Non-fever COVID-19 Detection by Infrared Imaging

This study proposed an infrared image-based method for febrile and non-febrile people screening to comply with the society needs for alternative, quick response, and effective methods for COVID-19 contagious people screening. The methodology consisted of: (i) Developing a method based on the face infrared imaging for early COVID-19 detection in people with and without fever;(ii) Recruiting 1206 emergency room (ER) patients to develop an algorithm for general application of the method, and (iii) Testing the method and algorithm effectiveness in 2558 cases (RTqPCR tested for COVID-19) from 227,261 workers evaluations in five different countries. Artificial intelligence was used with a convolutional neural network (CNN) to develop the algorithm that took face infrared images as input and classified the tested individuals into three groups: fever (high risk), non-febrile (medium risk), and without fever (low risk). The results showed that suspicious and confirmed COVID-19 (+) cases characterized by temperatures below the 37.5 °C fever threshold were identified. Also, average forehead and eye temperatures greater than 37.5 C were not enough to detect fever similarly to the proposed CNN algorithm. Most RT-qPCR confirmed COVID-19 (+) cases found in the 2558 cases sample (17 cases/89.5%) belonged to the CNN selected non-febrile COVID group. The COVID-19 (+) main risk factor was to be in the non-febrile medium-risk group, compared with age, diabetes, high blood pressure, smoking and others. In sum, the proposed method was shown to be a potentially important new tool for COVID-19 (+) people screening for air travel and public places in general. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

A PANDEMIA DE COVID-19 E O SEU IMPACTO NAS INAPTIDÕES À DOAÇÃO DE SANG1UE - EXPERIÊNCIA DO HCPA

Objetivo A pandemia de COVID-19 causou inúmeros impactos no cotidiano dos serviços de saúde, incluindo os serviços de hemoterapia. Foram necessárias diversas modificações de fluxos de trabalho e atendimentos visando a proteção dos profissionais e dos candidatos à doação. No banco de sangue do Hospital de Clínicas de Porto Alegre (HCPA) foi identificada diminuição no número de doadores por diferentes motivos e diversas causas de inaptidão dos candidatos à doação. Identificar as principais causas de inaptidão na doação de sangue no período de pandemia por COVID-19, traçar o perfil epidemiológico e verificar as causas de inaptidão irá nos permitir avaliar os pontos nevrálgicos e qualificar o processo de captação de doadores de sangue. Material e Métodos Foram analisados e comparados os dados de atendimentos no Banco de Sangue do HCPA no período de 2018-2019 (anteriores à pandemia) e durante a pandemia nos anos de 2020 e 2021. Resultados Nos anos de 2020-2021 houve uma diminuição do número total de doações de sangue, comparado ao período anterior. As inaptidões consideradas por problemas de saúde nos últimos 14 dias diminuíram em quase 53%. Houve diminuição em 61% na inaptidão à doação de sangue por motivo de viagens não realizadas e de 22,5% por cirurgias realizadas. Também se observou redução das inaptidões pelo motivo de realização de piercing e/ou tatuagem e pelo número de múltiplos parceiros sexuais. Em contrapartida, aumentou o número de inaptos por tratamento de doenças (70%) e pelo uso de medicamentos (55%). Além disso, o número de inaptidão por acidente com material pérfuro cortante aumentou em 145%, Discussão : A pandemia por COVID-19 causou impacto na doação de sangue, diminuindo o número total de doações e alterando os motivos de inaptidão. Como visto que as inaptidões por motivos de saúde diminuíram provavelmente em razão do isolamento social vivido e pela diminuição de transmissão de doenças gerais na população naquele período. Inaptidões por motivos que envolvem aglomerações ou deslocamentos e realização de procedimentos, diminuíram, como pode ser observado nas inaptidões por viagens, cirurgias, piercings e/ou tatuagens e múltiplos parceiros sexuais. Essa diminuição referente aos procedimentos cirúrgicos ocorreu provavelmente pois durante o período de pandemia cirurgias de caráter eletivo foram suspensas. Já as inaptidões por problemas pessoais, como tratamento de doenças e uso de medicações, aumentaram, o que pode refletir o impacto negativo da pandemia na saúde física e mental da população. O aumento da inaptidão por acidente com material perfuro cortante pode ser explicado pelo aumento de doações realizadas por profissionais da área da saúde e sobrecarga de trabalho desses. Conclusão A análise dos dados de inaptidão dos doadores e do perfil deles após a pandemia se faz necessário tendo em vista o grande impacto que esta mudança de perfil pode causar no número de doações realizadas e, consequentemente, na quantidade de hemocomponentes disponíveis em estoque. A manutenção do estoque dos Serviços de Hemoterapia sempre foi um desafio, mas durante a pandemia, este desafio foi mais evidenciado devido a queda no número de doadores. Cabe aos profissionais envolvidos neste processo pensar em alternativas para que possamos suprir a demanda transfusional com foco na qualidade da doação e cuidado ao paciente.

SAFETY of SARS-COV-2 VACCINES in PATIENTS with RHEUMATIC DISEASES: DATA from the NATIONAL REGISTRY SAR-COVAC from ARGENTINA

Background: Patients with rheumatic diseases (RD) have been excluded from SARS-CoV-2 vaccine trials, though data appear to show safety and efficacy, mostly evidence remains in mRNA vaccines. In our country, adenovirus-vector, inactivated and heterologous scheme vaccines are frequently used. Objectives: To describe the safety of SARS-CoV-2 vaccines in patients with RD from the national registry SAR-CoVAC and to assess sociodemographic and clinical factors associated to AE and disease fares after vaccination. Methods: Adult patients with RD who have been vaccinated for SARS-CoV-2 from de Argentine Society of Rheumatology Vaccine Registry (SAR-CoVAC) were consecutively included between June 1st and December 21st, 2021, This is a national multicentric observational registry that includes patients that have received at least one dose of any SARS-CoV-2 available vaccines in Argentina. Data is voluntarily collected by the treating physician. Naranjo scale was use to assess the association between the AE and vaccination. Homologous and heterologous schedules were defned according to whether both vaccines received were the same or different, respectively. Descriptive statics, Chi2 test, Fischer test, T test, ANOVA and multivariate regression logistic model were used. Results: A total of 1679 patients, with 2795 SARS-CoV-2 vaccine doses were included. Vaccines more frequently used were: Gam-COVID-Vac (1227 doses, 44%), ChAdOx1 nCov-19 (872 doses, 31%), BBIBP-CorV (482 doses, 17%) and mRAN-1273 (172 doses, 6%). Altogether, 510 EA were experienced by 449 (27%) patients. Pseudo-fu syndrome was the most frequent (11%), followed by injection site reaction (7%). They were signifcantly more frequent after the frst dose in comparison to the second one (13% vs 7% and 9% vs 5%, respectively, p<0.001 in both cases). All were mild or moderate and no patient was hospitalized due to an AE. One case of moderate anaphylaxis was reported by a patient who received Gam-COVID-Vac. No cases of vaccine-induced thrombotic thrombocytopenia were observed. There were 25 disease fares reported, 17 (68%) cases of arthritis. Among patients with two doses, those with heterol-ogous schedule presented AE more frequent after the second dose (39% vs 17%).Total incidence of EA was 182.5 events/10 00 doses, it was signifcantly lower for BBIBP-CorV (105.9 events/1000 dosis, p<0.002 for all cases). The higher incidence of AE was observed for mRAN-1273 (261.6 events/1000 doses) and ChAdOx1 nCov-19 (232.8 events/1000 doses). Patients with AE were younger [mean 55 years (SD 14) vs 59 years (SD 14), p <0.010], not Caucasian ethnicity [48% vs 35%, p<0.001], had higher education level [mean 13.8 years (SD 4) vs 11.9 years (SD 5), p<0.001], were more frequently employed [54% vs 44%, p<0.001], lived mostly in urban area [99% vs 95% p <0.001, had more frequently dyslipidemia [38% vs 28% p 0.012], and less frequently arterial hypertension [49% vs 65%, p<0.001]. Systemic lupus erythematosus [11% vs 7%, p=0.039] and Sjögren syndrome [6% vs 1.8%, p<0.001] were more frequent among them, while non infammatory diseases were less prevalent [19% vs 31%, p<0.001]. They were taking steroids [24 vs 18%, p=0.007], antimalarials [17% vs 10%, p<0.001] and methotrexate [41% vs 31%, p <0.001] more frequently. In the multivariable analysis, mRAN-1273 and ChAdOx1 nCov-19 were associated with AE, while BBIBP-CorV with lower probability of having one. (Figure 1) Conclusion: The incidence of AE was 1825 events/1000 doses, were signif-cantly higher for mRAN-1273 and ChAdOx1 nCov-19 and lower for BBIBP-CorV. Most common AE was pseudo-fu syndrome. Female sex, being younger, higher education level, ChAdOx1 nCov-19 and mRAN-1273 vaccines, the use of meth-otrexate and antimalarials were related of EA in patients with RD.

The social and occupational consequences of the COVID-19 pandemic among patients with multiple sclerosis in three distinct populations: A web-based cross-sectional survey

Background: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the disease COVID-19, has caused a pandemic that has rapidly affected the whole world and caused a significant threat to public health. The aim of this study was to investigate and analyze the social and occupational effects of the COVID-19 pandemic on patients with multiple sclerosis (MS) in three different countries: China, Spain, and Cuba. Methods: A cross-sectional survey was designed to assess the social and occupational effects of the COVID-19 pandemic in MS patients in these three countries, using a 25-item anonymous online questionnaire, structured into three sections. Quantitative data are expressed as mean (standard deviation), and quantitative data as absolute frequency and percentage. Results: A total of 361 participants responded to the questionnaire: 194 from China, 104 from Spain, and 63 from Cuba. We found no cases of COVID-19 among Chinese patients with MS, and few cases in Spain and Cuba. Respondents reported different levels of impact on relationships with friends, family, and colleagues, and patients in all three countries described increased use of digital or social media platforms. Spanish patients reported a significantly less negative impact than those in Cuba and China. Mental and cognitive effects were similar in all three countries, although China seemed to have a better situation. We also found that the time spent exercising decreased at specific points during the pandemic, but with few changes in dietary habits. Patients reported little or no change in their means of transport in all three countries. Most patients in all three countries reported little or no physical deterioration, especially in Chinese patients (82.47%), compared to the Spanish (70.20%) and Cuban respondents (73.02%). In general, patients from all three countries demonstrated confidence in overcoming the COVID-19 pandemic, although to a lesser extent among Spanish respondents. Conclusions: During the pandemic, family support was more effective in China than in Cuba and Spain. Neither COVID-19 infections nor the number of MS relapses increased significantly during lockdown in any of the three countries. Regarding their economic situation, Spanish MS patients reported a significantly less severe negative impact than those in Cuba and China. Patients from all three countries used digital or social media platforms more frequently, probably to maintain personal relationships. Chinese and Cuban respondents were more confident of the control of the pandemic than the Spanish, who were more pessimistic. © 2021

Epileptic seizures in the emergency room: clinical and electroencephalographic findings associated with brain perfusion patterns on computed tomography.

BACKGROUND: Diagnosis of epileptic seizures, particularly regarding status epilepticus (SE), may be challenging in an emergency room setting. The aim of the study was to study the diagnostic yield of perfusion computed tomography (pCT) in patients with single epileptic seizures and SE. METHODS: We retrospectively reviewed the records of patients who followed an acute ischemic stroke pathway during a 9-month period and who were finally diagnosed with a single epileptic seizure or SE. Perfusion maps were visually analyzed for the presence of hyperperfusion and hypoperfusion. Clinical data, EEG patterns, and neuroimaging findings were compared. RESULTS: We included 47 patients: 20 (42.5%) with SE and 27 (57.5%) with single epileptic seizure. Of 18 patients who showed hyperperfusion on pCT, 12 were ultimately diagnosed with SE and eight had EEG findings compatible with an SE pattern. Focal hyperperfusion on pCT had a sensitivity of 60% (95% CI 36.4-80.2) and a specificity of 77.8% (95% CI 57.2-90.6) for predicting a final diagnosis of SE. The presence of cerebral cortical and thalamic hyperperfusion had a high specificity for predicting SE presence. Of note, 96% of patients without hyperperfusion on pCT did not show an SE pattern on early EEG. CONCLUSIONS: In acute settings, detection by visual analysis of focal cerebral cortical hyperperfusion on pCT in patients with epileptic seizures, especially if accompanied by the highly specific feature of thalamic hyperperfusion, is suggestive of a diagnosis of SE and requires clinical and EEG confirmation. The absence of focal hyperperfusion makes a diagnosis of SE unlikely.

Antimicrobial Prescribing Guidance and Communication among Health Care Professionals in Five Guatemalan Hospitals

Background. Communication among health care professionals during antimicrobial prescribing is critical to ensure appropriate use. This is of concern in Guatemala where physicians seldom consider guidance from other professionals during antimicrobial prescribing activities. Methods. We carried out a cross sectional questionnaire and open ended interviews with physicians from five hospitals in Guatemala to describe perceptions of communication between health care providers, and acceptance of antimicrobial guidance during prescribing. Results. From January to April 2021 an electronic questionnaire was sent to enrolled physicians of which 74% completed participation (n=107/145). Fifty-five percent participated in open ended interviews (n=79/145). Respondents perceived high levels of communication between physicians and ID specialists (94% of respondents);52%, and 54% perceived high levels of physician-pharmacist, and physician-nurse communication respectively. Significant differences in the perception of physician-pharmacist communication were detected when comparing responses between hospitals, and between respondent sex (chi2, p< 0.05). Barriers to communication between professionals included lack of local guidelines or protocols, patient overload, COVID-19 pandemic, lack of mentorship, and little room to discuss antimicrobial therapy with higher-ranking physicians. Eighty percent and 45% of physicians were open to receiving antibiotic optimization recommendations from other physicians, and pharmacists respectively. Notable barriers to accepting recommendations from pharmacists included lack of regular communication, lack of clinical experience, and concern about evidence based recommendations. Conclusion. Effective communication is perceived between physicians during antimicrobial prescribing activities. Marginal levels of communication and acceptance of prescribing recommendations have been detected between physicians and pharmacists. In this milieu, there is an opportunity to strengthen multidisciplinary teams to optimize antimicrobial use.

Description of moderate-severe cases of covid-19 in pediatric cancer at the unidad nacional de oncologia pediatrica, Guatemala

Introduction. Guatemala reported the first confirmed SARS-CoV-2 case on March 13th 2020. Up to now, more than 140,000 confirmed cases have been documented, with 8% of them being <20 years-old. The impact of COVID-19 in pediatric cancer in not well known, even though pediatric oncological institutions did some initial recommendations, this new disease still represents a challenge in this population. The objective of the report is to describe the moderate-severe cases of COVID-19 in pediatric cancer during the first 8 months of the pandemic in the Unidad Nacional de Oncologia Pediatrica (UNOP). Methods. This is a descriptive, prospective report of pediatric cancer patients <20 years-old and SARS-CoV-2 infection confirmed by nasopharyngeal swab with PCR technique at UNOP from May to December 2020. The SARS-CoV-2 test was performed to all patients who developed symptoms of infection or as screening in patients who were admitted to UNOP regardless of symptoms. Information about sex, age, primary oncological diagnosis, confirmed coinfections and treatment received at time of COVID-19 was collected. Moderate illness was considered if the patient required supplemental oxygen and severe illness if admitted to Intensive Care Unit-ICU-secondary to COVID-19. Results. Two hundred one patients with pediatric cancer with the SARS-CoV-2 infection were confirmed. Sixty four percent were male (n=128), median of age was 9.5 years (5-m to 18-y). The primary oncologic diagnosis was leukemia 65% (n=129), and other solid tumors 35% (n=72), 5% (n=10) of patients were in palliative care. In leukemia patients, 40% were receiving induction therapy (n=51), 25% consolidation (n=32), and 19% maintenance (n=25). The most common initial symptom was fever in 32% (n=64) and 33% were asymptomatic (n=67). Twenty two percent developed moderate disease (n=44) and 13% severe disease (n=26). A total of 13 patients died during COVID-19 period (6%) and 7 of them died receiving active treatment (3%). The risk of developing moderate-severe disease was not higher in leukemia patients compared to patients with other tumors who were receiving intense chemotherapy (OR=0.7), but there might be a higher risk of death (OR=1.41). In patients with leukemia, the risk of developing moderate-severe disease was higher for patients receiving induction therapy compared with those in consolidation (OR=6.7) or maintenance (OR=3.04). Mortality risk seems to be higher in patients with leukemia during induction therapy (OR=1.94). Confirmed coinfections correlated with higher risk of severe illness (OR=1.95) and death during the COVID19 period (OR=5.2). Conclusions. The mortality due to COVID-19 in pediatric cancer is low and could be related to coinfections or intensive chemotherapy. Important limitation of our report is the lack of analysis of underlying clinical conditions in moderate-severe disease (neutropenia or other comorbidities), factors that could have an impact on our data analysis.

Longitudinal reduction of quality of life in patients with epilepsy and no seizure increase during the COVID-19 pandemic

Background and aims: In early 2020, the novel coronavirus disease (COVID-19) pandemic has impaired medical care of chronic neurological diseases, including epilepsy. The objective of this study is to evaluate the impact of the COVID-19 pandemic in the levels of anxiety, depression, somnolence and quality of life using validated scales in patients with epilepsy in real-life clinical practice. Methods: Self-administered scales of anxiety disorders (GAD-7), depression (NDDI-E), somnolence (Epworth Sleepiness Scale;ESS) and quality of life (QOLIE-31-P) in patients with epilepsy treated in the Refractory Epilepsy Unit of a tertiary hospital were longitudinally analyzed with Generalized Linear Mixed Models. Data were collected before the beginning (December 2019-March 2020) and during the COVID-19 pandemic (September 2020-January 2021). Results: 37 patients, 45.0±17.3 years of age, 43.2% women, epilepsy duration 23.0±14.9 years, number of anti-epileptic drugs 2.1±1.4, answered in the two periods. Significant longitudinal reduction of QOLIE-31-P scores (from 58.9±19.7 to 56.2±16.2, p=0.035) was identified. No statistically significant longitudinal changes in NDDI-E (from 12.3±4.3 to 13.4±4.4, p=0.293) or the number of seizures (from 0.9±1.9 to 2.5±6.2, p=0.125) were found. Significant higher ESS (from 4.9±3.7 to 7.4±4.9, p=0.001) and lower GAD-7 scores (from 8.8±6.2 to 8.3±5.9, corrected p=0.024 adjusted by refractory epilepsy and sleep disturbance) were found during the COVID-19 pandemic. Conclusion: During the COVID-19 pandemic, quality of life was lower in patients with epilepsy, levels of anxiety were reduced and sleepiness levels were raised, without seizure change. Additional studies would be useful to adequately manage these comorbidities.

Validation of a combined ELISA to detect IgG, IgA and IgM antibody responses to SARS-CoV-2 in mild or moderate non-hospitalised patients.

BACKGROUND: Frequently SARS-CoV-2 results in mild or moderate disease with potentially lower concentrations of antibodies compared to those that are hospitalised. Here, we validated an ELISA using SARS-CoV-2 trimeric spike glycoprotein, with targeted detection of IgG, IgA and IgM (IgGAM) using serum and dried blood spots (DBS) from adults with mild or moderate disease. METHODS: Targeting the SARS-CoV-2 trimeric spike, a combined anti-IgG, IgA and IgM serology ELISA assay was developed using 62 PCR-confirmed non-hospitalised, mild or moderate COVID-19 samples, ≥14 days post symptom onset and 624 COVID-19 negative samples. The assay was validated using 73 PCR-confirmed non-hospitalised, mild or moderate COVID-19 samples, ≥14 days post symptom onset and 359 COVID-19 negative serum samples with an additional 81 DBSs. The assay was further validated in 226 PCR-confirmed non-hospitalised, mild or moderate COVID-19 samples, ≥14 days post symptom onset and 426 COVID-19 negative clinical samples. RESULTS: A sensitivity and specificity of 98.6% (95% CI, 92.6-100.0), 98.3% (95% CI, 96.4-99.4), respectively, was observed following validation of the SARS-CoV-2 ELISA. No cross-reactivities with endemic coronaviruses or other human viruses were observed, and no change in results were recorded for interfering substances. The assay was stable at temperature extremes and components were stable for 15 days once opened. A matrix comparison showed DBS to correlate with serum results. Clinical validation of the assay reported a sensitivity of 94.7% (95% CI, 90.9-97.2%) and a specificity of 98.4% (95% CI, 96.6-99.3%). CONCLUSIONS: The human anti-IgGAM SARS-CoV-2 ELISA provides accurate and sensitive detection of SARS-CoV-2 antibodies in non-hospitalised adults with mild or moderate disease. The use of dried blood spots makes the assay accessible to the wider community.

Management of breast cancer in COVID-19 pandemic: a local experience / Manejo del cáncer de mama en tiempos de pandemia COVID-19: experiencia local

La pandemia por COVID-19 ha generado un estancamiento mundial en la atención y resolución de todas las patologías graves y crónicas, debido al colapso de los sistemas de salud, a la dificultad de consulta, dada por la disminución de movilidad de las personas, por las cuarentenas establecidas y también por el temor de los pacientes al contagio en los centros de salud. Los enfermos oncológicos han visto canceladas sus atenciones, suspendidos o postergado sus tratamientos y diferidas sus cirugías. Esto no ha sido ajeno a las pacientes con cáncer de mama. En el presente trabajo, se reporta la experiencia de una Unidad de Patología Mamaria de un hospital público de Santiago de Chile y de las acciones realizadas para mantener la continuidad de atención en una comuna con una alta tasa de infección por SARS-CoV-2.

The COVID-19 pandemic has generated a global stagnation in the care and medical treatment of serious and chronic illnesses due to the collapse of the health systems, the difficulty of consulting due to decreased mobility caused by forced quarantines and also because of the fear of infection when attending a health center. Cancer patients have had their medical appointments canceled, their treatments suspended or postponed, and their surgeries delayed. Breast cancer patients have not been the exception. We report the experience of a Breast Pathology Unit of a public hospital in Santiago of Chile, and the actions carried out to maintain continuity of care in a community with a high infection rate of SARS-CoV-2.