PROTEÔMICA PLASMÁTICA QUANTITATIVA DE PACIENTES SOBREVIVENTES E NÃO SOBREVIVENTES DE COVID-19 INTERNADOS NO HOSPITAL REVELA POTENCIAIS BIOMARCADORES PROGNÓSTICOS E ALVOS TERAPÊUTICOS

O desenvolvimento de novas abordagens que permitam a avaliação precoce de quais casos de COVID-19 provavelmente se tornarão críticos e a descoberta de novos alvos terapêuticos são importantes. Neste estudo de coorte, foi avaliado o perfil proteômico e laboratorial do plasma de 163 pacientes internados no Hospital Estadual de Bauru (Bauru, SP, Brasil) entre 4 de maio e 4 de julho de 2020, que foram diagnosticados com COVID-19 por RT-PCR a partir de amostras de swab nasofaríngeo amostras. Amostras de plasma foram coletadas na admissão para análises laboratoriais de rotina e análise proteômica quantitativa shotgun livre de marcadores. De acordo com o curso da doença, os pacientes foram divididos em 3 grupos: a) Sintomas leves, com alta sem internação em unidade de terapia intensiva (UTI) (n=76);b) Sintomas graves, alta após admissão em UTI (n=56);c) Críticos, faleceram após admissão em UTI (n=31). Os glóbulos brancos e os neutrófilos foram significativamente maiores em pacientes graves e críticos em comparação com os leves. Os linfócitos foram significativamente menores nos pacientes críticos em relação aos leves e as plaquetas foram significativamente menores nos pacientes críticos em relação aos leves e graves. Ferritina, TGO, uréia e creatinina foram significativamente maiores nos pacientes críticos em relação aos leves e graves. Albumina, CPK, LDH e dímero D foram significativamente maiores nos pacientes graves e críticos em comparação aos leves. A PCR foi significativamente maior em pacientes graves em comparação com os leves. A análise proteômica revelou mudanças marcantes entre os grupos nas proteínas plasmáticas relacionadas à ativação do complemento, coagulação sanguínea, resposta inflamatória aguda e resposta imune. Pacientes críticos apresentaram níveis mais elevados de proteínas associadas CLEC4, CCL24, SAA1, SAA2, 2-M, PCR e níveis reduzidos de proteínas associadas ao sistema imune e complemento, como CD5L e VDBP, AHSG e PGLYRP2. Pacientes com sintomas leves apresentaram maiores níveis de proteínas protetoras, como PGLYRP2, APOH e PON-1. Nossos resultados indicam várias proteínas plasmáticas envolvidas na patogênese da COVID-19 que podem ser úteis para predizer o prognóstico da doença quando analisadas na admissão dos pacientes no hospital. A validação de algumas destas. Confirmando-se o seu papel, as vias envolvendo estas proteínas podem ainda ser novos alvos terapêuticos em potencial para a COVID-19.

AN INTIMATE PARTNER VIOLENCE CURRICULUM IN THE ERA OF TELEMEDICINE: ASSESSING KNOWLEDGE, ATTITUDE, PRACTICE AND SKILLS

SETTING AND PARTICIPANTS: The COVID-19 pandemic has been associated with a rise of intimate partner violence (IPV) and increased use of televisits but there is no published curricula addressing IPV assessment and management in the primary care televisit setting. A novel and virtual 90-minute workshop was developed and delivered to small groups of internal medicine interns at an academic medical center. DESCRIPTION: The workshop consisted of a slide show reviewing IPV, audiovisual testimony of an IPV victim, fishbowl interview roleplaying, and a prerecorded session with our clinic social worker. The workshop answered five learning objectives that established a foundational knowledge of IPV, addressed specifically how it impacts our patient population, and presented tangible next steps to identify and manage IPV in the televisit ambulatory setting. EVALUATION: Interns' attitudes, beliefs, knowledge, and clinical interview practices were evaluated before and six weeks after the workshop with a voluntary two-section survey and virtual Objective Structured Clinical Examinations (OSCEs). First section reproduced a validated survey by Maiuro et al. with six categories: Blame, Inquiry, Role Resistance, Provider's Perceived Efficacy, System Support, and Victim/Provider Safety. Second section consisted of knowledge questions based on Insetta et al.'s shortened PREMIS survey. Statistical analysis was carried out with signed rank and McNemar's tests. Of the 40 interns who completed the workshop, 36 (90%) completed the pre-post survey. There were improvements in Provider's Perceived Efficacy, System Support, and IPV Inquiry categories. Learners had improved confidence in strategies to inquire about IPV (p <0.01), reported improved ability to provide resources (p <0.01) and make appropriate referrals (p <0.01), and increase in access to IPV management information (p <0.01). Learners felt social work or community advocates as well as mental health services were readily accessible (p <0.01). Post-workshop knowledge questions revealed an overall improvement (p <0.01). Most significant IPV knowledge improvements were in state- based reporting requirements and the effects of the COVID-19 pandemic on IPV incidence (p = 0.02, p = 0.05, respectively). Learners reported more frequent clinical practice inquiries about IPV in patients with chronic pelvic pain, headaches, and mood disorders (p = <0.01, 0.012, 0.014, respectively). DISCUSSION / REFLECTION / LESSONS LEARNED: A brief virtual and novel IPV curriculum increased resident knowledge of IPV and confidence in ability to identify, assess, and effectively manage IPV in televisits. It led to a reported increase in IPV inquiries in clinical practice. In combination, this readily transportable curriculum has potential for positively impacting the care of patients experiencing IPV. Next steps include analyzing our pre-post OSCEs to elucidate if IPV interviewing skills also improved.

Symptoms of COVID-19 in children.

The aim of this study was to review the symptomatic manifestations of COVID-19 in children in the scientific literature. An integrative review of studies published between December 2019 and September 5, 2021, from the Medical Literature Analysis and Retrieval System Online, Web of Science, Scopus, Literatura Latino-Americana em Ciência de Saúde, and Base de Dados de Enfermagem databases, was carried out to answer the following research question: What symptomatic manifestations does COVID-19 cause in children?". Twenty articles were included. The main symptoms described were fever, cough, diarrhea, vomiting, sore throat, dyspnea, headache, abdominal pain, malaise, and weakness or tiredness. The findings of this review can contribute to the diagnosis and clinical decision-making of the health team by providing information that facilitates the identification of COVID-19 in the target population, favoring early identification, better care, and consequently a better prognosis.

Parliamentarism and regionalism in the face of the pandemic: Constitutional assessment of an emergency

The essay carries out a critical reconstruction of the emergency powers activated to deal with the COVID-19 emergency. On the one hand, it intends to highlight the loss of centrality of Parliament and, on the other, the limits of competitive regionalism. In the first part, the essay tries to verify whether the special system of emergency powers activated in this circumstance is legitimate, considering its derogation from the general discipline dictated by the civil protection law. The essay tries to verify, then, if the instruments adopted are compatible with the Italian form of government or if they do not end up further compromising the centrality of the Parliament, which was already greatly reduced during the past decades. In particular, the essay analyzes the problems posed by the much-discussed decrees of the President of the Council of Ministers (d.P.C.M.), also considering their substantial overcoming in the last year and a recent judgement by the Constitutional Court. In this context, the essay questions what should be the spaces for ordinary legislation, in view of the overcoming of the pandemic emergency phase. Finally, the essay tries to verify whether the simultaneous state and regional interventions concerning the management of the pandemic, which in many cases overlap, has once again highlighted the limits of competitive regionalism, and whether it is not necessary to imagine a new discipline of relations between State and Regions © 2021 Societa Editrice il Mulino. All rights reserved.

COVID-19: risk perception and coping strategy in workers

Introduction: COVID-19 has posed a challenge to labor activities in the world favoring the modality of online work, as an alternative to avoid being present and thus increasing the transmission of SARS-CoV-2. The social behaviors of workers and administrations are associated with the risk perception regarding COVID-19.

The icon trauma study: The impact of the COVID-19 lockdown on major trauma workload in the UK

Introduction: Anecdotal evidence suggest a direct impact of the SARSCOV- 2-pandemic on presentation and severity of major trauma. Method: This observational study from a UK Major Trauma Centre matched a cohort of patients admitted during a 10-week period of the SARS-CoV-2-pandemic (09/03/2020 to 18/05/2020) to a historical cohort admitted during a similar time period in 2019 (11/03/2019 to 20/05/ 2019). Demographic differences, injury method and severity were compared using Fisher's and Chi-squared tests. Multivariable logistic regression examined the associated factors predicting 30-day mortality. Results: Of 642 patients, 405 and 237 were in the 2019 and 2020 cohorts respectively. 1.69%(4/237) of the 2020 cohort tested SARS-CoV-2 positive. There was a 41.5% decrease in trauma admissions in 2020. The 2020 cohort was older (median 46 vs.40 years), more comorbid and frailer (p<0.0015). There was a significant difference in injury method with a decrease in vehicle related trauma, but an increase in falls. There was a 2-fold increased risk ofmortality in the 2020 cohort that in adjustedmodels, was explained by higher injury severity and frailty. Positive SARS-CoV-2 status was not associated with increasedmortality onmultivariable analysis. Conclusions: Patients admitted during the SARS-CoV-2-pandemic were older, frailer, more co-morbid and had an increased risk of mortality.

Comment on: "Characterization of acute acro-ischemic lesions in non-hospitalized patients: a case series of 132 patients during the COVID-19 outbreak" COVID-19 and surgical training in Italy: Residents and young consultants perspectives from the battlefield

COVID-19 is seriously affecting Italy, putting the health system under extreme pressure. Training of medical students and residents is also suffering from this with the suspension of lectures and clinical rotations. What solutions have been taken to deal with the issue?

Clinical and histological characterization of vesicular COVID-19 rashes: a prospective study in a tertiary care hospital.

COVID-19 is an infectious disease caused by severe acute respiratory coronavirus 2 (SARS-CoV-2). Vesicular skin rashes have been reported as associated with COVID-19, but there is little information about this cutaneous manifestation. We designed a prospective observational study of patients diagnosed with COVID-19 who had vesicular lesions. Clinical characterization of skin findings was conducted by dermatologists. When possible, histological analysis and detection of SARS-CoV-2 in the content of the vesicles was performed. In total, 24 patients were included. A disseminated pattern was found in 18 patients (75%), and a localized pattern was found in 6 (25%). Median duration of the skin rash was 10 days. Of the 24 patients, 19 (79.2%) developed the skin rash after the onset of COVID-19 symptoms. Histological examination in two patients was consistent with viral infection, SARS-CoV-2 was not detected in four patients. This single-centre study shows the clinical characteristics of vesicular skin rashes in patients with COVID-19.