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Background: Since the introduction of COVID-19 vaccines, many reports have focused on adverse reactions. However, there is no global agreement on how to manage those patients. We aim to assess the management of adverse reactions by an immunoallergology department and its outcomes. Method(s): Retrospective analysis of the patients sent to our centre from January to October 2021 for adverse reactions to a COVID-19 vaccine, and who were considered ineligible for a 2nd dose by general practitioners. We collected data on the reported reactions, allergological study and outcomes. Result(s): 123 patients with adverse reactions were included (77% women, n = 95), mean age 55 years-old (min 12;max 92). Pfizer/ BioNTech Vaccine was inoculated in 64 patients (52%);Moderna in 15 (12%);AstraZeneca in 44 (36%). 65 patients (53%) presented symptoms compatible with allergic reactions: 86% (n = 56) with mucocutaneous symptoms, mainly urticaria-like lesions and/or angioedema;17% (n = 11) with suspected anaphylaxis and 5% (n = 3) with Steven-Johnson Syndrome. 19 patients performed skin testing with: PEG2000 (n = 17);polysorbate 80 (n = 15);COVID-19 vaccines (n = 21). Four patients had at least one positive test. 58 patients (47%) presented with non-allergic reactions. They showed great variability of symptoms. Most mild: 47% reported non-specific symptoms (such as malaise, headache, myalgia, fever, or fatigue) and 26% reported local reactions on the inoculation site. Some severe: 6 with deep vein or pulmonary thrombosis, 4 with myocarditis, 2 with stroke or myocardial infarction, and 1 with VITT. Patients with positive skin tests or severe previous reactions (n = 36, 29%) were referred for an alternative vaccine. Those with suspected allergic reaction but negative skin tests were premedicated with antihistamines before the 2nd dose. Follow-up showed: of the 81 patients (66%) who received an additional dose, 25% (n = 20) reported an adverse reaction, which was mild, and no case of anaphylaxis was reported. 16 (13%) refused a 2nd dose, and for 26 (21%) the information could not be obtained. Conclusion(s): The intervention of an allergologist had a significant positive impact on vaccination rates, with 2/3 of patients being reclassified as eligible for a 2nd dose. Allergological study and intervention identified vaccine-allergic patients and guided the decision on vaccine change and premedication, which resulted in a considerably lower number of adverse reactions to the 2nd dose, or at least its severity.
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Background: COVID-19 virus vaccines are associated with adverse events. We aim to characterize and compare adverse reactions to different COVID-19 vaccines in a Portuguese centre. Method(s): Retrospective analysis of patients with adverse reactions to COVID-19 vaccines referred to our Immunoallergology Department between January and October 2021. The patients were divided according to the vaccine used: Pfizer/BioNTech (Pf), Moderna (M), or AstraZeneca (AZ). Result(s): 123 patients were included. 64 patients (52%) reacted to the Pf vaccine (77% women, mean age 49 years old);15 (12%) to the M vaccine (87% females, mean age 50 years old);and 44 (36%) to the AZ vaccine (75% women, mean age 64.8 years old). All groups showed a higher number of non-immediate reactions (>6h after inoculation): 59% for Pf, 60% for M, and 91% for AZ. Reactions to Pf and M were more frequently allergic-like (63% and 60%, respectively). Reactions to AZ were predominantly non-allergic (64%). The most frequently reported reactions for Pf and M were: sensation of throat tightness (Pf 31%, M 20%), urticaria (Pf 30%, M 27%), angioedema (Pf 17%, M 33%), constitutional non-specific symptoms (Pf 25%, M 27%), and local reactions on the inoculation site (Pf 20%, M 33%). There were 8 (13%) patients with suspected anaphylaxis with Pf, 3 (20%) with M, and none with AZ. The most frequently reported reactions for AZ were cardiovascular events (30%): myocardial, cerebral or pulmonary thromboembolic events (n = 6), phlebitis (n = 5), myocarditis (n = 1), and vaccine-induced immune thrombotic thrombocytopenia (n = 1). Other common reactions were constitutional non-specific symptoms (32%), local reactions on the inoculation site (18%), urticaria (23%), angioedema (14%), and non-urticaria rash (14%). Conclusion(s): Adverse reactions were more common in women. The mRNA vaccines were more frequently associated with allergic-like reactions, including anaphylaxis. In contrast, AZ vaccine was associated with nonallergic cardiovascular reactions. Up to 1/3 of patients in each group reported constitutional non-specific symptoms and local reactions on the inoculation site.
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Introducao: A Sindrome de Evans (SE) e definida pela presenca de Anemia Hemolitica Autoimune (AHAI) de anticorpos quentes associada a purpura trombocitopenica imune (PTI). O curso da doenca geralmente e de momentos de remissao e exacerbacao. Sua fisiopatologia tem origem desconhecida, porem, sabe-se que ocorre apos uma desordem profunda do sistema imunologico. Objetivo: Apresentar um caso de SE em paciente com anemia falciforme. Metodologia: Trata-se de um relato de caso com revisao de prontuario, levantamento de dados clinicos, laboratoriais, exames complementares e revisao de literatura. Resultados: Paciente GMSF, seis anos, em acompanhamento no hemocentro da cidade do Rio de Janeiro desde o nascimento por anemia falciforme grave com crises algicas frequentes e quadros respiratorio. Uso de hidroxiureia e foi esplenectomizada previamente, por sequestros de repeticao. Em junho de 2021 foi internada com quadro de pneumonia e trombocitopenia. Recebeu pulsoterapia com metilprednisolona, sem reposta, passando a receber imunoglobulina com normalizacao da contagem de plaquetas. Em janeiro de 2022 nova internacao com crise algica e COVID-19, com boa evolucao clinica. Em abril de 2022 a paciente mais uma vez foi internada, por quadro de pneumonia, broncoespasmo e crise algica. Prescrito antibiotico e analgesia. No sexto dia de internacao apresentou angioedema em face e queda da saturacao. Hemograma com trombocitopenia importante de 23.000 mm3. Realizado aspirado de medula ossea onde se pode observar medula com celularidade aumentada, hiperplasia eritroide e hiperplasia de megacariocitos, sugestivo de PTI. Apresentou queda de hemoglobina, interpretada como hemolise associada a doenca falciforme, porem teve baixo aproveitamento de concentrado de hemacias, sendo solicitado estudo imunohematologico que mostrou coombs direto, PAI e Anti-Cw sugerindo SE. Iniciado imunoglobulina por dois dias, sem resposta, sendo iniciado pulsoterapia com metilprednisolona, tambem sem reposta. Apresentou estrabismo convergente do olho E, sendo submetida a tomografia computadorizada de cranio e orbita mostrou sinais compativeis com hematoma recente. Novo hemograma com contagem de plaquetas de 6.000 mm3. Decidido por suspender pulsoterapia e iniciar Rituximabe. Apos inicio da droga houve melhora significativa no numero de plaquetas. Recebeu um total de tres doses, com intervalo de 15 dias e no ultimo exame realizado a quantidade de plaquetas era de 417.000 mm3. Discussao: Na literatura o tratamento da SE se baseia no uso de corticoides como primeira linha e em pacientes com citopenia persistente e necessidade de uso prolongado ou altas doses de esteroides a imunoglobulina venosa pode ser benefica. A trombocitopenia e mais responsiva a essa terapia que a hemolise. Conclusao: O Rituximabe tem sido usado em caso de refratariedade ao tratamento e apesar da relativa falta de experiencia com a droga, principalmente em criancas, os estudos tem mostrado resultados promissores e seu uso seria mais seguro que esplenectomia, especialmente, nos menores de dois anos. E no caso apresentado a paciente ja era esplenectomizada por sequestros esplenicos de repeticao. Copyright © 2022
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Background: Human-associated microbial communities have been linked to host immune response to respiratory viral infections. Prior investigations have observed shifts in the composition of the gut or respiratory microbiome in severe COVID-19. However, there has been no comprehensive metagenomic evaluation of the interaction between lower respiratory and gut microbiomes and host immune factors in COVID-19. Methods: From April 2020 to May 2021, we prospectively enrolled 153 hospitalized patients with mild (n=12), moderate (n=65), and severe (n=76) COVID-19 infection categorized using established clinical criteria. We longitudinally collected stool (n=270) for metagenomic profiling, and in a subset, we generated comprehensive host-microbiome-molecular profiles by collecting sputum metagenomes (n=87 participants with 212 samples) and blood cytokine levels (n=109 with 181 samples) weekly until hospital discharge. We performed omnibus testing of overall gut and respiratory community structure, species-level differential abundance testing using mixed effects modeling accounting for repeated sampling, hierarchical clustering of paired gut and respiratory metagenomic profiles, and multi-omic machine learning classification of disease severity. Results: Patients with severe COVID-19 tended to be older, were more frequently male, had higher rates of overweight/obesity, and a greater mean Charlson Comorbidity Index. Patients with severe COVID-19 infection had significantly decreased stool and respiratory microbiome a-diversity irrespective of antibiotic administration. COVID severity accounted for a small proportion of variance in stool (R2=2.4%, p=0.002) and sputum (R2=4.4%, p= 0.03) profiles. Hierarchical clustering of paired gut and respiratory samples from patients with severe COVID revealed the joint expansion of oral-typical taxa typically present during systemic inflammation (i.e., increases in Streptococcus and Peptostreptococus spp. in both gut and sputum). A pro-inflammatory milieu defined by a composite elevation of circulating plasma cytokines (e.g., IL-6, TNF-a, and IL-29 among others) were linked to broad microbial excursions in community structure for both stool and sputum as measured by Bray-Curtis distances. A random forest classifier incorporating either stool or sputum taxonomic features and accounting for age, sex, body mass index, and recent antibiotic use achieved excellent classification of biospecimens from patients with severe vs. non-severe COVID patients (AUROC > 0.80). Conclusions: Alterations of the gut and respiratory microbiome were associated with differences in host immune response and COVID-19 disease severity. Further studies are needed to identify the potential role of human-associated microbial communities as a biomarker for poor patient outcomes in COVID-19 who may warrant escalated levels of care.(Figure Presented) Fig. 1. (A) Using unsupervised feature selection (species abundance > 0.001) inclusive of taxa differentially abundant by non-parametric Wilcoxon rank-sum testing (nominal p-value < 0.05), (B) we performed random forest classification using a twice-repeated 5-fold crossvalidation scheme to predict COVID-19 disease severity from shotgun metagenomic stool profiles (C) yielding an AUROC of 0.91.
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Objective: To promote the importance of nurses and their health in the face of a covid-19 pandemic. Methodology: This is a qualitative research, descriptive of an integrative literature review in the databases. The articles selected at this stage were read in full and obtained according to the eligibility criteria.
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Background: There are no objective criteria for the discontinuation of renal replacement therapy (RRT) in patients who have acute kidney injury (AKI). It is unknown if Kinetic Estimated Glomerular Filtration Rate (KeGFR) can be used as assessment of renal recovery in patients who underwent RRT. Methods: All critical patients in Hospital das Clínicas during September 2020 to May 2021 who started hemodialysis due to AKI and remained free of RRT for at least 2 consecutive days were included. Patients who stopped RRT due to decision for exclusive palliative care or hemodynamic instability were excluded. Patients were divided in two groups: Success group (free from RRT for 7 consecutive days after their last RRT session) and failure group. Discontinuation day was defined as the second day without RRT. Variables were expressed as median (25th and 75th percentile) and categorical data as percentage. Mann Whitney test was used. Statistical significance was defined as p<0.05. Results: 72 patients were enrolled. COVID19, ischemia-reperfusion and sepsis were the main causes of AKI (37%;28,7%;24,6%, respectively), with no difference in prevalence between groups. Success group (n=47) presented higher KeFGR on the day of discontinuation (keGFR1) and in the day after (keGFR2) when compared to failure group (n=25): KeGFR1: Success: 18.76ml/min vs. failure: 10.21ml/min, p=0.05. KeGFR2: Success: 29.38ml/min vs. failure: 16.03ml/min, p<0.05. Success group had lower non renal SOFA score at discontinuation (4 vs. 6;p<0.05) and higher urine output (1600 vs. 725;p<0.05) when compared to failure group. There was no difference in diuretic use. Conclusions: KeGFR is higher in patients who succeed in stopping RRT and it may be an useful tool for decision-making. Supported by FAPESP.
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Objective: To describe recommendations for the care and handling of preterm infants in the COVID-19 pandemic scenario. Methods: Integrated Literature Review (ILR) conducted in 2020 in databases in the Virtual Health Library (VHL) by extracting scientific productions from the databases: MEDLINE, SCIELO, PUBMED and LILACS, with a final sample of 14 publications. Results: Among the recommendations found in the studies analyzed, regarding childbirth, it is recommended to choose the best time, route and place, prioritizing the use of a negative pressure room. After delivery, newborns should have the umbilical cord clamped, be cleaned and dried as soon as possible, and isolated and tested early. After initial care, the use of a mask and hand hygiene is recommended before each meal or other close contact with the newborn. Ideally, suspected or contaminated RN should be kept in isolation and constantly monitored, with a quarantine period of at least 14 days. Conclusions: The knowledge of nurses and other health care professionals about prevention and control measures for newborn infection with COVID-19 is critical to the prevention, control, and reduction of the impact of the pandemic on the neonatal population. © 2021 Sociedad de Obstetricia y Ginecologia de Venezuela. All rights reserved.
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Online dating platforms, which have progressively multiplied and migrated from website to mobile app format and grown in number of users, offer an increasing variety and multiplicity of forms of socialization, which typically unfolds in three stages: profile building, matching with other users and discovery. Even if its users seek more than relationships or sex, the pandemic of COVID-19 and consequent limitations, in particular physical social distance and confinements, have changed the assumptions of its functioning and the way users interact, namely by the impossibility of mutual discovery migrating to face-to-face encounters. In this sense, we sought to investigate three major dimensions of analysis anchored to the national context: 1) how users reacted, in terms of behaviour and consumption habits, to the changes brought about by the pandemic, 2) how platforms adapted and 3) what attention was given by the media to the transformations of online dating. To answer the questions a triangulated analysis of user consumption, communication and platform evolution and media attention was carried out, in a mixed analysis (quantitative and qualitative) carried out using digital methods and tools for extraction, organisation and analysis, and secondary data. The main results point to COVID-19 as an important variable in changes registered in the construction of profiles and consumption habits by users, and of the platforms' services, both in terms of advice and suggestions and new features. The Portuguese media also focused their attention on online dating in adaptive novelties in terms of offers and technologies, and in questioning its use in times of pandemic. Copyright © 2021 (Rita Sepúlveda, Miguel Crespo, Jorge Vieira).
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Brazilian health workers and students must face, added to the coronavirus, the lack of Personal Protective Equipments (PPEs), keeping of same work force in the frontlines, as well as an unstable and uninformative public health policy, contributing to an exhausting endeavor. This research evaluates the effects of the Covid-19 pandemic on the different profiles of healthcare workers and students in the state of Sao Paulo. The online semi structured validated survey was applied, with quantitative analysis through data processing by STATA 13.0, and qualitative, through content analysis according to Bardin. Our findings corroborate the prevalence of an important overload within the students and healthcare workers, manifested through mood, sleep and cognition alteration, anxiety, physical discomfort, pessimism and increase in nightmares. As a counterpoint to these challenges, the pandemic has brought a powerful learning process, by understanding the need to adapt and the importance of scientific research. Copyright © 2021, Fundacao UNI Botucatu/UNESP. All rights reserved.