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BackgroundSystemic lupus erythematosus (SLE) is an autoimmune disease, which presents an immune disorder that leads to the production of autoantibodies with potential involvement of multiple organs. Infections are one of the most frequent causes of hospitalization and death in lupus patients, and SARS-CoV-2 infection has been a global threat since March 2020. Immunization of these patients has been strongly recommended, although vaccine evaluation studies have not included this profile of patients.ObjectivesTo evaluate the immunogenicity and safety after 2 doses of the vaccine against SARS-CoV2 in patients with SLE.MethodsSubgroup of SLE patients from the prospective multicenter cohort of patients with immune-mediated diseases "SAFER” – Safety and Efficacy on COVID-19 Vaccine in Rheumatic Disease, a phase IV study. Vaccination against SARS-CoV-2 took place with vaccines approved by Brazilian regulatory bodies CoronaVac (Inactivated SARS-CoV-2 Vaccine), ChadOx-1 (AstraZeneca) and BNT162b2 (Pfizer-BioNTech) and this project followed in line with the guidelines of the National Immunization Plan in Brazil. Patients aged 18 years or older with a previous diagnosis of SLE (according to the 2019 ACR/EULAR criteria) were included. Patients were evaluated by telephone contact and in a face-to-face visit on the 28th day after each dose. Patients were followed up by means of blood collection for measurement of IgG antibody against SARS-COV-2 by chemiluminescence and disease activity assessed using SLEDAI-2K score.ResultsA total of 367 individuals with SLE were included, of whom 207 received 2 doses of CoronaVac, 128 received 2 doses of ChadOx-1 and 32 received 2 doses of BNT162b2. 90% of the subjects were female with a mean age of 37 years. About 42% (154) of the individuals included did not have any other associated comorbidity. 50% (182) of patients were using oral glucocorticoids and azathioprine was the most frequent immunosuppressive therapy. Regarding disease activity parameters, 38% (140) of patients had zero SLEDAI-2K at baseline and 41% (147) had zero SLEDAI-2K 28 days after the 2nd dose. Anti-DNA positivity was 30.7% (16/52) at inclusion and 32.6% (17/52) 28 days after the 2nd dose. Complement consumption was present in 18% (10/55) at inclusion and in 14.5% (8/55) 28 days after the 2nd vaccine dose. The geometric mean titers of IgG antibodies against SARS-COV-2 increased in the different vaccine groups, log 2.27 BAU/mL at inclusion and log 5.58 BAU/mL 28 days after the 2nd dose. Antibody titers after second dose varied between different vaccines, 4.96 BAU/mL CoronaVac, 6.00 BAU/mL ChadOx-1 and 7.31 BAU/mL BNT162b2 vaccine, p < 0.001. Only 3.54% (13/367) patients had covid-19 infection after the 15th day of the second dose of immunization, 9 of them having received 2 doses of CoronaVac, 4 of them of ChadOx-1 and none of them receiving BNT162b2, with p-value of 0.63.ConclusionThis study suggests that vaccines against SARS-COV-2 are safe in SLE patients. Induction of immunogenicity occurred in different vaccine regimens. Only 3.5% of individuals had COVID-19 infection with no difference between the types of vaccines evaluated. Future analyzes to explore the association of the effect of immunosuppressive medication, as well as the impact of booster doses and longer follow-up on clinical outcome will be performed.References[1]Mason A, et al. Lupus, vaccinations and COVID-19: What we know now. Lupus. 2021;30(10):1541-1552.[2]Furer V, Eviatar T, Zisman D, et al. Immunogenicity and safety of the BNT162b2 mRNA COVID-19 vaccine in adult patients with autoimmune inflammatory rheumatic diseases and in the general population: A multicentre study. Ann Rheum Dis. 2021;80(10):1330-1338.[3]Izmirly PM, Kim MY, Samanovic M, et al. Evaluation of Immune Response and Disease Status in SLE Patients Following SARS-CoV-2 Vaccination. Arthritis Rheumatol. Published online 2021.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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BackgroundPatients with immune-mediated rheumatic diseases (IMRDs) have been prioritized for COVID-19 vaccination to mitigate the infection severity risks. Patients with rheumatoid arthritis (RA) are at a high risk of severe COVID-19 outcomes, especially those under immunosuppression or with comorbidities associated. However, few studies in the literature assessed the safety and immunogenicity of the COVID-19 heterologous vaccine schedules in patients with RA.ObjectivesEvaluate the safety and immunogenicity of two heterologous vaccine schedules against SARS-CoV-2 in patients with RA.MethodsThese data are from the study "SAFER - Safety and Efficacy on COVID-19 Vaccine in Rheumatic Diseases,” a Brazilian multicentric prospective phase IV study to evaluate COVID-19 vaccine in IMRDs in Brazil. Immunogenicity and adverse events (AEs) in patients with RA of all centers were assessed after two doses of ChAdOx1 plus additional dose of BNT162b2 or after two doses of inactivated SARS-CoV-2 vaccine CoronaVac plus additional dose of BNT162b2. The titers of neutralizing antibodies against the receptor-biding domain of protein spike (S) of SARS-CoV-2 (anti-RBD) were measured by chemiluminescence test after each dose of immunizers. Proportions between groups were compared using the chi-square and Fisher's exact tests for categorical variables. Clinical Disease Activity Index (CDAI) before and after vaccination was assessed using the McNemar test.ResultsA total of 107 patients with RA were include in the study, most of them female, with a mean age of 46 years. Biological disease modifying anti-rheumatic drugs (DMARDs) were used by 50 % of the patients and conventional synthetics DMARDs in 48 %. Two doses of CoronaVac plus additional dose of BNT162b2 was used in 66 patients and two doses of ChAdOx1 plus additional dose of BNT162b2 in 41. Only mild AEs were observed, mainly after the first dose. The most common AEs after all doses, regardless of the immunizer type, were pain at the injection, headache, arthralgia and myalgia. ChAdOx1 had a higher frequency of pain at the injection (66% vs 32 %, p < 0,001) and arthralgia (68% vs 15%, p < 0,001) compared to CoronaVac. No patients had flare after the vaccination. The titers of anti-RBD after two doses of ChAdOx1 were higher compared to two doses of CoronaVac (6,03 BAU/mL vs 4,67 BAU/mL, p < 0,001). However, after the additional dose of BNT162b2, the anti-RBD titers were similar in both groups (7.28 BAU/mL vs 7.06 BAU/mL, p = 0.56). Only two cases of COVID 19, with mild symptoms, were reported, one in each group.Figure 1.ConclusionChAdOx1, CoronaVac, and BNT162b2 vaccines are safe in RA patients. The frequency of local adverse effects, particularly pain at the injection site, is high. AEs are more frequent with ChAdOx1, especially after the first dose. The use of the immunizers does not change the degree of inflammatory activity of the disease. The immunogenicity of the two heterologous regimens analyzed was similar.References[1]Marques C, Kakehasi AM, Gomides APM, Paiva EDS, Dos Reis Neto ET, Pileggi GCS, et al. A Brazilian Cohort of Patients With Immuno-Mediated Chronic Inflammatory Diseases Infected by SARS-CoV-2 (ReumaCoV-Brasil Registry): Protocol for a Prospective, Observational Study. JMIR Res Protoc.[2]Medeiros-Ribeiro AC, Aikawa NE, Saad CGS, Yuki EFN, Pedrosa T, Fusco SRG, et al. Immunogenicity and safety of the CoronaVac inactivated vaccine in patients with autoimmune rheumatic diseases: a phase 4 trial. Nat Med. 2021;27(10):1744-1751.[3]Machado PM, Lawson-Tovey S, Strangfeld A, Mateus EF, Hyrich KL, Gossec L, et al. Safety of vaccination against SARS-CoV-2 in people with rheumatic and musculoskeletal diseases: results from the EULAR Coronavirus Vaccine (COVAX) physician-reported registry. Ann Rheum Dis. 2022;81(5):695-709.[4]Tavares ACFMG, Melo AKG, Cruz VA, Souza VA, Carvalho JS, Machado KLLL, et al. Guidelines on COVID-19 vaccination in patients with immunemediated rheumatic diseases: a Brazilian Society of Rheumatology task force. Adv Rheumatol. 2022;62:3.Acknowledg ments:NIL.Disclosure of InterestsNone Declared.
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Objectives: To evaluate the safety and immunogenicity of CoronaVac and ChAdOx1 vaccines against SARS-CoV-2 in patients with Rheumatoid Arthritis (RA). Method(s): These data are from the 'SAFER (Safety and Efficacy on COVID-19 Vaccine in Rheumatic Diseases)' study, a Brazilian multicentric longitudinal phase IV study to evaluate COVID-19 vaccine in immunomediated rheumatic diseases (IMRDs). Adverse events (AEs) in patients with RA were assessed after two doses of ChAdOx1 or CoronaVac. Stratification of postvaccination AEs was performed using a diary, filled out daily. The titers of neutralizing antibodies against the receptor-biding domain of SARS-CoV-2 (anti-RBD) were measured by chemilumine scence test after each dose of immunizers. Proportions between groups were compared using the Chi-square and Fisher's exact tests for categorical variables. Clinical Disease Activity Index (CDAI) before and after vaccination was assessed using the McNemar test. Result(s): A total of 188 patients with RA were included in the study, most of them were female. CoronaVac was used in 109 patients and ChAdOx1 in 79. Only mild AEs were observed. The more common AEs after the first dose were pain at injection site (46,7%), headache (39,4%), arthralgia (39,4%) and myalgia (30,5%), and ChAdOx1 had a higher frequency of pain at the injection site (66% vs 32 %, p alpha 0.001) arthralgia (62% vs 22%, p alpha 0.001) and myalgia (45% vs 20%, p alpha 0.001) compared to CoronaVac. The more common AEs after the second dose were pain at the injection site (37%), arthralgia (31%), myalgia (23%) and headache (21%). Arthralgia (41,42 % vs 25 %, p = 0.02) and pain at injection site (51,43% vs 27%, p = 0.001) were more common with ChAdOx1. No patients had a flare after vaccination. The titers of anti-RBDafter two doses of ChAdOx1 were higher compared to two doses of CoronaVac (6,03 BAU/mL vs 4,67 BAU/mL, p alpha 0,001). Conclusion(s): The frequency of local adverse effects, particularly pain at injection site, was high. AEs were more frequent with ChAdOx1, especially after the first dose. The use of the immunizers dis not change the degree of inflammatory activity of the disease. In patients with RA, ChAdOx1 was more immunogenic than CoronaVac. .
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Covid-19 has rapidly spread and affected millions of people worldwide. For that reason, the public healthcare system was overwhelmed and underprepared to deal with this pandemic. Covid-19 also interfered with the delivery of standard medical care, causing patients with chronic diseases to receive subpar care. As chronic heart failure becomes more common, new management strategies need to be developed. Mobile health technology can be utilized to monitor patients with chronic conditions, such as chronic heart failure, and detect early signs of Covid-19, for diagnosis and prognosis. Recent breakthroughs in Artificial Intelligence and Machine Learning, have increased the capacity of data analytics, which may now be utilized to remotely conduct a variety of tasks that previously required the physical presence of a medical professional. In this work, we analyze the literature in this domain and propose an AI-based mHealth application, designed to collect clinical data and provide diagnosis and prognosis of diseases such as Covid-19 or chronic cardiac diseases. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Background: In order to propose a destination for the bottom ash generated from biomass burning, its morphology, functional groups and mineral phases were studied. Dipyrone has been extensively used as an antipyretic, increased due to cases of COVID-19, and due to excretion by urine, incorrect disposal and industrial effluents has been destined to wastewater, being harmful to human and animal life. The present study proposes using biomass ash for the adsorption of dipyrone. Result(s): The characterization of biomass ash shows a sufficient surface area size for adsorption, and a mainly amorphous structure with some peaks of quartz, calcite and other mineral phases. The results show that the kinetic model which best describes the adsorption is the pseudo-first-order model. The Langmuir model best fits at 25 degreeC, and the Freundlich model best describes the adsorption at 35 and 45 degreeC. The thermodynamic parameters indicated that the process is endothermic with a maximum adsorptive capacity of 65.27 mg g-1. In addition, the adsorption is spontaneous, disordered and chemical. The ionic strength study reveals that the adsorbent is promising for real effluent treatment and there is evidence that electrostatic interaction is not the primary adsorptive mechanism, agreeing with the result obtained from pH testing. The proposed mechanism for dipyrone removal involves hydrogen bonds, pi bonds and electron donor-acceptor complex. Conclusion(s): The results are promising in comparison with recent literature and solve two environmental problems: biomass bottom ash disposal and pharmaceutical removal in aqueous medium. The ash may be regarded as a low-cost and environmentally friendly adsorbent. © 2023 Society of Chemical Industry (SCI).
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The COVID-19 pandemic increased the pollution of water resources by some contaminants, e.g., chloroquine (CQN), due to its probable benefit in the treatment of the virus. Thus, is necessary the removal of CQN from water through advanced techniques. Black soybeans have been widely used due to their benefits to human health, and as a result, there was an increase in soybean husk residue, the main by-product of the soybean processing industry. Given the current scenario and the need to develop new uses for this agricultural residue, this study aimed to establish an economical and environmental biotechnology by the CQN adsorption process onto black soybean hulls (BSH) for the first time. BSH was characterized by physicochemical and spectroscopic techniques that demonstrated porosity, organic functional groups and negative surface charges. The pH study did not affect CQN adsorption pronouncedly, indicating that π-interactions and hydrogen bonds are the main mechanisms of the adsorption process. The maximum adsorption capacity was 75.06 ± 2.24 mg g−1 with 240 min of contact time at 288 K. In order to verify the biosorbent applicability, the safranin orange dye and triclosan adsorption were also evaluated onto BSH. The absorption peaks of the contaminants used in the synthetic mixture demonstrated a removal rate of 90.81 ± 0.80% for safranin orange, 66.79 ± 1.12% for triclosan and 70.62 ± 0.67% for CQN. The satisfactory removal of other contaminants indicates that BSH is a promising, affordable and environmentally friendly biosorbent with applicability potential for alternative treatment of contaminated water. © 2023 Taylor & Francis Group, LLC.
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Innate immunity is the first line of host defense against microbes, including SARS-CoV-2. This pleiotropic immunological mechanism is initiated within minutes to hours after infection. Here, we summarize innate immune processes involved in SARS-CoV-2 recognition, cellular, and molecular response including inflammation, as well as the related immune modulatory therapies that have been evaluated in clinical trials for COVID-19. Innate immune responses limit viral replication, help identify and remove infected cells, sense pathogen-associated molecular patterns, trigger signaling pathways, inflammatory responses, cytokine production, programmed cell death, and contribute the development of adaptive immunity. Excessive activation of the host innate immune response is associated with severe disease and death. The availability and speed of implementation of these mechanisms in infected individuals may explain in part the heterogeneous disease spectrum and courses observed in patients. © 2023 Elsevier Inc. All rights reserved.
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Introduction and Objectives: Identifying independent risk factors for adverse outcomes in patients infected with severe acute respiratory syndrome coronavirus 2 can support prognostication, resource utilization, and treatment. The presenting symptoms of this virus are variable and the evolution and clinical significance of abnormal liver chemistries on outcomes in patients with coronavirus disease 2019 (COVID-19) is not well characterized. This study aimed to evaluate if aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels could predict disease severity in patients with COVID-19. Material(s) and Method(s): a retrospective, observational and cross-sectional study was carried out with data from the medical records of patients who had positive SARS-CoV2 nasal swabs, were over 18 years of age and were admitted consecutively and under free demand at a Brazilian academic hospital from April 1 to May 31, 2021. The characteristics of liver abnormalities and outcomes of patients with COVID-19 were compared. Result(s): altogether, 222 patients were enrolled, three patients with cirrhosis and 82% with abnormal liver chemistries during hospitalization. Of these, 20% showed transaminases >5 times the upper limit of normal (ULN). The most prevalent liver abnormality was AST. The increase in transaminases was directly proportional to the higher rates of intensive care unit admission, longer hospital stays, higher rates of vasoactive drug use and greater pulmonary involvement in its severe forms. We found that elevations of transaminases >5 times the ULN, at any time during hospitalization were associated with increased mortality. Conclusion(s): coronavirus 2 hepatitis may lead to poor outcomes in patients who are hospitalized for the disease. Therefore, monitoring liver chemistries, especially AST is necessary for hospitalized patients with COVID-19.Copyright © 2023
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The World Health Organization (WHO) has declared the novel coronavirus (COVID-19) outbreak a global pandemic in March 2020. Through a lot of cooperation and the effort of scientists, several vaccines have been created. However, there is no guarantee that the virus will shortly disappear, even if a large part of the population is vaccinated. Therefore, non-invasive methods, with low cost and real-time results, are important to detect infected individuals and enable earlier adequate treatment, in addition to preventing the spread of the virus. An alternative is using forced cough sounds and medical information to distinguish a healthy person from those infected with COVID-19 via artificial intelligence. An additional challenge is the unbalancing of these data, as there are more samples of healthy individuals than contaminated ones. We propose here a Deep Neural Network model to classify people as healthy or sick concerning COVID-19. We used here a model composed by an Convolutional Neural Network and two other Neural Networks with two full-connected layers, each one trained with different data from the same individual. To evaluate the performance of the proposed method, we combined two datasets from the literature: COUGHVID and Coswara. That dataset contains clinical information regarding previous respiratory conditions, symptoms (fever or muscle pain), and a cough record. The results show that our model is simpler (with fewer parameters) than those from the literature and generalizes better the prediction of infected individuals. The proposal presents an average Area Under the ROC Curve (AUC) equal to 0.885 with a confidence interval (0.881-0.888), while the literature reports 0.771 with (0.752-0.783). © 2023, Federal University of Rio Grande do Sul, Institute of Informatics. All rights reserved.
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Deep learning techniques, in particular generative models, have taken on great importance in medical image analysis. This paper surveys fundamental deep learning concepts related to medical image generation. It provides concise overviews of studies which use some of the latest state-of-the-art models from last years applied to medical images of different injured body areas or organs that have a disease associated with (e.g., brain tumor and COVID-19 lungs pneumonia). The motivation for this study is to offer a comprehensive overview of artificial neural networks (NNs) and deep generative models in medical imaging, so more groups and authors that are not familiar with deep learning take into consideration its use in medicine works. We review the use of generative models, such as generative adversarial networks and variational autoencoders, as techniques to achieve semantic segmentation, data augmentation, and better classification algorithms, among other purposes. In addition, a collection of widely used public medical datasets containing magnetic resonance (MR) images, computed tomography (CT) scans, and common pictures is presented. Finally, we feature a summary of the current state of generative models in medical image including key features, current challenges, and future research paths.
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Introducao: A doenca falciforme (DF) e uma condicao genetica frequente no Brasil caracterizada pela presenca da hemoglobina S nas hemacias. No inicio da pandemia do novo coronavirus, houve receio de que pacientes com DF tivessem maior risco de desenvolver doencas mais graves em decorrencia dessa infeccao viral. Contudo, dados publicados ate o momento nao apresentam consenso sobre o real impacto da DF na evolucao da infeccao pelo SARS-CoV-2 e muitos sao os questionamentos sobre a prevalencia da COVID-19 nesta populacao. Como essa populacao e imunossuprimida, a infeccao pelo novo coronavirus pode ser uma condicao associada a maior morbimortalidade, sendo importante compreender como este virus pode afetar os pacientes com DF. Objetivos: relatar os casos clinicos de duas pacientes com DF e COVID-19 atendidas no ambulatorio do Hemocentro de Belo Horizonte da Fundacao Hemominas. Material e metodos: o diagnostico da COVID-19 e os dados sobre sua evolucao clinica e laboratorial foram acessados por consulta aos relatorios de atendimento ambulatorial. Este estudo foi aprovado pelo Comite de Etica em Pesquisa da Fundacao Hemominas, CAAE: 36853820.5.0000.5118. Resultados: Caso 1 - paciente do sexo feminino, 20 anos, homozigota SS, apresentou anemia sendo necessaria a realizacao de transfusao de concentrado de hemacias e suplementacao de oxigenio. Nao estava em regime de hipertransfusao e nao fazia uso de hidroxiureia. A angiotomografia do torax revelou trombo em ramo segmentar para lobo medio;derrame plural bilateral, maior a esquerda;e importantes consolidacoes pulmonares em lobos inferiores. Foi coletado swab da nasofaringe para pesquisa do SARS-CoV-2 e por meio de RT-qPCR foi confirmada a COVID-19. A paciente apresentou melhora clinica e recebeu alta. Caso 2 - paciente do sexo feminino, 61 anos, com hemoglobinopatia SC deu entrada no hospital com dor no corpo e fraqueza. Nao estava em regime de hipertransfusao e nao fazia uso de hidroxiureia. Tinha historia pregressa de sindrome toracica aguda, retinopatia e hepatite C. Permaneceu internada no hospital para suplementacao de oxigenio e tratamento com dexametasona e enoxaparina. Foi coletada amostra de swab da nasofaringe para realizacao de RT-qPCR para SARS-CoV-2 e o resultado foi positivo. Apos 5 dias de internacao, a paciente recebeu alta. Discussao: Diferente do esperado, as pacientes com DF e infeccao pelo SARS-CoV-2 apresentaram evolucao clinica favoravel, uma vez que nenhuma apresentou quadro clinico grave da COVID-19 e ambas se recuperaram da infeccao. Conclusao: Nossos dados sugerem que a DF nao aumentou o risco de desenvolver formas graves de COVID-19 nas pacientes. Embora esse achado seja corroborado por relatos de caso em diferentes paises, ainda sao necessarios mais estudos para avaliacao dos fatores de maior gravidade pela COVID-19 em pacientes com DF, a fim de reduzir possiveis desfechos desfavoraveis nessa populacao. Copyright © 2022
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Introduction: Emerging evidence suggests that the COVID-19 pandemic had a negative impact on mental health. In particular, patients with Anorexia nervosa (AN) may have faced increased symptom severity. Objective(s): To compare the clinical characteristics of inpatients with AN admitted amidst the COVID-19 pandemic versus the two previous years. Method(s): Retrospective observational study of inpatients admitted between January 2018 and December 2020 in a psychiatry inpatient unit of a tertiary hospital. Result(s): There were 11 admissions of patients with AN in 2020 (8 from March onwards), a 22% increase relative to 2019, which in turn saw a 28% increase in admissions relative to 2018. Most patients had an AN diagnosis previous to the pandemic. The majority were undergoing outpatient treatment for over a year. Two patients were admitted within a month of outpatient treatment. There was an increase in admissions through the emergency service in 2020. The most frequent diagnostic was AN binge-eating/ purging type in 2020 and 2019, whereas in 2018 the AN restrictive type was dominant. Mean BMI at admission and average length of stay were similar across the three years. Readmission in a 12-month period was 54,5% in 2020 (22,2% in 2019 and 42,9% in 2018). Conclusion(s): Despite the widespread impression of a negative impact of the pandemic on AN patients, in our study the clinical characteristics of AN patients admitted in 2020 were mostly similar to the two previous years. Readmissions were higher in 2020, therefore future analysis of data from 2021 might be more enlightening.
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Deep learning techniques, in particular generative models, have taken on great importance in medical image analysis. This paper surveys fundamental deep learning concepts related to medical image generation. It provides concise overviews of studies which use some of the latest state-of-the-art models from last years applied to medical images of different injured body areas or organs that have a disease associated with (e.g., brain tumor and COVID-19 lungs pneumonia). The motivation for this study is to offer a comprehensive overview of artificial neural networks (NNs) and deep generative models in medical imaging, so more groups and authors that are not familiar with deep learning take into consideration its use in medicine works. We review the use of generative models, such as generative adversarial networks and variational autoencoders, as techniques to achieve semantic segmentation, data augmentation, and better classification algorithms, among other purposes. In addition, a collection of widely used public medical datasets containing magnetic resonance (MR) images, computed tomography (CT) scans, and common pictures is presented. Finally, we feature a summary of the current state of generative models in medical image including key features, current challenges, and future research paths.
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Introduction: PURE is an international registry of adult patients with moderate-to-severe psoriasis treated with secukinumab (Cohort 1) vs other approved therapies (Cohort 2). The SARS-CoV-2 (COVID-19) pandemic necessitated adaptations in the collection of data enabling continued, successful monitoring of patients in the registry. This presents an overview of these changes and their impact on the PURE registry. Materials and methods: This ongoing registry enrolled 2362 adult patients with moderate to severe psoriasis (1:1 ratio;secukinumab: other treatments) from 81 community and hospital sites. As a noninterventional study, PURE registry allowed for flexibility in the visit schedule and type of visit (remote visits vs face-to-face) per routine practice. This enabled monitoring of patient outcomes during the pandemic at sites where appropriate resources and capabilities were available to perform virtual visits (video teleconferencing, or through phone calls with photographs). The video conference/photographs should have ensured that the investigator was able to assess the disease activity and its extent. The eCRF was modified to record the type of visit (Remote or On-site) and COVID-19 related adverse events (AE). This included diagnostic testing, symptoms, and concomitant medications. Clear definitions for suspected/confirmed and symptomatic/asymptomatic COVID-19 diagnoses, and the associated data entry instructions with clear illustrative examples were provided. COVID-19 related outcomes are being reported separately at this congress. Conclusions: Adaptations to PURE registry successfully enabled continued follow-up of psoriasis patients through the COVID-19 pandemic. The COVID-19 AE data provides us with the opportunity to explore the impact of the pandemic on patients with psoriasis treated with secukinumab.
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The COVID-19 pandemic is interfering with one of our most important needs as human beings: people-based interactions. While a post-pandemic future is still uncertain, people feel the need to get back as soon as possible to that 'human touch', which has always been a fundamental characteristic of marketing. Based on a sample of representatives of hotels and their privileged interlocutors in corporate clients, this chapter focuses on the quality of business-to-business relationships, in which each organisation is represented by an individual, and proposes a relationship quality model from a people-based, inter-organisational perspective, while providing relevant insights in the context of the integration between traditional and digital approaches in modern marketing. © 2022, IGI Global. All rights reserved.
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Background: Sjögren Europe was founded on 23 February 2019 by several European patient organisations representing Sjögren's patient to help to address the lack of visibility, attention, and solutions for Sjögren's. Objectives: To show the frst achievements and contributions of the federation. Methods: Sjögren Europe's purpose is to promote the advancement of knowledge, research, information, treatment, and care, to foster patient involvement and participation in research and any other relevant area, to increase awareness, identify the different unmet needs and articulate patient voices throughout Europe. Results: Finding one's bearings and the right rhythm during the frst years of an organisation's life is a challenge in itself. The Covid-19 pandemic has made this process even more difficult. Our frst goal was to organise a frst face-to-face European patient conference. This meeting had to be postponed. However, we were able to adapt and develop a range of activities. We organised a series of informative webinars on different topics by leading European experts for patients and others interested in the subject. We have organised various awareness campaigns such as a campaign for Sjögren Awareness Month in 2021 for which we have created 2 awareness videos and published several testimonials. We also created a 3-axis campaign about fatigue for World Sjögren's Day 2021 which won the Best Practice Award at the 2021 PARE Conference, and during which we shared the patients' perspective on fatigue in publications in 13 languages on social media. We published a booklet about fatigue developed by a specialist and produced 3 informative leafets for patients. We also subtitled 2 videos made by one of our members in 10 European languages to disseminate quality information that many patients miss. We have been involved in various research projects, working groups and patient panels and have been able to bring the patient perspective to various stakeholders on many occasions. Conclusion: Despite the limited contacts, we were able to create strong links and rich discussions that stimulated our creativity. Sjögren Europe has become a privileged partner, recognised, and appreciated by the various stakeholders. Patients with Sjögren's are better represented at the supranational level. It is our members, the national patient organisations, who by their trust give us our legitimacy. In return, Sjögren Europe has been able to inject a new energy and dynamism that can be felt at the different national levels and that opens up many perspectives and opportunities. We have been able to strengthen our presence and visibility with patients on social networks, where our audience is constantly growing, as well as in the rheumatology feld with researchers, clinicians, industry, and associations such as EULAR. The resumption of face-to-face contacts is eagerly awaited to consolidate the links already created and to feed the richness, relevance, originality and diversity of our discussions and activities.
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Background: Since the COVID-19 vaccination campaign was launched all over Europe, there has been general agreement on how benefts of SARS-CoV2 vaccines outweigh the risks in patients with rare connective tissue diseases (rCTDs). Yet, there is still limited evidence regarding safety and efficacy of such vaccines in these patients, especially in the long-term. For this reason, in the framework of ERN-ReCONNET, an observational long-term study (VACCINATE) was designed in order to explore the long-term outcome of COVID-19 vaccination in rCTDs patients. The consent form was developed thanks to the involvement of the ERN ReCONNET ePAG Advocates (European Patients Advocacy Group). Objectives: To evaluate the safety profile of COVID-19 vaccination in rCTDs patients and the potential impact on disease activity. Primary endpoints were the prevalence of adverse events (AEs) and of disease exacerbations post-vaccination. Secondary endpoints were the proportion of serious adverse events (SAEs) and adverse events of special interest for COVID-19 (adapted from https://bright-oncollaboration.us/wp-content/uploads/2021/01/SO2-D2.1.2-V1.2-COVID-19- AESI-update-23Dec2020-review-fnal.pdf) Methods: The frst ad-interim analysis of the VACCINATE study involved 9 ERN-ReCONNET Network centres. Patients over 18 years of age with a known rCTD and who received vaccine against COVID-19 were eligible for recruitment. Demographic data and diagnoses were collected at the time of enrolment, while the appearance of AEs and potential disease exacerbations were monitored after one week from each vaccination dose, and then after 4, 12 and 24 weeks from the second dose. A disease exacerbation was defned as at least one of the following: new manifestations attributable to disease activity, hospital-ization, increase in PGA from previous evaluation, addition of corticosteroids or immunosuppressants. Results: A cohort of 300 patients (261 females, mean age 52, range 18-85) was recruited. Systemic lupus erythematosus (44%) and systemic sclerosis (16%) were the most frequent diagnoses, followed by Sjogren's syndrome (SS,12%), idiopathic infammatory myositis (IMM,10%), undifferentiated connective tissue disease (UCTD,8%), mixed connective tissue disease (MCTD,4%), Ehlers-Dan-los's syndrome (EDS,4%), antiphospholipid syndrome (APS,2%). AEs appearing 7 days after the frst and second doses were reported in 93 (31%) and 96 (32%) patients respectively, mainly represented by fatigue, injection site reaction, headache, fever and myalgia. Otitis, urticaria, Herpes Simplex-related rash, stomatitis, migraine with aura, vertigo, tinnitus and sleepiness were reported with very low frequency. Less than 2% of patients experienced AEs within 24 weeks from the second dose. No SAEs or AEs of special interest were observed in the study period. There were 25 disease exacerbations (8%), 7 of which severe. The highest number of exacerbations was observed after 4 weeks from the second dose (12 within week 4, 6 within week 12 and 7 within week 24). Disease exacerbation was most frequent in patients with EDS (33%) and MCTD (25%). Conclusion: This preliminary analysis shows that COVID-19 vaccination is safe in rCTDs patients. AEs appear most often early after vaccination and are usually mild. Disease exacerbations are not frequent, but can be potentially severe and tend to occur most frequently within the frst month after vaccination. Exacerbations can also occur 3-6 months after vaccination, although a causal relationship with the vaccination remains to be established. Our present data underline the importance of long-term observational studies.
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Introduction: The COVID-19 pandemic caused human losses, tensions in medical care, the economy and other social systems. Objective: To collect information on food safety and fortification of foods based on coffee pulp, considering that good nutrition counteracts infections. Methodology: Literature in SciELO and SCOPUS bases was analyzed, restricting search terms to food safety, COVID-19, block chain technology, food supply, micronutrients, regulation, iron fortification with emphasis on coffee pulp-based products. Results: In times of pandemic and other disasters, one of the factors that affect the response of a host to the virus is nutrition. The importance of food security is recognized with proposals especially in countries with high rates of malnutrition and anemia, for the fortification of common foods to contribute to guaranteeing nutritional adequacy as part of the governments’ responses, especially in impoverished rural and urban areas, considering food supply systems with block or Block Chain technology. Conclusion: The fortification of food products based on coffee pulp and their supply using block chain could be a response strategy to the consequences of the pandemic. © 2022. Revista Colombiana de Ciencias Quimico-Farmaceuticas(Colombia). All Rights Reserved.
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Background/Purpose: The Covid-19 pandemic has restricted in person care at our cleft treatment center, delayed patient turnout, and led to financial losses and an increased number of missed scheduled appointments. Thus, we have sought new ways to monitor the nutritional status of infant patients with clefts, by using the WhatsApp® application, so as to conduct timely nutritional interventions and to prevent malnutrition and anemia. The purpose was to monitor the nutritional status of newborn babies with cleft, using the WhatsApp® application, and to validate its use. Methods/Description: 71% of internet users in Brazil use WhatsApp® to send and receive messages. This application is easy to use, with privacy ensured by cryptography. This research project was approved by the Institutional Review Board. The protocol established: 1) new cases of infants up to 30 days old, with cleft lip and/or cleft palate;2) consent form signed by parent or guardian;3) the first appointment was in person;with mothers receiving training and guidance to send information about their children's height and weight every month;4) data comparisons were conducted against WHO benchmarks (WAZ score between 0 and - 1 = healthy weight;between - 1 and - 2 = nutritional risk;< - 2 = underweight);6) nutritional interventions considering RDI's. Results: 18 patients were followed up by regular data submission through the WhatsApp® application;8 had cleft lips, 3 cleft palates, and 7 cleft lip and palates. Among these patients, 1 had a gastrostomy tube, 2 had cow milk protein allergy, and 1 had cardiac disease. Thus far, 8 have already been submitted to lip surgery, and 10 are waiting to reach the appropriate age for surgery. Twelve were classified as coming from low-income families, and 6 from medium income families. Most of them (no. = 17) travelled between 100-500 km to receive care, and 1 more than 100 km. Eight received transportation and food subsidized by public funds, and 10 used their own funds. Thirteen children were fed breast milk for 120 days, 8 were breast fed directly and 5 were fed pumped breast milk;5 were fed formula. Nine began eating additional foods at 6 months, the remaining patients were not old enough for that yet. Eleven children had normal weight (eutrophic) since the onset, 3 were malnourished when the study began and recovered after about 54 days, 4 were at risk when the study began and recovered after about 26.5 days. No patient had to delay surgery because of anemia (mean Hb = 11.45g/ dL). Nutritional interventions included encouraging breast feeding and different breastfeeding positions, guidance regarding the appropriate concentration of infant formula and how /when to introduce of additional foods. Milk formula, bottles, scales, and measuring tapes were donated. Conclusions: The use of the WhatsApp® application for nutritional follow up proved to be a valid and effective way tomonitor the patients' growth and development, yielding efficient nutritional recovery.
ABSTRACT
This research aims to identify the main difficulties faced by teachers, given the virtualized teaching practice in the Google Classroom, during remote classes. In this context, remote education has stood out as an educational alternative for study studies during social withdrawal, caused by the pandemic of Covid-19 (New Coronavirus), affecting the practices that affect secondary education in the country. This is a descriptive qualitative research. As a tool for data production, run a semi-structured application that was made available through Google Forms. The collaborators were ten teachers who worked in a public school in Jeremoabo/BA. The study pointed out how the results of the greatest difficulty of the current period stem from changing habits and technological appropriation and the choice, by Google Classroom, was made using the need for digital inclusion practices. In this sense, the documents are being challenged to include technologies in teaching, even with difficulties, lack of resources and specific training to contemplate the use, in addition to the availability of digital resources and internet access by students.