COVID-19: Impact on Mental Health of Nursing Workers

The prolonged pandemic context by the new Coronavirus aggravated the physical and emotional strain of healthcare workers, negatively impacting mental health. The objectives of this study were to verify the prevalence of Mild Depression Disorder (MDD) and Mild Anxiety Disorder (MAD) and their associated factors. A cross-sectional study was conducted with nurses and nursing assistants from a private hospital in the city of Sao Paulo, Brazil. The sample consisted of 184 nursing workers, who answered a form using Google Forms (R), released by the social media group (WhatsApp (R)), restricted to employees and managers of the sectors. Demographic, occupational, clinical data, and indicators of MDD and MAD were obtained through the Hospital Anxiety and Depression Scale. Descriptive statistics and association tests between independent and dependent variables were used. There was a predominance of women (88%), in the role of nurse technicians and/or assistants (63.6%), and those who worked in specific units of patients with COVID-19 (58.7%). The prevalence of MDD was 43.5% (95% CI: 36.4% - 50.7%) and MAD was 46.2% (95% CI: 39.1% - 53.4%). There was a statistically significant association between MAD, age between 25 and 35 years (p=0.01) and hospital unit not specific for COVID-19 (p=0.04). The prevalence of mild depression and anxiety disorders was considered high. Mild anxiety disorder had a higher prevalence among younger workers and those working in units not specific to COVID-19.

Potential of Bike Sharing During Disruptive Public Health Crises: A Review of COVID-19 Impacts

With public transport (PT) continuing to be negatively affected by the coronavirus pandemic and private car usage surging, alternative modes need to be considered. In this study, we review the available evidence (from academic and gray literature sources) on the performance of bike sharing systems (BSSs) during COVID-19 around the world, with the goal of assessing their potential contribution to improving the resilience of transport systems during pandemics and similar disruptive events. We found BSS usage followed a decrease-rebound pattern, with BSSs overall sustaining lower ridership declines and faster recoveries compared with PT. During lockdowns especially, the average duration of BSS trips increased, following a rise in casual users and leisure trips, while commuting trips decreased. Evidence has also been found for a possible modal shift from some PT users to BSSs, with a decline in the share of multimodal trips conducted between PT and BSSs. Bike sharing is perceived as safer than other shared modes (e.g., PT, taxis, and ride-hailing/sharing) but as having a higher infection risk than personal modes (e.g., private car, walking, and personal bike). Moreover, the BSS was an important transport alternative for essential workers, with several operators providing waivers especially to healthcare staff, leading to ridership increases near healthcare facilities and in deprived neighborhoods. Findings from this research support policies for promoting bike sharing, namely through fee reductions, system expansions, and symbiotic integration with PT, as BSSs can increase the sustainability and resilience of transport systems during disruptive public health events like COVID-19.

An Intensivist-Led Extracorporeal Membrane Oxygenation Program: Design, Implementation, and Outcomes of the First Five Years.

We describe the development, implementation, and outcomes of an intensivist-led adult extracorporeal life support (ECLS) program using intensivists both to perform venovenous (V-V), venoarterial (V-A), and extracorporeal cardiopulmonary resuscitation (ECPR) cannulations, and to manage patients on ECLS throughout their ICU course. All adults supported with ECLS at the University of New Mexico Hospital (UNMH) from February 1, 2017 to December 31, 2021 were retrospectively analyzed. A total of 203 ECLS cannulations were performed in 198 patients, including 116 V-A cannulations (including 65 during ECPR) and 87 V-V cannulations (including 38 in patients with COVID-19). UNMH intensivists performed 195 cannulations, with 9 cannulation complications. Cardiothoracic surgeons performed 8 cannulations. Overall survival to hospital discharge or transfer was 46.5%. Survival was 32.3% in the ECPR group and 56% in the non-ECPR V-A group. In the V-V cohort, survival was 66.7% in the COVID-19-negative patients and 34.2% in the COVID-19-positive patients. This large series of intensivist-performed ECLS cannulations-including V-A, V-V, and ECPR modalities-demonstrates the successful implementation of a comprehensive intensivist-led ECLS program. With outcomes comparable to those in the literature, our program serves as a model for the initiation and development of ECLS programs in settings with limited access to local subspecialty cardiothoracic surgical services.

LOCUS (LOng Covid-Understanding Symptoms, events and use of services in Portugal): A three-component study protocol.

Approximately 10% of patients experience symptoms of Post COVID-19 Condition (PCC) after a SARS-CoV-2 infection. Akin acute COVID-19, PCC may impact a multitude of organs and systems, such as the cardiovascular, respiratory, musculoskeletal, and neurological systems. The frequency and associated risk factors of PCC are still unclear among both community and hospital settings in individuals with a history of COVID-19. The LOCUS study was designed to clarify the PCC's burden and associated risk factors. LOCUS is a multi-component study that encompasses three complementary building blocks. The "Cardiovascular and respiratory events following COVID-19" component is set to estimate the incidence of cardiovascular and respiratory events after COVID-19 in eight Portuguese hospitals via electronic health records consultation. The "Physical and mental symptoms following COVID-19" component aims to address the community prevalence of self-reported PCC symptoms through a questionnaire-based approach. Finally, the "Treating and living with Post COVID-19 Condition" component will employ semi-structured interviews and focus groups to characterise reported experiences of using or working in healthcare and community services for the treatment of PCC symptoms. This multi-component study represents an innovative approach to exploring the health consequences of PCC. Its results are expected to provide a key contribution to the optimisation of healthcare services design.

Forecasting Omicron Variant of Covid-19 with ANN Model in European Countries – Number of Cases, Deaths, and ICU Patients

Accurate predictions of time series are increasingly required to support judgments in a variety of decisions. Several predictive models are available to support these predictions, depending on how each field offers a data variety with varied behavior. The use of artificial neural networks (ANN) at the beginning of the COVID-19 pandemic was significant since the tool may offer forecasting data for various conditions and hence assist in governing critical choices. In this context, this paper describes a system for predicting the daily number of cases, fatalities, and Intensive Care Unit (ICU) patients for the next 28 days in five European countries: Portugal, the United Kingdom, France, Italy, and Germany. The database selection is based on comparable mitigation processes to analyze the impact of safety procedure flexibilization with the most recent numbers of COVID-19. Additionally, it is intended to check the algorithm's adaptability to different variants throughout time. The network's input data has been normalized to account for the size of the countries in the study and smoothed by seven days. The mean absolute error (MAE) was employed as a comparing criterion of two datasets, one with data from the beginning of the pandemic and another with data from the last year, since all variables (cases, deaths, and ICU patients) may be tendentious in percentage analysis. The best architecture produced a general MAE prediction for the 28 days ahead of 256,53 daily cases, 0,59 daily deaths, and 1,63 ICU patients, all numbers normalized by million people. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

4-Organ Sofa Score as Tool to Triage Crrt Use in Covid-19 Patients during Crisis Standards of Care

INTRODUCTION: Acute kidney injury requiring renal replacement therapy (AKI-RRT) is associated with high mortality, especially in the setting of COVID-19. During the peak of the delta wave in New Mexico in late 2021, crisis standards of care were declared and strategies to ration care were explored. Our hypothesis is that a simplified SOFA score in patients with COVID-19 and AKI-RRT may predict short-term mortality. METHOD(S): We retrospectively analyzed all COVID-19 patients started on CRRT for AKI in the medical ICU at our center between April 2020 and July 2021. A 4-organ SOFA score (4OSS), with renal and neurologic sub-scores excluded, was calculated at the time of CRRT initiation. Neurologic sub-score was excluded because it is subjective, inconsistently documented, and confounded by the frequent use of sedation and paralysis in severe COVID-19. ECMO patients were included and assigned the maximum respiratory sub-score. Patients started on RRT at an outside hospital, found to be incidentally COVID-positive, or on chronic dialysis were excluded. P values were obtained using 1-sided Mann-Whitney U tests. RESULT(S): 63 total COVID-19 patients on CRRT were identified with 73% 30-day mortality and 83% in-hospital mortality. The median 4OSS was 8 in both in-hospital survivors and non-survivors with interquartile range [IQR] of 4-9 and 7-9.75, respectively (difference between groups non-significant, p = 0.075). The median 4OSS was 7 [5.5- 8.5] and 8 [7-10] in 30-day survivors and non-survivors, respectively (p = 0.018). Those with 4OSS of >=10 (n=13, 20.6%) had 100% in-hospital mortality. CONCLUSION(S): Similar to other analyses of SOFA score in COVID-19, 4OSS at CRRT initiation in patients with COVID-19 and AKI-RRT appears to have limited prognostic ability, with substantial overlap in scores between survivors and non-survivors. However, while additional multicenter studies are needed, 4OSS of >=10 may identify a group of about 20% of COVID-19 patients with AKI-RRT and mortality approaching 100%. Given the absence of a superior validated metric, a 4OSS of >=10 may be a reasonable tool for triage of CRRT in the setting of crisis standards of care and CRRT machine or supply shortages. At a minimum, 4OSS could inform goals of care discussions prior to CRRT initiation in patients with COVID-19 complicated by AKI-RRT.

Diagnosis and management of patients with acute limb ischemia after Covid-19 infection: a case series

The Covid-19 pandemic caused by the Sars-Cov-2 virus created challenges and stimulated development of new forms of treatment in many different areas of medicine. Studies have described the clinical characteristics of patients and their outcomes, including disorders affecting the coagulation system, in which patients infected by the virus enter a hypercoagulable and proinflammatory state that mimics vasculitis. The objective of this study was to describe the clinical status and the treatment administered to three patients who developed acute arterial occlusion after Covid-19 infection. The management adopted in these cases enabled the patients to recover without sequelae. The low incidence and scarcity of published reports make it difficult to establish universally accepted treatment criteria and options for cases of ischemia in patients infected with the novel coronavirus, whether presenting early or late. Copyright © 2022 The authors.

Valorization of Ellagic Acid from Chestnut Shell as a Natural Anti-anxiety Food Supplement

Mental health is on the agenda, especially in pandemic times due to the COVID-19 virus. Nowadays, psychological problems, such as anxiety and depression, have been more discussed and have become even more critical during lockdown. This paper proposes the development process of an innovative product whose active ingredient-ellagic acid, extracted from the chestnut shell-has anxiolytic properties and can be potentially used in consumers' daily lives, preventing this type of illness. The product presented, Do Nut Stress – Acid ellagic enriched pancakes for anxiety control, consists of a pancake powder, considered a healthy and nutritious meal. © 2022, Universidade do Porto - Faculdade de Engenharia. All rights reserved.

Elevated SARS-CoV-2 in peripheral blood and increased COVID-19 severity in American Indians/Alaska Natives.

Epidemiological data across the United States show health disparities in COVID-19 infection, hospitalization, and mortality by race/ethnicity. While the association between elevated SARS-CoV-2 viral loads (VLs) (i.e. upper respiratory tract (URT) and peripheral blood (PB)) and increased COVID-19 severity has been reported, data remain largely unavailable for some disproportionately impacted racial/ethnic groups, particularly for American Indian or Alaska Native (AI/AN) populations. As such, we determined the relationship between SARS-CoV-2 VL dynamics and disease severity in a diverse cohort of hospitalized patients. Results presented here are for study participants (n = 94, ages 21-88 years) enrolled in a prospective observational study between May and October 2020 who had SARS-CoV-2 viral clades 20A, C, and G. Based on self-reported race/ethnicity and sample size distribution, the cohort was stratified into two groups: (AI/AN, n = 43) and all other races/ethnicities combined (non-AI/AN, n = 51). SARS-CoV-2 VLs were quantified in the URT and PB on days 0-3, 6, 9, and 14. The strongest predictor of severe COVID-19 in the study population was the mean VL in PB (OR = 3.34; P = 2.00 × 10-4). The AI/AN group had the following: (1) comparable co-morbidities and admission laboratory values, yet more severe COVID-19 (OR = 4.81; P = 0.014); (2) a 2.1 longer duration of hospital stay (P = 0.023); and (3) higher initial and cumulative PB VLs during severe disease (P = 0.025). Moreover, self-reported race/ethnicity as AI/AN was the strongest predictor of elevated PB VLs (ß = 1.08; P = 6.00 × 10-4) and detection of SARS-CoV-2 in PB (hazard ratio = 3.58; P = 0.004). The findings presented here suggest a strong relationship between PB VL (magnitude and frequency) and severe COVID-19, particularly for the AI/AN group.

THE DEPLOYMENT OF CHATBOT TO IMPROVE CUSTOMER SERVICE IN HIGHER EDUCATION INSTITUTIONS DURING COVID-19

Objective of the study: Present the customer service chatbot solutions implemented by MKT4EDU in three Brazilian HEIs. Methodology/Approach: We adopted the case study as a research method. In-depth interviews with four employees of MKT4EDU, the company responsible for the changes implemented in the student support processes at 3 HEIs, collected the data for this technical report interviews. Originality/Relevance: Describes in detail the chatbot implementation process adopted at these HEIs and the results obtained. Main Results: After implementing the changes, by introducing automated bots available 24/7, HEIs met the pent-up demands for student services at a lower cost. Theoretical/ Methodological Contribution: This study contributes to the chatbot literature by investigating how the education sector can implement this technology from five perspectives: interaction, information, accessibility, entertainment, and customization. We present the number of conversations between chatbot and users and the main topics addressed in these conversations. Social/Management Contribution: By reporting the improvements implemented with chatbot technology in three different HEIs at a time of crisis, we believe we are collaborating with organizations that face similar situations and need to adapt to a new context.

I9MASKS: FROM A MULTIDISCIPLINARY SUMMER PROJECT TO A NON-ACCREDITED SHORT COURSE

This study presents a research experience with engineering students at undergraduate and graduate levels, during the summer of 2020 at the School of Engineering, University of Minho, Portugal. Following the first pandemic event in Portugal, from March to May 2020, the Foundation for promoting Science and Technology (FCT) has opened a call for research projects among students and researchers at different Universities. The main aim of these projects was to motivate students to return physically to the campus during a summer course, and to promote a research environment among them. i9Masks was one of the projects approved by the University of Minho and its main objective was the development of innovative masks in a silicone elastomer for the protection of COVID-19 with the use of state-of-the-art technologies. The development of masks was at the time a very hot topic as well as a fashionable subject for research. Considering the results obtained, from the final works presented by students, a very positive balance of the experience was achieved. The i9Masks project was a useful learning experience for engineering education, particularly in Portugal, where the opportunity to participate in this type of "learning by doing" experience is very small. Copyright © 2021 by ASME

Kidney Injury in COVID-19: Epidemiology, Molecular Mechanisms and Potential Therapeutic Targets.

As of December 2021, SARS-CoV-2 had caused over 250 million infections and 5 million deaths worldwide. Furthermore, despite the development of highly effective vaccines, novel variants of SARS-CoV-2 continue to sustain the pandemic, and the search for effective therapies for COVID-19 remains as urgent as ever. Though the primary manifestation of COVID-19 is pneumonia, the disease can affect multiple organs, including the kidneys, with acute kidney injury (AKI) being among the most common extrapulmonary manifestations of severe COVID-19. In this article, we start by reflecting on the epidemiology of kidney disease in COVID-19, which overwhelmingly demonstrates that AKI is common in COVID-19 and is strongly associated with poor outcomes. We also present emerging data showing that COVID-19 may result in long-term renal impairment and delve into the ongoing debate about whether AKI in COVID-19 is mediated by direct viral injury. Next, we focus on the molecular pathogenesis of SARS-CoV-2 infection by both reviewing previously published data and presenting some novel data on the mechanisms of cellular viral entry. Finally, we relate these molecular mechanisms to a series of therapies currently under investigation and propose additional novel therapeutic targets for COVID-19.

THE CONSEQUENCES OF THE COVID-19 PANDEMIC ON THE HEALTH OF THE BLACK POPULATION

Covid-19 has recently presented a new scenario of coexistence, with the pandemic, we have developed and resumed basic hygiene and social isolation procedures. In view of the recommendations of the World Health Organization (WHO) and the Ministry of Health (MS), the Brazilian population must remain in quarantine, except for essential services, and avoid overcrowding. In a scenario of social inequalities, in which the black population is the target of this inequality, in peripheral territory, which faces the high number of family members in the same environment, the lack of basic sanitation, water and sewage, this population being is at the mercy of their own luck, as they are unable to remain at home during the pandemic. The method used was the analysis of data provided by official health agencies. The database used in this study was the Covid-19 Epidemiological Bulletins presented by the Ministry of Health, which show us weekly the evolution of the virus in the world and in Brazil. In relation to demographic data in Brazil, these indicate that the black population (blacks and browns) is mostly victimized by Covid-19.

Proliferative glomerulonephritis with monoclonal immunoglobulin deposits triggered by COVID-19: a case report.

Acute kidney injury (AKI) frequently complicates corona virus disease 2019 (COVID-19) and is associated with significant mortality. Kidney disease in COVID-19 is usually due to acute tubular injury, but a variety of glomerular processes, especially collapsing glomerulopathy, have been increasingly described. Until recently, proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) had not been reported in the setting of COVID-19. We present a case of dialysis-dependent AKI developing soon after symptomatic COVID-19 which, on kidney biopsy, was found to be due to PGNMID with IgG3 kappa deposits. As is typical of PGNMID, a search for evidence of extra-renal monoclonal immunoglobulin or clonal lymphocyte population was negative. However, the patient had a favorable response to anti-plasma cell therapy and was ultimately able to stop hemodialysis. Though monoclonal gammopathy of renal significance (MGRS) is usually not associated with infection, other cases of post-viral MGRS, including PGNMID, have been previously reported. PGNMID has recently been linked specifically to COVID-19, with this representing one of only four cases reported thus far. Though causality between the preceding viral infection and the subsequent glomerulonephritis cannot be proven in these reports, nephrologists should be aware that not all kidney disease occurring in the aftermath of COVID-19 is due to tubular injury or collapsing glomerulopathy. As such, kidney biopsy should be routinely considered in the setting of COVID-19-associated glomerular disease as findings may change management. In the case of COVID-19-associated PGNMID data to guide treatment are limited, but our report suggests that anti-plasma cell therapy may be effective.

The Virtual Kinect

The COVID-19 pandemic impacted researches that depended on making tests on patients and teams that had to be divided to avoid crowding in laboratories. Sharing equipment is no longer a simple strategy;the acquisition of extra equipment is beyond the means of many researchers. Research with Kinect V2 applied to body tracking suffers from sanitary restrictions, product discontinuation and limited access to newer sensors (like the Azure Kinect). Kinect V2 is an RGB-D sensor with many applications in health, ergonomics, sports, games and other areas. That is why a lot of research is still under development with it. Because of the applicability of Kinect V2 on research and the current acquisition limitations, Virtual Kinect (VK) was created. VK is an open-source solution that enables the programmer to code using Kinect SDK functions and test it without a Kinect V2 sensor or a previous recording. It simulates the behavior of a Kinect V2 sensor through MediaPipe's Pose estimation, providing RGB image and joint tracking information, correlating the joints of the two devices. This correlation is possible due to the proximity of the devices' joint estimates. The VK was made to be simple and practical, so that its use only depends on the DLL exchange and the use of an ordinary RGB camera. © 2021 ACM.

Augmented Reality on Museums: The Ecomuseu Virtual Guide

Studies point that smartphones show an important role in the improvement of museum visitors experience. Mobile devices have become the main tool available for travellers, which enables the diffusion of augmented reality solutions through this channel. Based on that, a virtual guide prototype was developed to enhance the museum visitors experience inside a famous attraction from Foz do Iguaçu, the Ecomuseu, constructed with the objective to show the work of Itaipu's hydroelectric power plant and the history regarding the region occupied by its reservoir. The developed application inserts virtual elements in different locations of the museum. Whenever such elements are "captured", they tell the visitor information about what is being exhibited so the perception of the visitor and knowledge absorption can be improved. To validate the proposed solution, we tested the app with 15 different users. Due to the COVID-19 pandemic, we adapted the app and performed the evaluation over the virtual tour of the same museum, which is available online. For the sake of our knowledge, this is the first time an augmented reality application is evaluated over a virtual representation of a museum. Despite the difficulties imposed by the current context, the feedback from the tested users was very positive. © 2021 ACM.

P.0206 Mental health during covid-19 infection

Background: Patients with Covid-19 are under great psychological stress, which can lead to the development of various psychiatric symptoms and maladaptive responses, such as anxiety, fear, depression, and insomnia. Psychiatric and psychological support can play a fundamental role in the general control of the disease. During the pandemic, whenever possible, services must provide help through telemedicine approaches. Digital solutions such as “PLANO-A-SAÚDE-C19” that allow to evaluate and to monitor the signs of infection of the SARS-CoV-2 while monitoring the states of mind, allow to maximize the capacity of the services without compromising on the quality-of-service provision. Objectives: To present and describe a digital platform that is being developed to remote monitoring Covid-19 patients and their mental health status at different points of the infection, from diagnosis to recovery. Methods: A set of sensors, coupled with a small low-cost device, is used to acquire biometric data according to different profiles. The device is connected wirelessly to a patient's smartphone, which transfers the acquired data to a central platform. Doctors can remotely access the data to assess the patient's condition and make decisions. The application running on the patient's smartphone can generate alerts (such as medication time) and alarms in case of dangerous biometric signals. In the case of Covid-19, the monitored parameters include blood pressure, heart rate, weight, body temperature, peripheral oxygen saturation, blood glucose, and the respiratory cycle. Validated psychiatric scoring tools are also used (the Montgomery–Åsberg Depression Rating Scale, the Pittsburgh Sleep Quality Index, the Insomnia Severity Scale, and the World Health Organization Quality of Life - BREF). Results: In this work, we would like to provide some preliminary data related to the impact of SARS-CoV-2 on the mental health of individuals infected during the course of the disease. We will describe the signs and symptoms of the virus, highlighting its relevance in changing the infected person's mental health status. Through the use of the digital platform, we hope to guarantee the quality of health services, proactively and continuously, following the fluctuations in the conditions of each patient, and contribute to the Proximity of Health, through the easy access between the patient and the provider of health. Conclusion: Healthcare services are facing a dramatic change in demand related to the effects of COVID-19. Scarce resources have mandated maximal operational efficiency and productivity to ensure timely patient access to best-suited treatment. Many hospitals have already telemedicine and launched hotlines to provide some help to people in need. Digital solutions that allow a double control of the state of organic and mental health can benefit the long-term economic, social and clinical results. The translation of therapeutic strategies that improve coping responses to stress following the needs of infected patients, contributes to the relief of related signs and symptoms. Apart from the Covid pandemic, distant mood follow-up monitoring promises a lot of others benefits. No conflict of interest

P22-05 In vitro toxicity assessment of paints with antimicrobial properties - a comparative study

In this work, the in vitro cytotoxicity of self-disinfecting wall paints containing antimicrobial substances was assessed, using skin and lung cell lines. Self-disinfecting surfaces have appeared as an alternative to common cleaning and disinfection protocols applied in different scenarios. These surfaces are even more trend nowadays due to the Covid-19 pandemic. We developed a wall paint formula with antimicrobial properties to be applied in areas with high propensity for infection spreading. To do so, substances with known activity against microorganisms were incorporated on a commercial wall paint. Both paints containing Bacitracin (0.6 g/L) or Colophony (3.2 g/L) showed good antimicrobial activity against several bacteria, namely Staphylococcus aureus and Escherichia coli. However, an important step of our work is to assure these surfaces' safety, both for people contacting with it and for workers handling the products. Following ISO 109931, direct contact and extracts tests were performed. The surfaces were placed in direct contact with in vitro cell cultures of HaCaT skin cells for 24h at 37°C, 5% CO2. In parallel, the surfaces were lixiviated in culture media and their extracts at several concentrations were exposed to HaCaT cells and A549 human alveolar epithelial cells, for 24h at 37°C, 5% CO2. Then, neutral red uptake (NRU), cell proliferation reagent WST-1 and lactate dehydrogenase activity (LDH) assays were performed, both on direct contact and extracts tests, for quantitative evaluation of cytotoxicity. For direct contact tests on HaCaT cells, both surfaces containing Bacitracin or Colophony showed cell viabilities of around 90%, with NRU and WST-1 showing similar results. LDH release was around 25% for both surfaces. Regarding the tests with the extracts on HaCaT cells, cell viability fluctuated between 85-70% for Bacitracin and between 80-90% for Colophony, according to the extract concentration. A proportional response was detected when decreasing the concentration of extract. LDH release was around 5-15% for Bacitracin and around 5-20% for Colophony. On A549 cells, the test on extracts demonstrated a cell viability of 100% for both surfaces and a LDH release of 15-25% for Bacitracin and 10% for Colophony. These results suggest that the extract forms of the Bacitracin and Colophony are more toxic to HaCaT cells comparing to the direct contacting surfaces containing the same compounds, however, with lower LDH release levels. Comet assay, measuring DNA damage is being performed to further evaluate the formulas' toxicity.

Acupuncture for healthcare workers during the COVID-19 pandemic: The experience of a University Hospital in southern Brazil

Introduction: Complaints related to mental health and psychiatric illnesses have emerged since the beginning of SARSCoV- 2 pandemic, especially among health-care workers (HCWs). Acupuncture could be a useful tool in this context. Objective: To describe the experience of using acupuncture in an integrative initiative at the University Hospital of the Federal University of Santa Catarina (HU-UFSC) to provide care to HCWs with medical disorders that have emerged or aggravated during the pandemic. Methods: HU-UFSC has implemented a contingency plan to cope with the new demands that emerged as a result of the SARS-CoV-2 pandemic. Within this contingency plan, a support team to HU-UFSC's HCWs was established. The initiative offered a comprehensive integrative approach that included acupuncture, psychiatry, psychology and homeopathy. HCWs sought support as they presented evolving symptoms or worsening of chronic conditions. Results: From April 2020 to July 2020, the acupuncture team completed a total of 340 appointments. Most patients were treated with acupuncture once a week for approximately 4 weeks. A survey of chief complaints showed that 83% of patients had mental health complaints. Among those, 56% had concurrent pain disorders;10% sought care for pain conditions exclusively and 7% reported other complaints. Mental health-related complaints were mostly associated with worsening of preexisting conditions, mainly anxiety, followed by irritability and sleep disorders. We observed a large number of patients with acute chronic pain associated with mental health complaints (56%). The three acupuncture medical professionals and two acupuncture residents involved in this project observed a significant improvement in symptoms among HCWs treated with acupuncture. In addition, the integrative approach facilitated the process of coping with suffering triggered by the pandemic. Conclusion:The present experience of using acupuncture for workers in a Brazilian university hospital setting suggests that acupuncture may help individuals suffering from mental health issues triggered by the pandemic.

Proliferative glomerulonephritis with monoclonal immunoglobulin deposition (PGNMID) associated with COVID-19

Introduction: Renal disease in COVID-19 is often due to acute tubular injury but can include multiple glomerular lesions such as collapsing glomerulopathy. This is the first reported case of COVID-19-associated PGNMID. Case Description: A 71-year-old woman with normal baseline creatinine (Cr) was admitted with COVID-19 and discharged on oxygen and dexamethasone (Dex). She improved but returned a month later with edema and nausea. She was found to have nephrotic syndrome, hematuria, and AKI (peak Cr 8.5 mg/dL) requiring HD. Kidney biopsy revealed PGNMID with clonal IgG3-kappa. SPEP, serum free light chains (sFLC), 24h urine UPEP, bone marrow biopsy with flow cytometry, fat pad biopsy, and PET-CT were negative for monoclonal immunoglobulin (Ig) or cell line, amyloid, or malignancy. Though symptoms had long since resolved, she was still PCR-positive for SARS-CoV-2 on nasal swab. Upon discharge she was given cyclophosphamide (Cy). Her renal function improved (Cr 2.5) and she came off HD 2 weeks later. Her outpatient oncologist opted not to continue therapy. However, 2 months later she was readmitted with nausea, dyspnea, and anasarca with recurrent AKI (Cr 6.7) and nephrotic syndrome. HD was restarted. Repeat kidney biopsy [Figure] was noted to be a carbon copy of the first. SPEP, spot UPEP, and sFLC were again negative. She was started on Cy, bortezomib, and Dex with similar partial response (Cr <2.5). Discussion: PGNMID is a rare type of monoclonal gammopathy of renal significance (MGRS) that often has no detectable extrarenal monoclonal Ig or cell line. MGRS and PGNMID, though usually not postinfectious, have been reported with other viruses (e.g., viral hepatitis, parvovirus-B19). However, though causality is unclear, this is the first case of MGRS reported in association with COVID-19.