Achados Imuno-Hematologicos Em Pacientes Durante a Pandemia Covid-19

Objetivos: Descrever os principais achados imuno-hematologicos de pacientes com solicitacao de transfusao sanguinea durante a pandemia. Material e metodos: Esse e um estudo observacional e retrospectivo realizado atraves da coleta de dados dos arquivos do laboratorio de imuno-hematologia do Hemoce Crato, durante o periodo de janeiro a dezembro de 2021 (ano considerado de pico na regiao estudada). Foram utilizadas para o ensaio 371 amostras de pacientes que apresentaram reacao positiva na pesquisa de anticorpos irregulares pela tecnica de aglutinacao em gel liss/coombs, sendo realizadas tecnicas complementares de identificacao de anticorpos como eluicao, aloadsorcao, tratamento com dithiothreitol e autoadsorcao. Resultados: Durante os dois primeiros anos da pandemia tivemos um aumento da demanda transfusional, onde em 2020, foi de 16.971, 2021, de 18.419 quando comparado a 2019, que foi de 16.567. Como podemos ver o ano de 2021 foi o que tivemos maior demanda em decorrencia do aumento de numero de casos na regiao. O numero de casos enviados para estudo imuno-hematologico tambem foi maior em 2021 (364), 2020 (177), 2019 (170) dentre os casos enviados em 2021 tivemos 98 (27%) de casos inconclusivos, 54 (15%) foi encontrado somente autoanticorpos e 252 (69,2%) apresentaram anticorpos identificados. Dos 252 identificados, 174 (69%) apresentaram um aloanticorpo, e 78 (31%) possuiam mais de um aloanticorpo. Dos 252 pacientes identificados, 180 (72%) possuiam anticorpos contra antigenos do sistema Rh. Discussao: Os casos confirmados de COVID-19 no Ceara na fase inicial do processo epidemico, se concentravam na capital. Passado o periodo de um ano, tomando como base o coeficiente de incidencia de casos e obitos por 100.000 habitantes, verifica-se que, no entanto, no ano de 2021 os valores sao mais acentuados no interior cearense, justificando o aumento da demanda transfusional e aumento do numero de casos enviados para estudo imuno-hematologico. Nao tivemos a resolucao da investigacao imuno-hematologica em 98 (27%) dos casos enviados. Dos casos solucionados 180 (72%)% apresentavam anticorpos contra antigenos do sistema Rh. Conclusao: Neste trabalho, buscamos destacar os desafios de elucidacoes de casos imuno-hematologicos vivenciados durante a pandemia na regiao do cariri cearense. Os resultados mostram uma taxa alta de casos inconclusivos durante esse periodo. Copyright © 2022

FLUID BALANCE AS AN INDEPENDENT PROGNOSTIC INDICATOR OF IN-HOSPITAL MORTALITY IN PATIENTS WITH HEART FAILURE AND COVID-19

SESSION TITLE: Outcomes Across COVID-19 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Fluid resuscitation confers protection against in-hospital mortality in heart failure (HF) patients with severe sepsis. SARS COV-2 infection can lead to a cytokine storm that is clinically similar to severe sepsis. Little is known about fluid balance in patients with HF admitted for covid 19. We aim to evaluate whether positive fluid balance is associated with in-hospital mortality in HF patients admitted for Covid-19. METHODS: This single center retrospective cohort study was conducted in patients admitted in the ICU for confirmed Covid 19 from 10/2020 to 3/2021 in a community hospital in Newark. The primary outcome was survival to discharge. Clinical SAS 9.4 was used to obtain summary statistics, perform chi-squared test and multivariable logistic regression analysis. RESULTS: We included 91 patients admitted in the ICU with covid 19. Out of these 33 patients were diagnosed with heart failure. Out of 33 people with HF 23 (69.70%) were male, 10 (30.3%) were females. Of the 33, 17(56.67%) were latino, 5(16.67%) were caucasian and 6(20%) were african-american. Mean age of population with and without Heart Failure was 70.78 yrs(?12.52) and 58.57 yrs(?13.37) respectively. Amongst them 18(54.55%) had DM, 27(81.82%) had HTN, 5 (15.15%) had chronic respiratory disease and 7(21.21%) had CKD. Amongst those with Heart Failure, 20(60.61%) had multiple comorbidities. The odds for negative survival are shown in table 1. Odds of negative survival outcome in those with positive fluid balance after adjusting for heart failure as compared to those with negative fluid balance in patients of COVID 19 was 12.958 (P value= 0.0183). CONCLUSIONS: Positive fluid balance in HF patients admitted with Covid 19 may be associated with adverse outcomes. Larger, prospective studies are needed to investigate the correlation between covid 19 and fluid balance in HF patients. CLINICAL IMPLICATIONS: This study creates awareness on the need of caution while fluid resuscitation in heart failure patients with Covid-19 as a positive fluid balance might be associated with unfavorable outcomes DISCLOSURES: No relevant relationships by Ruhma Ali no disclosure on file for Joaquim Correia;No relevant relationships by Neev Mehta No relevant relationships by Aditya Patel No relevant relationships by jihad slim, value=Honoraria Removed 03/25/2022 by jihad slim No relevant relationships by jihad slim, value=Honoraria Removed 03/25/2022 by jihad slim No relevant relationships by jihad slim, value=Honoraria Removed 03/25/2022 by jihad slim No relevant relationships by jihad slim, value=Honoraria Removed 03/25/2022 by jihad slim No relevant relationships by jihad slim, value=Honoraria Removed 03/25/2022 by jihad slim

The impact of COVID-19 pandemic on suicides in portugal during the emergency state

Introduction The mental health impact of the COVID-19 pandemic is well documented. Portugal entered the emergency state on 19th march due to rising numbers of infected patients. The emergency state introduced regulatory measures that restricted people’s movements, applied a curfew, and closed most non-essential spaces and activities, such as shops and religious celebrations. Objectives To evaluate the rates of suicides during the emergency state in Portugal. Methods We obtained the number of probable suicides during 19th march and 2nd may 2020, 2019 and 2018 from SICO/eVM (Real Time Mortality Electronic Surveillance). This system is used for health planning in Portugal and provides provisory data which is updated every 10 minutes. ExcelÒ was used for the statistical analysis. Results During the Emergency State in Portugal there were 57 probable suicides. Comparing to the same period in 2018 and 2019, there were 62 and 70 probable suicides, respectively. Social isolation, anxiety, fear of contagion, chronic stress, and economic difficulties may lead to the development or exacerbation of depressive, anxiety, substance use, and other psychiatric disorders. Literature on suicides due to COVID-19 mention not only fear of infection, but also social isolation and distancing and economic recession as causes for suicide attempts and completions. Conclusions During the emergency state there was not an increase of probable suicides, compared to previous years. The greater vigilance of people’s movements may have deterred many attempts. However, policymakers and health care providers must be alert as the current psychosocial predispose to an increase in suicide rates. Disclosure No significant relationships.

COVID-19 mental health helpline: A tool for a rural population

Introduction Coronavirus disease 2019 (COVID-19) pandemic has had a negative impact for mental health. ULS-Guarda in cooperation with Portugal National Health Service, provided the population of the district of Guarda with a mental health helpline (MHHL). Objectives Provide a descriptive data analysis of the MHHL calls received between April 1st and September 20th of 2020. Methods The data was obtained through the filling out of questionnaires. It included fields for gender, age, the type of service provided, relation to COVID-19, symptoms displayed and the number calls made per patient. For the statistical analysis, Microsoft Excel TM was utilized. Results MHHL received 191 calls. The largest volume was received during April, which saw 116 instances of patients seeking the MHHL. The number of calls then tapered progressively throughout the following months. The services provided were split between psychiatric assistance, psychologic assistance, and the renovation of medical prescriptions, in 44%, 31% and 19% of the cases, respectively. The 101 patients who resorted to the MHHL were unevenly distributed in gender, being 74 female and 27 male individuals. Their ages were mostly between 50 and 69 years old. The most common symptoms were anxiety, depressed humor and insomnia, in 35%, 16% and 11% of the cases, respectively. Conclusions The largest influx of calls coincides with the home confinement period, and decreased alongside the relaxation of the confinement measures held. The MHHL had enough adherence to warrant consideration of it being an alternative means of healthcare access, especially in situations where physical access to healthcare is restricted.

The impact of COVID-19 lockdown - case report

Introduction In early 2020, governments started to implement different forms of public health measures, from physical distancing recommendations, to stay-at-home orders, to limit the propagation of COVID-19. Here we report the case of a 41-year-old woman, with a diagnosis of panic disorder. During the end of the lockdown, the patient presented psychopathological worsening, from her fear of Covid-19 infection, stemming from a heart failure disease and concerns regarding the hygiene and safety measures of those around her. Objectives Presentation of a clinical vignette. Methods Selection and analisis of clinical case and review of the literature using PubMed database. Results The COVID-19 pandemic and the measures adopted to prevent the spread of the disease had a huge impact on a personal, social, and economic level for the world population. The rise of fear and anxiety among people due to uncertainty about the disease are coupled with essential yet disruptive measures such as lockdowns and quarantines. The chronically ill population are especially vulnerable during such circumstances and require addressing their physical health and any psychological difficulties they might experience, being at higher risk of suffering physically from the pandemic’s disease as well as psychologically from the implemented countermeasures. Conclusions This vignette provides a case where a person’s psychiatric conditions are worsened due to the end of a pandemic lockdown, rather than the lockdown itself. Additional work should aim at comparing the experiences of the different countries affected by the pandemic in order to understand the size of the psychological impact, the potential risk and protective factors. Disclosure No significant relationships.

Spatial-temporal monitoring risk analysis and decision-making of COVID-19 distribution by region

The purpose of this study is to model, map, and identify why some areas present a completely different dispersion pattern of COVID-19, as well as creating a risk model, composed of variables such as probability, susceptibility, danger, vulnerability, and potential damage, that characterises each of the defined regions. The model is based on a risk conceptual model proposed by Bachmann and Allgower in 2001, based on the wildfire terminology, analysing the spatial distribution. Additionally, a model based on population growth, chaotic maps, and turbulent flows is applied in the calculation of the variable probability, based on the work of Bonasera (2020). The results for the Portuguese case are promising, regarding the fitness of the said models and the outcome results of a conceptual model for the epidemiological risk assessment for the spread of coronavirus for each region. © 2022 Inderscience Enterprises Ltd.. All rights reserved.

AWAKE PRONING: A FUTURE STANDARD OF CARE IN ACUTE RESPIRATORY DISEASES?

TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: COVID19 leads to Acute Respiratory Failure (ARF) with dyspnea and respiratory exhaustion, ultimately progressing to Acute Respiratory Distress Syndrome (ARDS). The authors present a case of an awake proning/reposition (APR) strategy in a patient with COVID19-ARF. CASE PRESENTATION: A 65-year-old man was admitted for severe COVID19 in February, 2021. At presentation, he was dyspneic on the 10th disease day, had mild hypoxemia and mild systemic inflammation. Immediately, dexamethasone 6mg qd, prophylactic anticoagulation and conventional oxygen therapy (COT) were started. In the first 48 hours, ARF kept worsening and increasing COT demand was needed. APR was started, leading to hypoxemia and polypnea improvement. The patient was ultimately transferred to the Intensive Care Unit (ICU), where non-invasive-ventilation (NIV) and APR were maintained for one week and invasive ventilation (IV) avoided. After twenty days of hospitalization, the patient was discharged without COT. DISCUSSION: Proning position (PP) is an already largely diffused strategy in ICU patients, which improves ARF and prevents ARDS and IV. Supine position leads to dorsal alveoli atelectasis by causing direct (compression) and indirect (over-inflation of ventral alveoli) pressure, which ultimately leads to V/Q mismatch. PP improves V/Q mismatch, reduces shunt and recruits posterior alveoli. APR is a PP strategy in awake/conscious patients, which improves oxygenation and dyspnea, and maybe prevents IV. APR can be autonomously achieved, which can be relevant during a pandemic context. CONCLUSIONS: APR leads to oxygenation and respiratory comfort improvement, possibly improving COVID19 prognosis and avoiding IV. Moreover, it may become a standard of care in ARF by other acute respiratory diseases. DISCLOSURE: Nothing to declare. KEYWORD: Awake proning

P0125 Post-operative infections, a silver lining from the COVID-19 pandemic. A retrospective cohort study from urology departments

Introduction & Objectives: In response to the COVID-19 pandemic, hospitals had to reorganize, and sanitation measures were reinforced. Some of these procedures have been shown to lower the rate of hospital acquired infections, and as a result, we hypothesise that the occurrence of postoperative infection during the pandemic would be lower. The objective of this study is to compare the rate of post-operative infections and patterns of antimicrobial resistance before and during the pandemic in Urology departments. Materials & Methods: An observational retrospective cohort study was carried out in two centers in Portugal. Data from all elective surgical procedures between April and June 2018 and the homologous period in 2020 were collected. Outpatient and non-elective surgeries were excluded. Patient data included age, sex, post-operative in-hospital length of stay, American Society of Anaesthesiologist (ASA) score, type of procedure, antibiotic prophylaxis, pre-operative urine cultures, peri-operative use of medical devices, post-operative infections, microbial culture and antimicrobial susceptibility testing. Infection was defined according to the European Centre for Disease Prevention and Control (ECDC) protocol. Multidrug resistant (MDR) organism was defined asa microorganism resistant toone or more classes of antimicrobial agents tested. Main outcomes were the number of post-operative infections during the pandemic and the number of MDR isolates. Results: Baseline characteristis are presented in Table 1. The post-operative infection rate during the pre-pandemic period was of 14.1% compared to 12.1% during the pandemic (p=0.494). Ninety two percent of isolates were MDR in the pre-pandemic period compared to 52 % during the pandemic (p=0.002). The pandemic period was associated with a reduced risk for MDR isolate's on multivariate logistic regression analysis (OR - 0.1;95% CI:0.07 - 0.57;p=0.010), but not with reduced number of infections (OR - 0.84;95% CI 0.53-1.34;p=0.47). (Table presented.) Conclusions: MDR isolates were lower during the pandemic in Urology wards, possibly as an indirect result of COVID-19 preventive measures, such as increased hand hygiene, room disinfection and reduced family visits to inpatients. No statistically significant difference was found between the number of post-operative infections in our sample. Further reports, such as those from the ECDC are needed to confirm our results.

The diabesity and COVID 19 pandemics association with climate change and the role of Telehealth

Diabesity was considered the pandemic of the 3rd millennium until the Covid-19 pandemic. Recent evidence has highlighted how both pandemics are strongly associated: obese and diabetic patients are at increased risk of COVID 19 infection and have a worse prognosis when infected due to the impairment of the immune response to infections and due to the mechanical limits that make the management of these patients more difficult. There is also evidence that both pandemics are the cause and effect of climate change. Indeed, population growth, urbanization, motorized transportation and agricultural productivity increase greenhouse gas emission and consequently global warming. These factors are also incriminated in the diabesity pandemic by the promotion of the nutrition transition and physical inactivity. It has also been suggested that the emergence and dissemination of the COVID 19 outbreak, as well as other zoonosis, could be linked to this population and urban growth, encroaching into wildlife habitats leading to an increased interaction between humans and animals, providing opportunities for inter species infection. Telehealth interventions have proven to be effective in tackling both pandemics, by providing care to both patients with COVID-19 infections and for those with obesity and diabetes, without increasing the risk of potential exposure for patients, clinicians, and staff. Furthermore, these tools have shown to be a potent carbon reduction strategy in the health sector which can significantly reduce greenhouse gas emission. However, several barriers still need to be overcome for a widespread use of eHealth solutions. These require important adaptation on the part of the caregivers and their therapeutic approach, as well as the patient.

THE BENEFITS OF CORTICOSTEROIDS IN COVID-19 WITH ORGANIZING PNEUMONIA-LIKE PATTERN: A CLINICAL REPORT OF SUCCESSFUL TREATMENT

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Since the outbreak of COVID-19 (disease caused by severe acute respiratory syndrome coronavirus 2 - SARS-CoV-2), the world faces a major public health crisis.Organizing pneumonia (OP) is a relatively rare condition, that can be idiopathic or, more commonly, result from infections, drugs or autoimmunity (secondary OP) #1. Viral induced OP throughout the severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and H1N1 viral pandemics was well documented #2. The reported imaging findings of COVID-19 suggest that secondary OP may be occurring even more often #2. CASE PRESENTATION: 74-y-old man, evaluated in the emergency room for dry cough and asthenia with 1 week of evolution. He presented with hypoxemic respiratory failure (PaO2/FiO2 ratio: 276), and tested positive for SARS-CoV-2, being admitted in the COVID department. Treatment with Dexamethasone 6mg was started but a week later (day 14 of illness) there was a clinical deterioration, with worsening of the respiratory insufficiency (PaO2/FiO2 ratio: 175), requiring introduction of non-invasive mechanical ventilation with high oxygen rates. A clinical and gasometrical improvement (PaO2/FiO2 ratio: 230»253) was then observed with slow reduction and weaning from corticosteroids at D10 of dexamethasone. At day 20 of the disease, there was a new clinical and gasometrical worsening (PaO2/FiO2: 162), and it was decided to restart dexamethasone 6mg. No clinical improvement was observed in the following days and a chest computed tomography (CT) was performed, revealing multiple peripheral areas of consolidation and bilateral ground glass opacities, suggestive of an OP-like pattern. Given these findings, the case was discussed in a multidisciplinary team reunion, who considered the diagnosis of OP secondary to COVID-19 infection. It was decided to initiate 'pulse-dose' methylprednisolone 1000mg IV for 3 days and posteriorly the dosage of steroids was tapered every 3 days. There was an abrupt reduction in oxygen and ventilatory support needs and he was discharge requiring only 1L of oxygen and showing significant radiological improvement. After 3 months of follow-up, chest CT scan revealed dramatic improvements regarding previous findings. DISCUSSION: The definitive role of SARS-CoV-2 infection in diffuse lung injury is still unclear, but it is expected that it might induce host immune responses that damage the lungs. Corticosteroids, as immunosuppressive and anti-inflammatory agents, can reduce lung damage by regulating various inflammatory responses #3. CONCLUSIONS: This case suggests that corticosteroids may be an option to consider in COVID-19 pneumonia with an OP-like pattern. Secondary OP often requires prolonged corticosteroid treatment. It is important to increase recognition of this diagnosis, in order to start the appropriate treatment, which may lead to a reduction of the harmful consequences of COVID-19. REFERENCE #1: Drakopanagiotakis F, Paschalaki K, Abu-Hijleh M, Aswad B, Karagianidis N, Kastanakis E, Braman SS, Polychronopoulos V. Cryptogenic and secondary organizing pneumonia: clinical presentation, radiographic findings, treatment response, and prognosis. Chest. 2011 Apr;139(4):893-900. doi: 10.1378/chest.10-0883. Epub 2010 Aug 19. PMID: 20724743. REFERENCE #2: Kory P, Kanne JP. SARS-CoV-2 organising pneumonia: 'Has there been a widespread failure to identify and treat this prevalent condition in COVID-19?'. BMJ Open Resp Res 2020;7:e000724. doi:10.1136/ bmjresp-2020-000724 REFERENCE #3: Fauci AS. Mechanisms of the immunosuppressive and anti-inflammatory effects of glucocorticosteroids. J Immunopharmacol. 1978;1:1-25. DISCLOSURES: No relevant relationships by Mariana Argel, source=Web Response No relevant relationships by Joana Correia, source=Web Response No relevant relationships by Marta Sousa, source=Web Response No relevant relationships by António Torres, source=Web Response

Learning and teaching in times of pandemic: Remote education in the tourism and hotel courses of the federal university of maranhao

This study aims to present the activities offered by professors of the Tourism and Hospitality courses at the Federal University of Maranhao during the pandemic period of COVID-19, and, in addition, has the specific objective of verifying how students perceive teaching and learning remote in this context. The study has a qualitative approach, and develops from a double path: The bibliographic review and the case study. A semi-structured questionnaire was applied to students of tourism and hospitality courses in the Google forms format. In their narratives, students demonstrate that there are positive and negative points at this moment, but that both the Institutions, as teachers and students are reinventing themselves, and exploring new ways to learn and teach with the use of digital technologies. It is also necessary to implement public policies to include everyone involved in this process of teaching and remote learning. © 2021 UNIVERSIDADE FEEVALE . All Rights Reserved.

The impact of COVID-19 lockdown - case report

IntroductionIn early 2020, governments started to implement different forms of public health measures, from physical distancing recommendations, to stay-at-home orders, to limit the propagation of COVID-19. Here we report the case of a 41-year-old woman, with a diagnosis of panic disorder. During the end of the lockdown, the patient presented psychopathological worsening, from her fear of Covid-19 infection, stemming from a heart failure disease and concerns regarding the hygiene and safety measures of those around her.ObjectivesPresentation of a clinical vignette.MethodsSelection and analisis of clinical case and review of the literature using PubMed database.ResultsThe COVID-19 pandemic and the measures adopted to prevent the spread of the disease had a huge impact on a personal, social, and economic level for the world population. The rise of fear and anxiety among people due to uncertainty about the disease are coupled with essential yet disruptive measures such as lockdowns and quarantines. The chronically ill population are especially vulnerable during such circumstances and require addressing their physical health and any psychological difficulties they might experience, being at higher risk of suffering physically from the pandemic’s disease as well as psychologically from the implemented countermeasures.ConclusionsThis vignette provides a case where a person’s psychiatric conditions are worsened due to the end of a pandemic lockdown, rather than the lockdown itself. Additional work should aim at comparing the experiences of the different countries affected by the pandemic in order to understand the size of the psychological impact, the potential risk and protective factors.DisclosureNo significant relationships.

COVID-19 mental health helpline: A tool for a rural population

IntroductionCoronavirus disease 2019 (COVID-19) pandemic has had a negative impact for mental health. ULS-Guarda in cooperation with Portugal National Health Service, provided the population of the district of Guarda with a mental health helpline (MHHL).ObjectivesProvide a descriptive data analysis of the MHHL calls received between April 1st and September 20th of 2020.MethodsThe data was obtained through the filling out of questionnaires. It included fields for gender, age, the type of service provided, relation to COVID-19, symptoms displayed and the number calls made per patient. For the statistical analysis, Microsoft Excel TM was utilized.ResultsMHHL received 191 calls. The largest volume was received during April, which saw 116 instances of patients seeking the MHHL. The number of calls then tapered progressively throughout the following months. The services provided were split between psychiatric assistance, psychologic assistance, and the renovation of medical prescriptions, in 44%, 31% and 19% of the cases, respectively. The 101 patients who resorted to the MHHL were unevenly distributed in gender, being 74 female and 27 male individuals. Their ages were mostly between 50 and 69 years old. The most common symptoms were anxiety, depressed humor and insomnia, in 35%, 16% and 11% of the cases, respectively.ConclusionsThe largest influx of calls coincides with the home confinement period, and decreased alongside the relaxation of the confinement measures held. The MHHL had enough adherence to warrant consideration of it being an alternative means of healthcare access, especially in situations where physical access to healthcare is restricted.

The impact of COVID-19 pandemic on suicides in portugal during the emergency state

IntroductionThe mental health impact of the COVID-19 pandemic is well documented. Portugal entered the emergency state on 19th march due to rising numbers of infected patients. The emergency state introduced regulatory measures that restricted people’s movements, applied a curfew, and closed most non-essential spaces and activities, such as shops and religious celebrations.ObjectivesTo evaluate the rates of suicides during the emergency state in Portugal.MethodsWe obtained the number of probable suicides during 19th march and 2nd may 2020, 2019 and 2018 from SICO/eVM (Real Time Mortality Electronic Surveillance). This system is used for health planning in Portugal and provides provisory data which is updated every 10 minutes. ExcelÒ was used for the statistical analysis.ResultsDuring the Emergency State in Portugal there were 57 probable suicides. Comparing to the same period in 2018 and 2019, there were 62 and 70 probable suicides, respectively. Social isolation, anxiety, fear of contagion, chronic stress, and economic difficulties may lead to the development or exacerbation of depressive, anxiety, substance use, and other psychiatric disorders. Literature on suicides due to COVID-19 mention not only fear of infection, but also social isolation and distancing and economic recession as causes for suicide attempts and completions.ConclusionsDuring the emergency state there was not an increase of probable suicides, compared to previous years. The greater vigilance of people’s movements may have deterred many attempts. However, policymakers and health care providers must be alert as the current psychosocial predispose to an increase in suicide rates.DisclosureNo significant relationships.

Impact of the covid-19 pandemic in the gastroenterology department-the gastroenterologists' perspective nationwide and the real impact in a portuguese center

Aims Several Gastroenterology Societies created recommendations in order to reduce any non-essential exposure to thesevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. The purposes of this paper are 1) to evaluate thenational gastroenterologists' perspective of the impact of COVID-19 and 2) to evaluate the impact of the reorganization ofthe Gastroenterology department of Centro Hospitalar Vila Nova de Gaia/Espinho (CHVNG/E) during COVID-19 Pandemic. Methods For the 1 purpose, an online survey of 32 questions was distributed to gastroenterologists nationwide. For the2 purpose the authors conducted a retrospective analysis of some endoscopic procedures performed at theGastroenterology Department of CHVNG/E between March 16 and May 8 during the years 2019 and 2020. Results 67 gastroenterologists have answered our survey between April 15th and May 5th 2020, mostly females (53.7 %)and 55 to 65 years-old group was the most prevalent (25.4 %). Only 14.9 % were residents. 86.6 % worked in a hospital with COVID-19 patients, with 16.4 % assigned to assist those patients. All the departments had suffered modifications. 90 %of the residents affirmed that their activity has changed mainly endoscopic practice, and 64.2 % respondents agreeing withan internship extension. 94 % declared to have non-essential endoscopic procedures postponed. 85.1 % maintained in-person medical visits, 88.1 % were already having remote consultations and 11.9 % did not have any clinical visit. In ourgastroenterology unit, the number of endoscopic procedures had decreased 73.1 % from 2019 to 2020. Conclusions The advent of the COVID-19 outbreak has led to important changes among Gastroenterology activities inPortugal, and national gastroenterology units are complying with the recommendations. Furthermore, PortugueseGastroenterologists believed that the decrease in endoscopic activity can compromise residents' education and training. Thegastroenterology department at CHVNG/E has shown a significant reduction in the number of endoscopic proceduresperformed during the same period from 2019 to 2020.

Using discrete Ricci curvatures to infer COVID-19 epidemic network fragility and systemic risk

The damage of the novel Coronavirus disease (COVID-19) is reaching an unprecedented scale. There are numerous classical epidemiology models trying to quantify epidemiology metrics. To forecast epidemics, classical approaches usually need parameter estimations, such as the contagion rate or the basic reproduction number. Here, we propose a data-driven, parameter-free, geometric approach to access the emergence of a pandemic state by studying the Forman-Ricci and Ollivier-Ricci network curvatures. Discrete Ollivier-Ricci curvature has been used successfully to forecast risk in financial networks and we suggest that those results can provide analogous results for COVID-19 epidemic time-series. We first compute both curvatures in a toy-model of epidemic time-series with delays, which allows us to create epidemic networks. We also compared our results to classical network metrics. By doing so, we are able to verify that the Ollivier-Ricci and Forman-Ricci curvatures can be a parameter-free estimate for identifying a pandemic state in the simulated epidemic. On this basis, we then compute both Forman-Ricci and Ollivier-Ricci curvatures for real epidemic networks built from COVID-19 epidemic time-series available at the World Health Organization (WHO). This approach allows us to detect early warning signs of the emergence of the pandemic. The advantage of our method lies in providing an early geometrical data marker for the pandemic state, regardless of parameter estimation and stochastic modelling. This work opens the possibility of using discrete geometry to study epidemic networks.

[A double pandemic : the impact of anti-Covid measures on obesity]

To deal with the COVID-19 pandemic, several restrictive measures have been put in place that cause significant disruption to lifestyle habits. We conducted a review of the literature to study the impact of these changes on the body weight of populations. We observed changes in eating habits (increase in the number of snacks and consumption of sugary products), a decrease in physical activity and an increase in stress that can exacerbate eating disorders. Increased efforts must be made to support patients during this difficult time, including public health measures to counteract these behaviours in order to prevent health complications.