Effect of Early Treatment with Pegylated Interferon Lambda for Covid-19

Background: We assessed the efficacy of a single dose of peginterferon lambda in preventing clinical events among acutely symptomatic COVID-19 outpatients. Method(s): We conducted a placebo-controlled, randomized, adaptive platform trial among predominantly vaccinated SARS-CoV-2-positive adults in Brazil and Canada receiving either one subcutaneous injection of peginterferon lambda or placebo. The primary composite endpoint was medical admission to hospital, defined as either observation in a COVID-19 emergency setting for > 6 hours, or transfer to a tertiary hospital due to symptomatic COVID-19 within 28 days post-randomization. Result(s): For this evaluation, 931 patients received peginterferon lambda and 1018 received placebo. 84% of the population were vaccinated and the trial occurred across multiple COVID-19 variants. In the primary analysis of patients, the primary outcome was reduced by 51% in the peginterferon lambda vs. placebo groups (relative risk 0.49 [25/916 vs 57/1003], 95% Bayesian credible interval 0.30-0.76, posterior probability >99.9%). This effect was maintained in subgroup analyses including COVID-19-related hospitalization alone (relative risk 0.57, 95% Bayesian credible intervals 0.33-0.95, ) and COVID-19-related hospitalization or death (Hazard ratio 0.59, 95% Bayesian credible interval 0.35- 0.97). The effects were consistent across dominant variants and vaccination status. Among individuals with a high viral level at baseline, peginterferon lambda resulted in lower viral loads by Day 7, compared to placebo. The incidence of adverse events was similar in the two groups. Conclusion(s): Among predominantly vaccinated outpatients with COVID-19, single-dose of peginterferon lambda resulted in significantly decreased clinical events.

Incidental tomographic findings in patients with a Confirmed Diagnosis of COVID-19: An Observational Study

Objective: Describe incidental tomographic in the sample, correlating them with risk factors for chest diseases and sociodemographic data. Method(s): This is a retrospective and observational study covering 162 patients admitted to the COVID sector of the HU/UFJF, from April 1, 2020, to July 7, 2021, with a confirmed laboratory diagnosis of COVID-19. The variables were described in absolute and relative frequencies. The comparison of the correlation between the outcome variable (the tomographic findings) for independent samples was performed using Pearson's chi-square test (without correction) or Fisher's test when relevant. Result(s): Of the 162 patients, 15.4% had a solitary pulmonary nodule;14.8% had multiple pulmonary nodules;1.8%, lung mass;3.1%, mediastinal mass, and 9.3% had mediastinal adenomegaly. Findings such as excavations, pleural effusion, emphysema, PTE, pneumothorax, chronic interstitial disease, cavitation, aneurysms, and significant atheromatosis, classified in this study in the "Other" category showed impressive results, with an overall prevalence of 81.5%. This study demonstrated that 34% of patients had two or more types of incidental CT findings and that 88.3% of patients had at least some type of incidental CT finding. Conclusion(s): The pandemic of SARS-CoV-2 infections has brought a series of challenges and lessons learned to healthcare teams around the world. The massive implementation of highly sensitive diagnostic methods, such as chest tomography, ends up bringing an additional challenge, which is to deal with incidental findings, making good clinical reasoning necessary to avoid unnecessary investigations and not leave without diagnosis and treatment of diseases in early and asymptomatic stages.Copyright © 2023 Faculdade de Medicina de Ribeirao Preto - U.S.P.. All rights reserved.

Children's Physical Activity During the COVID-19 Lockdown: A Cross Cultural Comparison Between Portugal, Brazil and Italy.

The COVID-19 pandemic forced governments to implement measures that disrupted the daily routines of many families worldwide. We studied how the COVID-19 lockdown affected children's routines in Portugal (PT), Brazil (BR), and Italy (IT) to determine if children's age and country impacted their physical activity (PA) and sedentary time. We launched an anonymous online survey to assess how 3-12 years old children adjusted their daily routines to this situation. Parents reported the times each child was engaged in different activities throughout the day, and we used these data to calculate separately overall sedentary and physical activity time. We conducted separate analyses of variance for age and country on the percentage of time spent in the different activities. Results, based on the data from 3045 children in these three countries (PT n = 2044; BR n = 836; IT n = 165), showed that, during lockdown, most children spent most of their awake daily hours in sedentary activities. There was a clear age effect on the way their routines were organized. Percentages of time spent in intellectual activity, playful screen activity, and overall sedentary time were greater in the older age groups, whereas percentages of time spent in play (with and without PA) and in overall PA were greater in the younger groups. We found a main effect of country for all variables except play without PA. The country effect was mainly due to the difference between the routines in BR when compared to PT and IT. Values of playful screen time and overall sedentary activity were higher in BR than in the two European countries. Conversely, values for play with PA, PA, and overall PA (except in the older group) were lower in BR. Patterns of time spent in these activities were similar in IT and PT, but PA and overall PA times were higher in the two younger age groups in IT. In summary, percentage of PA time of confined children was low and decreased with age across all three countries and was particularly low for children in BR relative to those in PT and IT.

Factors associated with disability in patients after discharge from Intensive Care Units COVID-19

Objective: to evaluate factors associated with disability of patients after hospital discharge in COVID-19intensive care units. Methods: cross-sectional analytical research with sociodemographic, clinical, self-perception of health and WHODAS 2.0 scale data of patients discharged from a teaching hospital. Patients admitted to an intensive care unit for COVID-19 for more than eight days, discharged from the hospital at least 365 days before data collection and older than 18 years were included. Information analysis was performed using data mining. Results: 32 individuals were eligible, 25% were disabled. These individuals presented low cognition, mobility, self-care, limitation in daily activities, justified by biological and clinical parameters. Still, 37% by obesity and polymedication, 75%, impaired concentration and 50%, neurological developments. The length of hospitalization and the therapeutic resources demanded in this period were also associated with the disability observed. Conclusion: the COVID-19 virus added to the length of hospitalization and clinical factors ware related to disability 12 months after hospital discharge with strong presence of neurological symptoms. Contributions to practice: it is expected to contribute to the understanding of the long-term impacts of COVID-19, enabling to offer better assistance and quality of life to patients affected by the disease.

Covid-19 and the Case of the New Federal Universities: Is There a Possible Learning Relationship to Democracy and the Common?

This essay aims to establish a possible relationship of institutional and organizational learning to the problems caused by Covid-19 and it's health emergency, from the Brazilian experience of creation of it's "brand-new" federal universities. In these institutions, social participation and engagement prevailed so that they could be formatted based on the logic of regionalized education, as a potentializer of territorial development processes. This theoretical-reflexive relationship is built from the considerations of Tenorio (2020) and Giannella (2020) on the social effects of Covid-19, with regard to the increased social area, regarding to a new and necessary democracy, and the redefinition of the Common in a post-pandemic world, respectively. In the end, this essay proposes that the experience of the brand-new federal universities can be an important instrument for multiple answers to the questions raised by this contribution.

Training and Performance of Early Childhood Teachers in Times of Pandemics: A Critical-Dialectic Analysis

The discussions on teacher training and work have been expanded through the emergence of the Sars-Cov 2 virus, generator of the pandemic state of COVID-19, with the following questions: How is the training of Early Childhood Education teachers taking place in this pandemic context and how is it impacting the teaching performance? Thus, the general objective is to analyze the continuing education of teachers and its implications in Early Childhood Education. The present study was based on discussions and analyses that took place in the Discipline "Education, human formation and praxis: implications of Marxism, Historical-Cultural Theory and Historical-Critical Pedagogy for School Education" linked to the Post-Graduate Program in Education at the Londrina State University. The research is bibliographic with research and critical-dialectical analysis, with authors who deal with this perspective, which involves the Historical-Cultural Theory and the Historical-Critical Pedagogy, whose aim is to contribute in the new thinking the formation and action of the teacher of Early Childhood Education.

Health promotion measures in people with diabetes mellitus during covid-19: an integrative review

Objective: To map scientific evidence on health promotion measures to improve the quality of life of people living with Diabetes Mellitus during the COVID-19 pandemic. Method: This is an integrative review, performed in MEDLINE databases via PubMed, CINAHL-Ebsco, Scopus, LILACS and IBECS, using the descriptors "diabetes mellitus", "coronavirus infections", "covid-19", "health promotion” and “quality of life”.The sample counted 17 articles. Results: Data were grouped into three dimensions: focusing on the individual;in the community and in government actions or public policies. Conclusion: Individual measures were more prevalent in the studies, to the detriment of a limitation of collective and governmental measures © 2022. Enfermeria Global.All Rights Reserved.

Repercussions of infodemia associated with COVID-19 on the mental health of the elderly in Brazil

The phenomenon called infodemia refers to the increase in the volume of information on a specific topic, which multiplies rapidly in a short period of time, and has stood out in the context of the health crisis triggered by the COVID-19 pandemic. Too much information can trigger feelings of fear, anxiety, stress, and other conditions of mental distress. The study aims to describe the profile of exposure to information about COVID-19 and its repercussions on the mental health of elderly Brazilians. This is a cross-sectional study carried out with 1924 elderly Brazilians. Data were collected through a web-based survey sent to the elderly via social networks and email, from July to October 2020. The results of the descriptive analysis of the data show that most of the elderly were aged between 60 and 69 years (69.02%), female (71.26%), married (53.79%) and white (75.57%). About 21.67% (n = 417) concluded their graduation, 19.75% (380) concluded their specialization and 16.63% (320) concluded their master's or doctoral degrees. Television 862 (44.80%) and social networks 651 (33.84%) were reported as frequent sources of exposure to news or information about COVID-19. Participants indicated that television (46.47%;n = 872), social networks (30.81%;n = 575) and radio (14.48%;251) affected them psychologically and/or physically. Receiving fake news about COVID-19 on television (n = 482;19.8%) and on social media (n = 415;21.5%) mainly resulted in stress and fear. The disseminated information contributes to awareness, but also affects physically and/or psychologically many elderly people, mainly generating fear and stress. © 2022, Centro Nacional de Informacion de Ciencias Medicas. All rights reserved.

Reccurence of atypical hemolytic uremic syndrome after COVID-19 vaccination

Background: Atypical Hemolytic Uremic Syndrome (aHUS) is a complement-mediated thrombotic microangiopathy. Pathophysiological mechanism involves uncontrolled complement activation due to a genetic or acquired anomaly coupled with a triggering event. We report a case of aHUS recurrence following COVID-19 vaccination. Material and methods: Whole blood (EDTA) was collected and processed with CD46-PE, CD45-PerCP, isotype control-PE markers. Staining was measured through median fluorescence intensity and expressed as CD46/isotype ratio. Sanger sequencing was used for identification of variants in CD46 gene. All the participants provided informed written consent. Results: Proband (P) is a 39-year-old woman admitted for nausea, vomiting, epigastric pain and haematuria, three days after first dose of ChAdOx1 nCov-19 vaccine. Laboratory testing showed MAHA (Hb:8.8g/dL, Ht:26%), thrombocytopenia (80x109/mm3) and acute kidney injury (Cr:2.15mg/dL, Ur:92mg/dL). P and three of her siblings have experienced recurrent TMA episodes since childhood. In 2019, genetic study from P's sister (S) identified two heterozygous variants in CD46, one pathogenic (Glu179Gln) and one of uncertain significance (Cys94Tyr). We demonstrated that P carries the same variants and observed a 50% decrease of CD46 expression in both P and S (fig.1). Platelet transfusion, corticosteroids and 9 sessions of plasmapheresis contributed to rapid recovery of P. Discussion: Glu179Gln was reported to increase CD46 expression on granulocytes in aHUS patient and to reduce C4b cofactor activity1. We observed that combination of Glu179Gln and Cys94Tyr was associated with low levels of CD46 on cell surface. Conclusion: This case report supports the evidence of COVID-19 vaccine as a precipitating event for aHUS recurrence.

Mesenchymal stem/stromal cell-based therapies for severe viral pneumonia: therapeutic potential and challenges.

Severe viral pneumonia is a significant cause of morbidity and mortality globally, whether due to outbreaks of endemic viruses, periodic viral epidemics, or the rarer but devastating global viral pandemics. While limited anti-viral therapies exist, there is a paucity of direct therapies to directly attenuate viral pneumonia-induced lung injury, and management therefore remains largely supportive. Mesenchymal stromal/stem cells (MSCs) are receiving considerable attention as a cytotherapeutic for viral pneumonia. Several properties of MSCs position them as a promising therapeutic strategy for viral pneumonia-induced lung injury as demonstrated in pre-clinical studies in relevant models. More recently, early phase clinical studies have demonstrated a reassuring safety profile of these cells. These investigations have taken on an added importance and urgency during the COVID-19 pandemic, with multiple trials in progress across the globe. In parallel with clinical translation, strategies are being investigated to enhance the therapeutic potential of these cells in vivo, with different MSC tissue sources, specific cellular products including cell-free options, and strategies to 'licence' or 'pre-activate' these cells, all being explored. This review will assess the therapeutic potential of MSC-based therapies for severe viral pneumonia. It will describe the aetiology and epidemiology of severe viral pneumonia, describe current therapeutic approaches, and examine the data suggesting therapeutic potential of MSCs for severe viral pneumonia in pre-clinical and clinical studies. The challenges and opportunities for MSC-based therapies will then be considered.

Detection of SARS-CoV-2 in Saliva by RT-LAMP During a Screening of Workers in Brazil, Including Pre-Symptomatic Carriers

The coronavirus pandemic has been causing damage to many nations, as public and private health systems deteriorate by the increasing demand. Some infected patients have culturable severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) even though not presenting any symptoms, and therefore, are probably able to transmit it. Correctly diagnosing and isolating infected patients is an important step towards preventing new infections. Current diagnostic methods rely mainly on reverse transcription quantitative polymerase chain reaction (RT-qPCR). Methods such as reverse transcription loop-mediated isothermal amplification (RT-LAMP) have risen as viable alternatives, as they are cheaper and require less infrastructure, they have the potential to be applied in low-resource scenarios and even at point-of-care. Here we report a colorimetric RT-LAMP assay capable of detecting SARS-CoV-2 in ribonucleic acid (RNA) from saliva. In some cases, the test was able to detect viral RNA before symptom onset and even in a self-reported asymptomatic carrier. It had a limit of detection of 300 copies per reaction and showed a sensitivity of 80%, a specificity of 100%, a general accuracy of 99.59%, and a Cohen's kappa of 0.887. The possibility of detecting positive cases even before the clinical manifestation shows great potential and can contribute to controlling the pandemic.

Serological response to SARS-CoV-2 vaccination in multiple sclerosis patient in a real-life experience

Introduction: Vaccination against COVID-19 has been widely recommended for patients with multiple sclerosis (MS), although the effect of different disease-modifying treatments (DMTs) on said immunization is not well known. Some studies begin to point out a relationship between DMTs of greater efficacy with a lower rate of seroprotection. Objectives: To assess serological response to SARS-CoV-2 vaccination in MS patients receiving disease-modifying treatments (DMTs) in a real-life setting. Methods: Anti-spike protein-based serology was measured in 191 patients with MS and 6 patients with neuromyelitis optica spectrum disorder (NMOSD). Patients were either untreated or under treatment with different DMTs. A group of healthy subjects similarly vaccinated served as control. The percent of subjects that developed protective antibodies, the antibody-titer, and lymphocyte counts were evaluated. Results: Patients and controls were vaccinated with different available vaccines: BNT162b2 (68.6%), mRNA-1273 (5.4%), ChAdOx1-S (20.7%) and Ad26COVS1 (4.3%). Protective serological response was observed in 100% of controls, NMOSD, untreated (n=19), Interferon-beta (n=17), Glatiramer-acetate (n=15), Cladribine (n=11), Dimethyl-fumarate (n=15), Teriflunomide (n=29) and Natalizumab (n=25) patients. 100% was also observed in Alemtuzumab (n=11) patients but none received treatment dose in last year. Serological response was observed in 42%, 44% and 0% of Fingolimod (n=12), Ocrelizumab (n=26) and Rituximab (n=6) patients respectively. Time from the last dosing was related to serological response in anti-CD-20 therapies;age, disease duration, disease phenotype, vaccine used, or lymphocyte counts did not affect humoral response to COVID-19 vaccination. Conclusions: Anti-CD20 therapies and Fingolimod seem to condition a lower humoral response to vaccines against SARS-CoV-2. Vaccination prior initiation of these DMTs medication administration would be recommendable whenever possible.

Categories of fake news about COVID-19 disseminated in the first year of the pandemic in Brazil

The objective of this study was to analyze the false news about COVID-19 disseminated in Brazil during the first year of the pandemic in the country. This was a documentary type study, which investigated the fake news inserted in the Coronaverificado.news platform until February 27, 2021, totaling 938 news items, which were submitted to the IRaMuTeQ software, resulting in the Descending Hierarchical Classification. This enabled the clarification of four thematic categories analyzed with theoretical and methodological support from Hermeneutics-dialectics. The results revealed social networks as the most used vehicles for sending fake news (n=625;66.6%), whose contents were predominantly texts (n=488;52%). In the categorization of subjects, “Government and authorities” was the category that concentrated the most widespread subjects (56.6%), followed by “Development and application of vaccines” (14.8%), revealing the multifaceted scope and intention of the fake news items, which confuse the population and encourage adherence to unsafe practices. It is essential that the mass media function as a vehicle for reliable scientific and technical content about COVID-19's coping actions, since true communication associated with the ethical commitment of government officials will help to reduce the risk of people's inappropriate behavior, aiding the conscious adoption of measures that promote overall health in the pandemic and post-pandemic context. © 2021 Centro Universitario Sao Camilo. All rights reserved.

Sleep apnea care during the COVID-19 pandemic: Perspectives on the transition to telemedicine from clinicians and patients

Introduction: Covid-19-related public health control measures have necessitated a rapid transition in healthcare delivery. We qualitatively explored clinicians' and patients' experiences of the pandemic's impact on the delivery and receipt of obstructive sleep apnea (OSA) care. Methods: Between September and December 2020, we conducted ten 90-minute virtual focus groups with sleep clinicians (n=19) and English and Spanish-speaking patients with OSA (n= 30) recruited through an urban academic sleep clinic, national organizations, social media, and snowball sampling. An interdisciplinary team conducted a rapid qualitative analysis that included prefigured and emergent domains. The team developed a comprehensive analytic matrix, identifying key themes within and between groups and triangulating them across participant types. Results: Clinicians and patients across all groups confirmed a rapid shift to the adoption of telemedicine. Clinicians reported telemedicine enhanced evaluations by enabling direct observation of the home environment, providing opportunities to guide patients on medical equipment used in the home, and cultivating meaningful social connections for patients. Perceived benefits varied across patient subgroups (age, language, technological self-efficacy). The majority of clinicians reported that telemedicine's initial uptake resulted in delays in care and revenue loss, but sustained use was thought to be feasible over time. Patients reported delays in care related to the pandemic's disruption on healthcare and their personal safety concerns. Additionally, telemedicine's adoption directly altered other elements of care, including the delivery of patient education materials and loss of tacit information gained during the in-person visit. All groups reported adequate mask fitting as a central challenge for patients using positive airway pressure therapy. Spanish-speaking patients noted concerns of increased difficulty accessing care and navigating the OSA care system due to limited English proficiency, in addition to the limited availability of OSA resources in Spanish. Conclusion: During the Covid-19 pandemic, the rapid adoption of telemedicine largely facilitated OSA care but altered patient-clinician interactions, delivery of patient education materials, and mask fitting success. Given that telemedicine will likely be sustained post-pandemic, there are needs for targeted efforts aimed at addressing disparities in telemedicine, enhancing practitioner telepresence and education, and new approaches for mask fitting to ensure successful OSA care.

MENTAL HEALTH OF TEENAGERS DURING THE COVID-19 PANDEMIC: VULNERABILITIES ASSOCIATED WITH THE USE OF THE INTERNET AND SOCIAL MEDIA

In the face of an increasing number of infected people and the SARS-CoV-2 (Covid-19) community transmission identification, some contention measures have been taken, including social distancing. The repercussions of this measure have been discussed, highlighting the increase of the internet and social media use by teenagers. The objective of this essay is to discuss the impacts of the internet and social media use on the mental health of teenagers, especially during the Covid-19 pandemic. Specifically, the main consequences related to the increasing of those tools use are discussed, including stress, violence vulnerability, sleeping disorders and internet addiction, highlighting possible interventions.

Dynamics of conflicts on the twitter social network: A case study on the use of chloroquine in Brazil

Concerns about the advances of the COVID-19 epidemic have sparked many debates around the world. One such discussion revolved around the use of the drug called chloroquine, initially thought to be effective in reducing the mortality rate of the infection. Particularly in Brazil, even after new studies pointed to the drug's ineffectiveness, the federal government kept the recommendation of this drug as an official treatment. The publication of an official authorization of the use of chloroquine on Twitter sparked an intense debate on social media with arguments against and in favor. This paper studies the dynamics of interactions among different user groups around this discussion, relying on network science and topic modeling analyses. Our results highlight two distinct behaviors in Twitter interaction networks, where retweets serve as positive reinforcements within information bubbles and replies act as a space of direct debate. Also, discussions are seeded by public figures, but regular users carry on the debate per se. The topic modeling analyses revealed three observable user groups in this debate: strong supporters of the Brazilian government, progressive opposition to this government, and moderate users that oppose to this specific topic but do not reject the government agenda as a whole. © 2021 IEEE Computer Society. All rights reserved.

The media in shaping the agenda in public health policies in the COVID-19 pandemic

The present study analyzes the influence of the media in the decision-making process that results in the formation of the public policy agenda focused on the health area. The problematization of the theme "agenda formation" will guide the theoretical and methodological framework in order to address issues relevant to the field of public health policies in the Brazilian context in the Pandemic period of COVID-19. The research problem aims to determine how the choices regarding the formation of agendas in public policies in the area of health are configured? The hypothesis states that the media plays a central role in the choice of social priorities through the speech addressed to interest groups. © Praksis 2021.

Brazil as an epicenter of the Covid-19 crisis in Latin America and the probable consequences in more vulnerable socioeconomic stratifications: a perspective for understanding the role of the state and social democracy centered on John Maynard Keynes

In 2020, the structure of capitalism and liberalism proclaimed by several countries, including Brazil, was badly shaken by a serious health crisis. The enemy this time is invisible: Covid-19, an infectious disease, caused by the new coronavirus, declared a pandemic by the World Health Organization (WHO). Because of the Covid-19 mortality rate in Brazil, the country has become the epicenter of the Latin America crisis. The economy has begun to emanate typical signs of a recession with projections of a decline in the GDP of up to 6.25%. In terms of socioeconomic stratification, the pandemic has accentuated social inequality, revealing old anomalies regarding the poor distribution of income, generating a greater deepening of poverty, a significant increase in unemployment and, principally, a worsening of racial, cultural, age, ethnic and gender discrimination. With this prolegomena in mind, it is possible to arrive at the fundamental objective of the article: to understand the role of the State and of social democracy - inspired by the theory of John Maynard Keynes - in times of the novel coronavirus and of the liberalist, authoritarian, denialist management of the President, Jair Messias Bolsonaro. To achieve this objective, the article will make use of exploratory and qualitative research methodology. The main conclusion is that Brazil urgently needs to rescue the welfare state - defended by Keynes - within the framework of social democracy, under threat of entering a state of conflagration and suffering a major post-coronavirus economic depression with negative consequences for more vulnerable socio-economic stratifications.

Two million COVID-19 cases in Brazil

On March 11, 2020, the World Health Organization (WHO) officially declared the 2019 coronavirus disease (COVID-19), an acute respiratory disease caused by a new coronavirus (SARS-CoV-2, previously known such as 2019-nCoV), as a pandemic. COVID-19 has spread across China and received worldwide attention. Here, we draw attention to the impact of the historical mark of 2 million cases confirmed by COVID-19 in Brazil and to the fact that, in absolute numbers, Brazil is the second in the world with more deaths from COVID-19. We discuss the fact that, in a moment in which Brazil seems to become the new epicenter of the COVID-19 pandemic, it has been implemented strategies for relaxing social distancing and social isolation. © 2020 Faculdade de Medicina de Ribeirao Preto - U.S.P.. All rights reserved.