial suggest montelukast may have a role in treating COVID-19 patients as an adjuvant treatment by diminishing hospitalization days until discharge. Data were presented as median (25th percentile-75th percentile) unless otherwise states. Bpm: beats per minute;cpm: cycles per minute;NEWS: National Early Warning Score);SoC: standard of care. NEWS is based on 7 clinical parameters (respiration rate, oxygen saturation, any supplemental oxygen, temperature, systolic blood pressure, heart rate, level of consciousness), and is being used as an efficacy measure. Higher points represent higher risk of poor outcomes. COVID-19 scale is as follows: (1) Death;(2) Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO);(3) Hospitalized, on non-invasive ventilation or high flow oxygen devices;(4) Hospitalized, requiring supplemental oxygen;(5) Hospitalized, not requiring supplemental oxygen-requiring ongoing medical care (COVID-19 related or otherwise);(6) Hospitalized, not requiring supplemental oxygen-no longer requires ongoing medical care;(7) Not hospitalized, limitation on activities and/or requiring home oxygen;(8) Not hospitalized, no limitations on activities. (Figure Presented).
Subject(s)
Betacoronavirus , Coronavirus Infections/virology , Delivery, Obstetric/methods , Patient Isolation/methods , Pneumonia, Viral/virology , Pregnancy Complications, Infectious/virology , Adult , COVID-19 , Coronavirus Infections/transmission , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Live Birth , Pandemics , Pneumonia, Viral/transmission , Portugal , Pregnancy , SARS-CoV-2 , Vagina/virologyABSTRACT
The pandemic situation in countless regions of the planet had significant impacts on the world tourism activity. The present article addresses this issue based on the cases of two tourist regions: the Tourist Region of Belem and the Tourist Region of Campos do Marajo. It aims to analyze the tourism planning and management carried out through the implementation of sanitary measures, social distancing and other policies aimed at mitigating the impacts of the Covid-19 pandemic, and their applicability in the realities of the municipalities of Belem, Soure and Salvaterra. A qualitative research study was conducted, using data collected through a bibliographical review and a documentary research on the management instruments created in 2020, both at the federal and at the state and municipal levels of government. A documentary analysis of the laws, plans and decrees made by the federal government and the municipalities of Belem, Soure and Salvaterra with the aim of mitigating the socioeconomic impacts of covid-19 in tourist activies. Finally, recorded semi-structured interviews were done, via the Google Meet platform, both with government representatives involved in the planning and management of the tourist regions of Belem and Campos do Marajo;and with representatives of Civil Society Organizations, mainly those linked to the market. Based on the analysis of the sanitary measures aimed at restricting the movement of people and transportation;on the interviews with representatives of tourist trade organizations and state and municipal government agencies;and on the analysis of the main strategies designed for the post-pandemic period, the article concludes that the pandemic had a significant impact on the tourism sector during the year 2020.
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The territorial diversity in the state of Para, made the Covid-19 pandemic caused and imposed specific situations on tourism in its sub-regions. In this regard, considering a production of tourist space approach, in a pandemic context, this work analyzes the par-ticularities of Covid-19 impacts in the state of Para tourist regions during 2020: Metro-politan Region of Belem, Campos do Marajo, Baixo Tapajos, and Carajas. In all four regions Covid-19 impacts are presented, as on transport flows and events in Tapajos Region;contradictory data of Covid-19 pandemic in Carajas region from restaurants, food service establishments, and hotels;and the impacts on jobs, hospitality sector are presented, as well as on the events sector on Metropolitan Region of Belem and Campos Marajo, Finally, the Covid-19 pandemic main impacts are pointed out by the agents in-terviewed in these last two regions. Based on statistical data from institutions that col-lect periodic information, it is concluded that in all the regions selected for tourism impacts analysis, there was a significant indebtedness of the sector during 2020, despite the measures adopted by the state of Para to resolve those impacts. However, the low level of capital in these establishments and the lack of a forecast of a full resumption of activities by agents in the sector have prevented the resumption of tourism in the territo-ry of Para.
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The purpose of the current study was to explore the delivery of the Group Lifestyle Triple P (GLTP) parent group programme through digital practice. Eight mothers of obese children aged 6–11 were recruited from a university hospital. Using a mixed-methods approach, the study sought to characterise the perceived changes throughout the intervention and explore the outcome measures on children’s BMI z-score, weight-related behaviour problems, parents’ self-efficacy, interparental conflict and parenting styles assessed pre- and post-intervention. Participants identified changes in themselves, in positive parenting, and in their ability to manage children’s nutrition and physical activity, contributing to improve children’s lifestyle behaviours. The clinical results were similar to the findings of studies in which GLTP was delivered in-person. Delivering GLTP through digital practice seems to be a possible way of implementing the intervention, particularly during the COVID-19 pandemic. Practitioner points: GLTP sessions’ contents and activities were adapted for digital delivery without compromising the programme’s implementation fidelity. Parents perceived an increase in positive parenting behaviours and their ability to manage children’s nutrition and physical activity. The clinical results of the GLTP delivered through digital practice were similar to those of studies in which the programme was delivered in-person. © 2021 The Association for Family Therapy and Systemic Practice
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SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: The coronavirus disease 2019 (COVID-19) is characterized by flu-like symptoms or complications related to pneumonia and acute respiratory distress syndrome. Later in the disease course, clinically significant thrombotic events, both venous and arterial, are being recognized. Our case describes ST elevation myocardial infarction (STEMI) as a complication of COVID-19. CASE PRESENTATION: A 38-year-old male with no medical history and non-smoker presented with 10 days of fever, cough, malaise, myalgia, and exertional dyspnea. He denied chest pain. He had completed a five-day course of azithromycin and steroids. No personal or family history of clotting disorders or heart disease. Exam revealed oxygen saturation of 89% on room air with bilateral crepitations. Chest x-ray showed bilateral patchy parenchymal airspace disease. Electrocardiogram (EKG) showed sinus tachycardia without ischemic changes. Labs showed C-reactive protein 179 mg/L and D-dimer 0.64 ug/mL. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by polymerase chain reaction assay was positive. He was started on ceftriaxone, doxycycline, hydroxychloroquine, enoxaparin, and methylprednisolone. After 5 days, he was discharged on prophylactic apixaban. He returned 1 day later with substernal chest pain. EKG showed ST elevation in the inferior leads. Troponin T was 3.74 ng/mL, D-dimer 0.75 ug/mL, and coagulation profile was normal. Emergent coronary angiography revealed 100% occlusion of mid-right coronary artery and right posterolateral branch requiring extensive thrombectomy and placement of drug eluting stents. He was started on aspirin, ticagrelor, eptifibatide, high intensity statin, and metoprolol. Echocardiography revealed severe basal to mid- inferior and posterior wall hypokinesis with left ventricular ejection fraction of 40%. He was discharged on ticagrelor, apixaban, atorvastatin and metoprolol. Anti-phospholipid antibody panel testing results returned normal. DISCUSSION: It is becoming increasingly evident that SARS-CoV-2 predisposes to venous thromboembolism, but arterial thromboembolism, especially manifest as acute STEMI, is rare. A recent Dutch study of 184 ICU patients with COVID-19 demonstrated confirmed arterial thrombotic events in 3.7%.(1) The pro-coagulant pattern is characterized by increased clot strength, elevated platelet and fibrinogen contribution to clot strength, elevated D-dimer levels, and hyperfibrinogenemia.(2) In a recent case series, 67% of patients with COVID-19 undergoing coronary angiography for STEMI had obstructive coronary artery disease (CAD) with 83% requiring PTCA (3). Interestingly, none of these patients had a known prior history of CAD. CONCLUSIONS: Further discussion regarding prophylactic anti-platelet and anti-coagulation strategies in patients with COVID-19 and studies to identify risk factors for thrombotic disease is warranted. Reference #1: Kloka, F A, Kruipb M J H A, van der Meerc N J M, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thrombosis Research. 2020. doi:10.1016/j.thromres.2020.04.013 Reference #2: Ranucci, M, Ballotta, A, Di Dedda, U, et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. Journal of Thrombosis and Haemostasis. April 2020. doi:10.1111/jth.14854 Reference #3: Bangalore, S, Sharma, A, Slotwiner, A, et al. ST-Segment Elevation in Patients with Covid-19 — A Case Series. NEJM. April 17, 2020. doi: 10.1056/NEJMc2009020 DISCLOSURES: No relevant relationships by Juliann Allen, source=Web Response No relevant relationships by Aalap Chokshi, source=Web Response No relevant relationships by Kyle Foster, source=Web Response No relevant relationships by Rani Sittol, source=Web Response No relevant relationships by Matthew Tavares, source=Web Response