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Case report The first approved COVID-19 vaccines include BNT162B2 Pfizer-BioNTech and mRNA-1273 Moderna mRNA vaccines. Some severe allergic reactions to these vaccines have been report, and even though there is a lack of robust evidence, IgE-mediated hypersensitivity to excipients may be the cause of several. The excipient polyethylene glycol (PEG) is present in both, whilst Moderna further contains trometamol (or tromethamine), a buffer additive present in drug formulations and contrast media. We report the case of a 40 year-old woman, with controlled allergic rhinitis and asthma, who was referred to our Immunoallergology Department due to an anaphylactic reaction to Moderna COVID-19 vaccine. She described an episode of cervical and facial pruritus 5 minutes after receiving the first dose of vaccine, which rapidly evolved to generalized urticaria. She was promptly given intravenous (IV) clemastine with improvement of symptoms. However, 1h later she developed respiratory symptoms (dry cough, shortness of breath and wheezing). IV hydrocortisone was also given, and the patient was kept under medical supervision for 6h, after which she was discharged home. The following day, she had urticaria that resolved with oral deflazacort (60 mg). She denies exercise practice, alcohol consumption or outset of new drugs prior to vaccination. During investigation, the patient described two similar reactions in the past, 5 minutes after the administration of trometamol-containing contrast media (10 years before with an iodinated contrast and 2 years ago with a gadolinium contrast, both with trometamol). A week after the reaction all laboratory evaluation were within normal limits, including tryptase level. Skin tests were performed, 2 months after, with contrast media that contain trometamol (iopromide, iomeprol, iodixanol, ioversol, gadobutrol) and that do not (ioxitalamate, amidotrizoate, gadoterate meglumine), in accordance with the EAACI/ENDA guidelines. Iopromide and iodixanol were positive on intradermal testing (1:10 dilution), suggesting trometamol as the culprit excipient. She was advised not to receive the 2nd dose of Moderna vaccine. She received Pfizer-BioNTech vaccine at the hospital, without any reactions. This case demonstrates that an IgE-mediated reaction to trometamol may be an underlying mechanism for immediate hypersensitivity to mRNA Moderna vaccine. The risk of an allergic reaction to it increases when a previous history of hypersensitivity to contrast media exists.
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Curiosity reflects an individual's intrinsic motivation to seek information in order to close information gaps. In laboratory-based experiments, both curiosity and information seeking have been associated with enhanced neural dynamics in the mesolimbic dopaminergic circuit. However, it is unclear whether curiosity and dopaminergic dynamics drive information seeking in real life. We investigated (i) whether curiosity predicts different characteristics of real-life information seeking and (ii) whether functional connectivity within the mesolimbic dopaminergic circuit is associated with information seeking outside the laboratory. Up to 15 months before the COVID-19 pandemic, curiosity and anxiety questionnaires, and a 10-minute resting-state fMRI session were conducted. In a follow-up survey early during the COVID-19 pandemic, participants repeated the questionnaires and completed an additional questionnaire about their COVID-19-related information seeking. Individual differences in curiosity but not anxiety were positively associated with the frequency of information-seeking behaviour. Additionally, the frequency of information seeking was predicted by individual differences in resting-state functional connectivity between the ventral tegmental area and the nucleus accumbens. The present translational study paves the way for future studies on the role of curiosity in real-life information seeking by showing that both curiosity and mesolimbic dopaminergic functional network support real-life information-seeking behaviour.
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Objetivos: O Venetoclax tem como alvo a proteina BCL-2. Aprovado para LLC, mostrou eficacia tambem LMA em combinacao com agentes hipometilantes como a Azacitidina. No ultimo ano, tivemos experiencias bem-sucedidas com a utilizacao desta associacao. Selecionamos 4 casos representativos de LMA e SMD para relatar nossa experiencia com este protocolo e desfechos obtidos. Material e Metodos: As informacoes foram obtidas por meio de revisao do prontuario. Resultados: Caso 1 - E.Q.O., 42 anos, sexo feminino, diagnosticada em janeiro de 2019 com LMA, evoluiu com 3 recidivas, quando foi optado pela associacao de Azacitidina e Venetoclax. Realizou ciclos com boa evolucao. Caso 2 - F.G.S., 72 anos, sexo feminino, historico de Linfoma Folicular EIIA em 2003. Em janeiro de 2021 recebeu diagnostico de LMA. Houve associacao de Azacitidina e Venetoclax como tratamento. Foram realizados 2 ciclos sem intercorrencias. Entretanto, antes do terceiro ciclo, a paciente relatou sindrome gripal, com diagnostico de COVID-19 e evoluiu a obito. Caso 3 - J.W.L.L., 37 anos, sexo masculino, em agosto de 2020 foi diagnosticado com SMD. Evolui com remissao e melhora significativa das citopenias de base. Foi submetido a TCTH nao aparentado com sucesso em julho de 2021, com enxertia no D+16 e internacao sem intercorrencias. Caso 4 - Paciente de 72 anos, sexo masculino, com diagnostico de SMD com excesso de blastos. Iniciou protocolo com Azacitidina associado a Venetoclax, persistia com elevada necessidade transfusional. Houve reducao das dosagens no segundo ciclo. O paciente evoluiu com melhor tolerabilidade, mantendo padrao transfusional. Manteve dose de Azacitidina e ajustada novamente dose de Venetoclax. Apos o quarto e quinto ciclos, paciente retornou com melhora significativa de indices hematimetricos O mielograma estava normal, bem como a imunofenotipagem e o cariotipo. Discussao: Apresentamos aqui 4 casos distintos de indicacao bem-sucedida da associacao entre Azacitidina e Venetoclax. A dose padrao utilizada foi de 75 mg/m2/dia de Azacitidina, do D1 ao D7 e 100 mg/dia de Venetoclax, com escalonamento progressivo ate atingir 400 mg/dia, do D1 ao D28. O caso 1 descreve paciente com doenca refrataria. Na literatura, esse perfil de pacientes tem beneficio importante com essa combinacao. Em nossa pratica clinica, o ajuste de dose ou duracao do Venetoclax e/ou espacamento entre os ciclos tem se mostrado uma alternativa viavel para minimizar os impactos da neutropenia. O caso 2 refere-se a paciente idosa, com mutacao do NPM1, sem status performance para quimioterapia intensiva, em primeira linha de tratamento. O impacto favoravel da mutacao NPM1 tende a reduzir em pacientes idosos (>65 anos). Nos casos 3 e 4 relatamos pacientes com SMD. Os bons resultados de Azacitidina e Venetoclax em LMA levaram os pesquisadores a avaliar a combinacao em pacientes com SMD de alto risco. Conclusao: A escolha do tratamento depende em grande parte da idade do paciente, status performance, remissao, caracteristicas geneticas e moleculares.A quimioterapia de baixa intensidade, em especial a associacao de Azacitidina com Venetoclax e uma opcao viavel, mesmo em pacientes com recidiva multipla/doenca refrataria ou naqueles com baixo status performance. Tambem aparenta ser promissora nos casos de SMD de alto risco. Os efeitos adversos mais frequentes dizem respeito as infeccoes decorrentes da neutropenia prolongada, mas nos 4 casos relatados, os pacientes evoluiram com estabilidade. Copyright © 2022
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Background In the first COVID-19 series, a larger percentage of severe and lethal cases were seen among oncologic patients, including those with malignant hematologic diseases. Nonetheless, patients with CML showed more favorable prognosis, posing that tyrosine-kinase inhibitors might have a therapeutic effect against SARS CoV2. In this study a clinical and epidemiological description was performed in patients with LMC on TKIs that were tested for COVD-19 in CCERC in Tegucigalpa. Methods Cross sectional analytic study. Sample were patients with CML with ph+ with at least one diagnostic test performed for COVID-19 in CCERC. Sociodemographic and clinical variables were analyzed. Data collection and statistical analysis was done in epiinfo 7.2.4.0 and STATA/MP 16.0. COVID-19 percent positivity was determined along with association between severity and TKI used and molecular response through Fisher exact test and OR. Data was extracted solely from clinical records. Approval was given by board of directors from the CCERC. Results 149 patients with ph+ CML were included;20.1% were positive for COVID-19, 56% were male, mean age was 46 years, 81% receiving imatinib, mean time of treatment of 6 years;55% in molecular response of BCR-ABL & LE;0.1% (IS). 21% had comorbidities. 38.7% had an asymptomatic COVID-19 disease, 35.5% had mild disease and 9.7% were severe, one patient died;lethality was 3.2%. No statistical significance was found between COVID-19 severity and treatment with imatinib vs other TKI. Conclusions Despite a high positivity rate of COVID-19 in CML patients compared to current evidence, a low lethality rate was found. The TKI used or the molecular response of CML were not associated with disease severity. The efficacy of TKIs for treatment of COVID-19 must be stablished by randomized-controlled trials.
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Background: COVID-19 vaccination is essential for the pandemic control. Adverse reactions after vaccination are com-mon, although anaphylaxis is rare. Objective(s): To characterize the immunoallergological reactions responsible for pre--vaccination referral by Primary Care (PC), to analyze the impact of drug allergy on this referral, and to evaluate the vaccination outcome after risk stratification. Method(s): Retrospective observational study including patients referred by PC to the Allergy & Clinical Immunology Department of a tertiary hospital to evaluate the risk of severe hypersensitivity reactions (HSR) after COVID-19 vaccination, from January to June 2021. Risk stratification was carried out in accordance with the Allergy & Clinical Immunology Department's protocol. Result(s): From a total of 733 patients referred by the CSP, 510 were admitted, 445 of which were evaluated, 369 (83%) females, mean age 66+/-13 years [20-99 years], 122 (27%) atopic. The majority (n=349, 78%) were referred due to previous drug reactions, of whom 69 (15.5%) due to vaccine reactions. Nonste-roidal anti-inflammatory drugs (n=97, 51%) and antibiotics (n=70, 36%) were the most reported drugs in suspected/confirmed HSRs. Drug reaction profile differed in low-risk (61% with HSR, 39% anaphylaxis) and intermediate/high risk (92% with HSR, 65% anaphylaxis) patients. After risk assessment, 323 patients were referred for vaccination at the vaccination center, of whom 280 received at least one dose of the vaccine. Two patients had chronic urticaria worsening and one patient had a vasovagal reaction after the vaccine. 122 patients were vaccinated at the hospital, of whom 69 received one dose of the vaccine. Only two patients had mild skin reactions. Conclusion(s): Drug allergy was the main cause for pre-vaccination risk assessment. Most patients were vaccinated at the vaccination center with no HSR. Risk assessment protocol was effective, with no significant reactions or cases of anaphylaxis. Copyright © 2022, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved.
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This study, carried out with waste picker organizations in 32 municipalities in the State of São Paulo, seeks to analyze the impacts of the pandemic (Covid-19) on their activities, including measures taken by the government and other actors, in order to alleviate the impacts resulting from the crisis. Our theoretical framework discusses the relationships between social movements and public policies. Organized waste pickers provide selective collection services, interacting with different levels of government in situations of collaboration and conflict, with frequent collective actions seeking improvements. Bibliographic research and application of questionnaires inform about the interactions of waste pickers, showing structural and systemic problems, highlighting their demands as a social movement. © All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Atribution License
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Inserted in our research, still under development, on the marks of Brazilian legal culture, in this article, we seek to explain how Brazilian federalism, in its relations with citizenship, has revealed itself in the current pandemic times. In particular, from the analysis of the judgments already made by the STF in ADI 6341 we discus health protection, in relation to the role and limits of federative entities, in combating the pandemic.
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Background: On March 11, 2020, COVID-19 was declared a global pandemic. Caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), this infection may remain asymptomatic. The European Society of Medical Oncology and the Portuguese Health Authority recommended both a symptomatic survey and laboratory testing in all cancer patients (pts) undergoing immunosuppressive treatment (IT). The impact of this measure is still unknown. We report our experience in a Portuguese center. Methods: Since March 2020, a symptomatic survey has been performed at our institution before each hospital visit. From April 6 through May 8, 2020, reverse-transcriptase polymerase chain reaction (RT-PCR) SARS-CoV-2 testing was added on cancer pts before undergoing IT. The impact of this intervention was evaluated comparing the hospitalization rate of cancer pts due to COVID-19, before and after the introduction of RT-PCR testing. Retrospective analysis of clinical data was performed. Results: 444 tests were carried out on 244 pts and laboratory SARS-CoV-2 infection was confirmed in 11 (5%);5 were male, with a median age of 65 years [34-76]. Breast and colorectal cancer were prevalent;2 pts had lung cancer;6 advanced disease. Ongoing IT in these pts was temporarily suspended: 9 pts under chemotherapy, 1 atezolizumab and 1 rituximab. Only 1 patient was symptomatic (9%) and previously hospitalized. No admission due to COVID-19 was registered in this group. Since March 7, 179 pts were admitted due to COVID-19 at our center: 12 were active cancer pts (6.7%) of which 4 were under IT. 6 of the oncological pts passed away, all of them had advanced diseases, 1 was under IT. Of the dead pts, lung and breast tumors were prevalent. Among all COVID-19 hospitalizations, the prevalence of pts under IT was similar before and after the implementation of the RT-PCR testing (2.2% vs. 2.4%). Conclusions: We found a significant percentage of active cancer pts diagnosed with asymptomatic COVID-19. Due to the small sample size of COVID-19 pts under IT, it is difficult to evaluate the impact of RT-PCR testing. However, on a long-term analysis, this intervention may reduce the risk of severe complications related to COVID-19 in cancer pts. Health education and dynamic organization are also important measures. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
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Objective: to identify depression symptoms in Nursing professionals during the COVID-19 pandemic. Method: a cross-sectional and observational study, conducted with Nursing professionals through an electronic form in the five Brazilian regions. An instrument with general information was used, as well as the Patient Health Questionnaire-9 to identify depression symptoms. The Student’s t hypothesis and Analysis of Variance tests were adopted. Results: the participants were 3,249 professionals. Of these, 2,092 (64.4%) did not present depression symptoms or presented minimal symptoms;603 (18.6%) presented moderate symptoms;330 (10.2%) had moderate to severe symptoms;and 224 (6.9%), severe symptoms. Women, workers from the North region, young adults, single and with an income of up to four minimum wages presented higher depression scores (p0.05). Conclusion: the Nursing professionals did not present depression symptoms, or presented mild symptoms of the disease. Variables such as gender, age group, marital status, region of the country, having contact with people infected by COVID-19, and not using masks presented significant differences with depression symptoms. © 2020 Trans Tech Publications Ltd, Switzerland.