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1.
International Journal of Strategic Change Management ; 7(4):290-313, 2021.
Article in English | Scopus | ID: covidwho-1875145

ABSTRACT

Globalisation has changed the way business is viewed and oriented. Its impact is broad and wide-ranging, requiring an analysis and reflection of the existing business approaches and their respective practices. Covid-19 pandemic accelerated this situation and made it necessary for organisations to create new methods and tools to adapt to the actual context we are living in. This paper has as main goal to analyse the influence of strategy on the performance of REMAX real estate companies in Portugal. To achieve this objective, this research was developed according to a quantitative methodology, whose data was collected through a questionnaire survey, addressed to the directors boards of the real estate mediation companies of REMAX network, in Portugal, of which 70 valid answers were obtained. The obtained results show that the strategy has a strong influence on the performance. In addition, the results reveal that only the adopted prospective strategy by the companies has a direct impact on performance. The performance skills of the organisations, such as financial performance, customers and internal processes are the antecedents that most influence the strategy. © 2021 Inderscience Enterprises Ltd.

2.
Hematology, Transfusion and Cell Therapy ; 43:S542, 2021.
Article in English | EMBASE | ID: covidwho-1859761

ABSTRACT

A pandemia da COVID-19 trouxe alterações e necessidades de adaptações nas atividades laborais, que passaram a ser, na sua maioria, realizadas na modalidade online. Para muitos profissionais, essas alterações, aliadas ao sofrimento de outras perdas e inseguranças em função do cenário pandêmico, foram fontes de sofrimento emocional. Descrever a implementação de um programa de atenção à saúde mental dos colaboradores de um Hemocentro no segundo ano de pandemia da COVID-19. Um questionário sobre adaptação do trabalho durante a pandemia foi respondido por 113 colaboradores: 75% relataram aumento de ansiedade;65% aumento de cansaço;61% notaram aumento de sobrecarga. Frente a essas queixas, a equipe de psicologia elaborou um plano de intervenção que constava de atividades psicoeducativas e de um grupo de apoio emocional. Inicialmente, foi realizada uma palestra com o tema sofrimento emocional no trabalho, enfocando, em especial, ansiedade, depressão e estresse. Em seguida, foi proposto um grupo de conversa sobre os impactos emocionais da pandemia, com cinco encontros de uma hora de duração, sempre nos mesmos dias e horários e com os mesmos coordenadores. Ressaltou-se o fato de que o conteúdo do grupo seria sigiloso e que aconteceria depois do horário do expediente de trabalho. Antes e após os encontros dos grupos, os participantes foram solicitados a realizar avaliações de estresse, ansiedade e de depressão com os seguintes instrumentos: Inventário de Sintomas de Stress para adultos de Lipp- (ISSL) e Hospital Anxiety and Depression Scale (HAD). Dos dezoito colaboradores que manifestaram interesse na proposta, nove aderiam e foram distribuídos em dois grupos, sendo que um grupo contou com quatro participantes e outro, com cinco integrantes. Dos nove participantes, sete responderam os instrumentos pré-grupo. Observa-se que cinco apresentavam estresse, sendo quatro na fase de resistência e um na fase de quase exaustão. Sintomas de depressão foram mais frequentes do que de ansiedade. Os tópicos abordados nos encontros tangenciaram os impactos da pandemia na vida cotidiana, com acentuada incerteza a respeito do futuro e diminuição da socialização de das atividades de bem-estar. Em relação ao trabalho, foram notadas dificuldades decorrentes do aumento da sobrecarga de trabalho e na interação com outros colaboradores, que foi prejudicada devido mudanças na organização do trabalho e do estresse causado pela pandemia. Segundo avaliação dos participantes, os encontros contribuíram para ventilação de emoções, compartilhamento de experiências, aumento do sentido do trabalho, promoção apoio entre os colaboradores e desenvolvimento de estratégias para controle das atividades de forma a evitar sobrecarga. Depois do grupo, os participantes foram solicitados a responder novamente os mesmos instrumentos. Pós-grupo, cinco respostas foram registradas. Observou-se uma queda nos sintomas de ansiedade e uma não alteração nos de depressão. O melhor resultado foi encontrado na redução de estresse: dos cinco participantes que apresentaram quadro de estresse pré-grupo, somente um participante continuava com estresse. Conclui-se que intervenções preocupadas com a saúde emocional dos colaboradores e alinhadas com suas necessidades podem contribuir para a prevenção e o cuidado de sintomas de depressão, ansiedade e estresse.

3.
Hematology, Transfusion and Cell Therapy ; 43:S312, 2021.
Article in English | EMBASE | ID: covidwho-1859635

ABSTRACT

Objetivo: Relatar um caso de tetraparesia flácida após início do esquema vacinal em paciente submetida a transplante de medula óssea (TMO) autólogo para tratamento de linfoma não Hodgkin. Relato do caso: Trata-se de uma mulher parda, de 32 anos, com histórico de linfoma não Hodgkin, hipertensão arterial e diabetes mellitus tipo 2, submetida a TMO em abril/2020 que, após iniciar regime vacinal de rotina pós-TMO, em outubro/2020, evoluiu com sintomas sistêmicos inespecíficos, caracterizados por febre não aferida, náuseas e vômitos. Nenhum quadro infeccioso foi detectado naquele momento. Cerca de 12 dias mais tarde, a paciente passou a apresentar quadro sensitivo-motor caracterizado por parestesia e paresia ascendentes, inicialmente em pés, com progressão para o abdome e mãos em 24 horas, além de disfagia para líquidos e diplopia. Familiares relatavam ainda alguns episódios de síncope nos últimos dois dias anteriores à consulta médica e sudorese extrema e intermitente na região da face. A paciente foi admitida em unidade de terapia intensiva onde foram verificadas hipotonia generalizada, arreflexia global, disautonomia e dissociação proteíno-citológica na análise do líquido cefalorraquidiano, estabelecendo-se o diagnóstico de Síndrome de Guillain-Barré (SGB). Foram descartados quadros infecciosos, inclusive COVID-19, assim como a recidiva do linfoma. Três dias depois houve deterioração da função respiratória com necessidade de intubação orotraqueal e ventilação mecânica. Optou-se por tratamento com plasmaférese (cinco sessões em dias alternados com troca de uma volemia plasmática por sessão). Os efeitos colaterais ao procedimento foram um pequeno hematoma em local de inserção do acesso venoso e distúrbios eletrolíticos moderados, corrigidos sem dificuldade. A recuperação motora foi rápida e a paciente recebeu alta hospitalar após 20 dias de internação, deambulando sem apoio e mantendo-se livre de quaisquer sequelas sensitivo-motoras durante o seguimento. Discussão: paralisias flácidas progressivas são condições frequentes em departamentos de urgência, mas que ainda constituem relevante desafio diagnóstico. Na maioria das vezes a SGB está associada a uma resposta imunológica a um estado infeccioso prévio, porém, em alguns raros casos, pode se desenvolver após imunizações ou transplante de medula óssea. A plasmaférese é tão efetiva quanto a infusão de imunoglobulinas no tratamento da SGB, embora com mais efeitos colaterais em potencial como hipotensão, sepse, reações transfusionais e problemas relacionados ao acesso vascular. Os resultados tendem a ser superiores quando a plasmaférese é iniciada nos primeiros sete dias do surgimento dos sintomas, melhorando a força muscular, diminuindo a necessidade de ventilação mecânica e acelerando a recuperação dos pacientes com SGB grave. Conclusão: a rápida progressão sintomática apresentada pela paciente e a excelente resposta clínica após a instituição da plasmaférese reforçam a importância de um diagnóstico precoce pois, com a terapia adequada é possível atingir uma reversão completa das manifestações e evitar danos neurológicos permanentes.

4.
Hematology, Transfusion and Cell Therapy ; 43:S32, 2021.
Article in Portuguese | EMBASE | ID: covidwho-1859587

ABSTRACT

Objetivos: Descrever os parâmetros hematológicos encontrados em pacientes hospitalizados com Covid-19, identificando possíveis alterações e sua relação com os desfechos de mortalidade e necessidade de ventilação mecânica. Material e métodos: Estudo observacional, retrospectivo, quantitativo. Foram examinados em busca de alterações hematológicas clínicas e laboratoriais os prontuários eletrônicos de todos os pacientes admitidos no Hospital Universitário da Universidade Federal de Juiz de Fora que possuíam diagnóstico confirmado de Covid-19 por exames sorológicos e/ou moleculares (RT-PCR – reação em cadeia da polimerase – transcriptase reversa), entre 1°de março e 30 de agosto de 2020, como também avaliados os desfechos (óbito, necessidade de ventilação mecânica). Para verificar possíveis associações entre as variáveis foi utilizado o teste exato de Fisher, com o auxílio do software SPSS, v.20. Resultados: 57 pacientes foram confirmados laboratorialmente para Covid-19 e admitidos para internação durante o período do estudo, sendo 61,4% do sexo masculino. A idade dos pacientes variou de 23 a 98 anos, com média de 61,3 anos (desvio padrão 15,8). Apenas 5 (8,7%) pacientes não apresentavam comorbidades. A comorbidade mais frequente foi hipertensão arterial sistêmica (70,2%), seguida por diabetes mellitus (36,8%). Em relação às alterações hematológicas, foi possível observar que os pacientes apresentaram anemia em algum momento da hospitalização (56,1%), enquanto plaquetopenia foi um achado menos frequente (22,8%). Na avaliação da série branca, tanto leucocitose (61,4%) quanto a leucopenia (68,4%) estiveram presentes ao longo da internação. Alterações em marcadores inflamatórios também foram detectados regularmente, com elevação de Proteína C Reativa em 93% dos pacientes à admissão, de ferritina em 70,2% dos pacientes durante a evolução, bem como uma elevação dos valores de D-dímero, observada em 91,3% dos pacientes. Ao analisar as variáveis clínicas e laboratoriais com o desfecho óbito, foram identificadas associações estatisticamente significativas com: necessidade de ventilação mecânica (p < 0,001), necessidade de diálise (p = 0,003), valor de hemoglobina menor que 10 g/dl à admissão (p = 0,22), elevação de ferritina (p = 0,043), de lactato desidrogenase (LDH) (p = 0,038) e de troponina (p = 0,006). Já para o desfecho de necessidade de ventilação mecânica, foram obtidas associações estatisticamente significativas com as variáveis: internação prolongada (p < 0,001), necessidade de diálise (p = 0,001), necessidade de pelo menos uma transfusão de concentrado de hemácias (p = 0,025), hemoglobina menor que 10 g/dL à admissão (p = 0,035), e elevação de ferritina e LDH (p = 0,001 para ambos). Discussão: A Covid-19 causa alterações clínicas e laboratoriais sistêmicas. Diversos estudos vêm mostrando que anormalidades hematológicas como linfopenia e plaquetopenia possuem valor prognóstico na evolução da doença. No presente estudo, foi demonstrado que outros parâmetros também tiveram relevância prognóstica, como anemia, elevação de ferritina e LDH. Foram encontradas associações de variáveis clínicas e laboratoriais com os desfechos de óbito e necessidade de ventilação mecânica. Conclusão: O estudo mostra que exames laboratoriais usualmente disponíveis nas instituições hospitalares podem ser utilizados como ferramenta prognóstica, que devem ser considerados pelos profissionais de saúde ao admitir e acompanhar pacientes diagnosticados com Covid-19.

5.
Portuguese Journal of Public Health ; : 43-51, 2022.
Article in English | Scopus | ID: covidwho-1846589

ABSTRACT

Perception of risk is known to change throughout the lifespan. Previous studies showed that younger adults are more prone to risk behaviours than older adults. Do these age-related differences influence risk perception during a pandemic crisis? Here, we investigated how age influenced predicted risk during the COVID-19 emergency state in Portugal. We show that time-projected estimations (e.g., appraisals based on 'now' vs. 'in two weeks' time', or 'in four weeks' time') of both risk behaviour and importance of transmission prevention decrease over time. Importantly, projected risk decreased more steeply for younger than older adults. Our findings suggest that younger adults have a different perception of epidemic-related risk than older adults. This seems to support the view that public health policy making during epidemics should differentially target younger adults. © 2022 The Author(s). Published by S. Karger AG, Basel on behalf of NOVA National School of Public Health.

6.
Revista Brasileira de Politicas Publicas ; 11(3):474-496, 2021.
Article in Portuguese | Scopus | ID: covidwho-1789592

ABSTRACT

This study aimed to understand the role of the Public Prosecutor’s Office of the State of Rio Grande do Norte in the context of the COVID-19 pandemic between March and September 2020. Therefore, a survey of Parquet activities was carried out based on the portal of MPRN news, considering, in the analysis, the period of operation;the classification of the measure;the theme;the territorial cut of the performance;involved actors and the stage of public policy of each measure analyzed. Then, the activities of the MPRN were classified based on the typologies pointed out by Goulart;Coelho and Kozicki;Silva and Da Ros. The results obtained evidenced, on the one hand, the preference for dialogue regarding public policies and extrajudicial action in a context of sanitary crisis and, on the other, the existence of internal conflicts that explained the discretion that characterizes the performance of the Public Ministry in the Brazil. It is noteworthy that the data refer to the performance reported by the institution itself, not covering the entire effort made by the MPRN during the research period. © 2021 Centro Universitario de Brasilia. All rights reserved.

7.
Revista Iberoamericana de Turismo ; 11(2):42-68, 2021.
Article in Portuguese | CAB Abstracts | ID: covidwho-1770949

ABSTRACT

The events sector in the municipality of Ouro Preto Minas Gerais is an important contributor to the local economy, they exercise the function of attracting thousands of tourists every year to the city and its districts, thus contributing to the image of the destination and generating employment and income for the Ouro Preto population. In the beginning of 2020, the World Health Organization declared the outbreak of COVID-19 as a pandemic, since then numerous biosafety measures have been adopted to minimize the spread of the new coronavirus, such as the use of masks and social distancing, measures which are incompatible and prevent the holding of in-person events, which caused major impacts in the events sector. Given this scenario, through a qualitative-quantitative approach and with exploratory descriptive purpose, this article aims to reveal the impacts that the COVID-19 pandemic is causing in the events sector in the city of Ouro Preto - MG. Therefore, the research demonstrates the difficulties that institutions, entrepreneurs and workers in the event sector in the city are facing, as well as reports that show what measures are being taken to minimize damage and survive the crisis.

8.
Web of Science; 2022.
Preprint in English | Web of Science | ID: ppcovidwho-331396

ABSTRACT

BACKGROUND: Countries have focused research on developing strategies to fight COVID-19, prevent hospitalizations, and maintain economic activities. OBJECTIVE: This study aimed to establish a survival analysis and identify risk factors for patients with COVID-19 in a upper middle-income city in Brazil. METHODS: We performed a retrospective cohort study with 280 hospitalized patients with COVID-19. The eCOVID platform provided data used to monitor COVID-19 cases and help communication between professionals. RESULTS: Survival analysis showed that age ≥ 65 years was associated with decreased survival (54.8%). Females had lower survival rate than males (p=0.01). Regarding risk factors, urea concentration (p<0.001), hospital LOS (p=0.002), oxygen concentration (p=0.005), and age (p=0.02) were associated with death. CONCLUSION: Age, hospital LOS, high blood urea concentration, and low oxygen concentration were associated with death by COVID-19 in the studied population. These findings corroborate with studies conducted in research centers worldwide.

9.
Pulmonology ; 2022 Mar 23.
Article in English | MEDLINE | ID: covidwho-1763950

ABSTRACT

INTRODUCTION AND OBJECTIVES: There is a lack of information regarding bronchoscopy practice in adults in Portugal. Our objective was to obtain an overview of the characteristics, resources, techniques and behaviors in national interventional pulmonology (IP) units, before and after SARS-CoV-2 outbreak. MATERIALS AND METHODS: An online survey was developed by an expert panel with a total of 46 questions comprising the specifications of each unit, namely physical space, equipment, staff, procedure planning, monitoring, technical differentiation, and numbers pre- and post-COVID-19. Forty-one interventional pulmonology centers were invited to participate between April and May 2021. RESULTS: 37 units (90.2%) responded to the survey. The majority (64.9%) have a fully dedicated space with a weekly presence of ≥3 chest physicians (82.1%) and support of an anesthesiologist on specific days (48.6%). There is marked heterogeneity in the IP unit's equipment, and 56.8% acquired disposable bronchoscopes after COVID-19 pandemics. Pre-bronchoscopy hemogram, platelet count and coagulation tests are regularly asked by more than 90% of the units, even when deep sedation or biopsies are not planned. In 97.3% of cases, topical anesthesia and midazolam are utilized. Propofol (21.6%) and fentanyl (29.7%) are occasionally employed in some institutions. Most units use ancillary sampling techniques to diagnose central or peripheral lesions, with radial EBUS being used for guidance of distal procedures in 37.8% of centers, linear EBUS and EUS-B-FNA for mediastinal diagnosis and/or staging in 45.9% and 27.0% of units, respectively. Cryobiopsies are used by 21.6% of respondents to diagnose diffuse lung diseases. Rigid bronchoscopy is performed in 37.8% of centers. There was a decrease in the number of flexible (p < 0.001) and rigid (p = 0.005) bronchoscopies and an upscale of personal protective equipment (PPE) during the COVID-19 outbreak. CONCLUSIONS: IP units have variable bronchoscopic practices, but during the COVID-19 pandemic, they complied with most international recommendations, as elective procedures were postponed and PPE levels increased.

10.
ESMO Open ; 7(2): 100448, 2022 04.
Article in English | MEDLINE | ID: covidwho-1763725

ABSTRACT

BACKGROUND: Androgen-deprivation therapy (ADT) has been associated with cognitive decline, but results are conflicting. This study describes changes in cognitive performance in patients with prostate cancer, according to ADT, during the first year after prostate cancer diagnosis. PATIENTS AND METHODS: Patients with prostate cancer treated at the Portuguese Institute of Oncology of Porto (n = 366) were evaluated with the Montreal Cognitive Assessment (MoCA), before treatment and after 1 year. All baseline evaluations were performed before the coronavirus disease 2019 (COVID-19) pandemic and 69.7% of the 1-year assessments were completed after the first lockdown. Cognitive decline was defined as the decrease in MoCA from baseline to the 1-year evaluation below 1.5 standard deviations of the distribution of changes in the whole cohort. Participants scoring below age- and education-specific normative reference values in the MoCA were considered to have cognitive impairment. Age- and education-adjusted odds ratios (aORs) were computed for the association between ADT and cognitive outcomes. RESULTS: Mean MoCA scores increased from baseline to the 1-year evaluation (22.3 versus 22.8, P < 0.001). Cognitive decline was more frequent in the ADT group, and even more after the onset of the COVID-19 pandemic (aOR 6.81 versus 1.93, P for interaction = 0.233). The 1-year cumulative incidence of cognitive impairment was 6.9% (9.1% before and 3.7% after the pandemic onset), which was higher among patients receiving ADT, but only after the pandemic (aOR 5.53 versus 0.49, P for interaction = 0.044). CONCLUSIONS: ADT was associated with worse cognitive performance of patients with prostate cancer, mostly among those evaluated after the first COVID-19 lockdown.


Subject(s)
COVID-19 , Cognitive Dysfunction , Prostatic Neoplasms , Androgen Antagonists/adverse effects , Androgens , Cognitive Dysfunction/complications , Cognitive Dysfunction/etiology , Communicable Disease Control , Humans , Male , Neon , Pandemics , Prospective Studies , Prostatic Neoplasms/complications , Prostatic Neoplasms/drug therapy
11.
Medicine and Law ; 40(3):397-410, 2021.
Article in English | Web of Science | ID: covidwho-1738342

ABSTRACT

This article aims to provide a reflection on the World Health Organization sponsored Project: "Responsibility for Public Health in the Lusophone World: Doing Justice In and Beyond the Covid Emergency". This initiative was designed to gather experiences and data regarding the preparedness and response to the SARS-CoV-2 Pandemic in Angola, Brazil, Mozambique, Portugal and the Macao Special Administrative Region. Launched in November 2020, it combines the in-depth analysis of the most recent legislation and bibliography on the matter with data obtained through a Questionnaire, addressed to a significant number of participants (from healthcare workers to academics and non-government organisations (NGOs), of which there were 41 respondents), which aims to gather different experiences and analyse ethical difficulties, identified in the response to the Pandemic.

12.
Science ; 372(6544):815-821, 2021.
Article in English | EMBASE | ID: covidwho-1735994

ABSTRACT

Cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Manaus, Brazil, resurged in late 2020 despite previously high levels of infection. Genome sequencing of viruses sampled in Manaus between November 2020 and January 2021 revealed the emergence and circulation of a novel SARS-CoV-2 variant of concern. Lineage P.1 acquired 17 mutations, including a trio in the spike protein (K417T, E484K, and N501Y) associated with increased binding to the human ACE2 (angiotensin-converting enzyme 2) receptor. Molecular clock analysis shows that P.1 emergence occurred around mid-November 2020 and was preceded by a period of faster molecular evolution. Using a two-category dynamical model that integrates genomic and mortality data, we estimate that P.1 may be 1.7- to 2.4-fold more transmissible and that previous (non-P.1) infection provides 54 to 79% of the protection against infection with P.1 that it provides against non-P.1 lineages. Enhanced global genomic surveillance of variants of concern, which may exhibit increased transmissibility and/or immune evasion, is critical to accelerate pandemic responsiveness.

13.
European Respiratory Journal ; 58:2, 2021.
Article in English | Web of Science | ID: covidwho-1708214
14.
Cadernos Gestao Publica E Cidadania ; 27(87):22, 2022.
Article in Portuguese | Web of Science | ID: covidwho-1698749

ABSTRACT

This article aimed to understand how the federative model contributed to the judicialization of the crisis and influenced the responses to combat the pandemic, as well as the role of the Judiciary in the context of crisis. For this purpose, 931 lawsuits filed in Federal and State Courts were analyzed. The results demonstrate problems of coordination and cooperation between federated entities and the need for constant action by the Judiciary in confronting the pandemic and as a key player in conflicts involving public and private actors. In the end, there was a growing trend in judicial action related to COVID-19, with the extension of restrictive measures, revealing multiple crises from a diversity of agendas recurrently brought to the Judiciary. It is concluded that, despite the identification of Rio Grande do Norte (Potiguar) Judiciary power's relevant role with quick responses, health and federative crises cannot be analyzed separately.

15.
MEDLINE;
Preprint in English | MEDLINE | ID: ppcovidwho-326624

ABSTRACT

Cases of SARS-CoV-2 infection in Manaus, Brazil, resurged in late 2020, despite high levels of previous infection there. Through genome sequencing of viruses sampled in Manaus between November 2020 and January 2021, we identified the emergence and circulation of a novel SARS-CoV-2 variant of concern, lineage P.1, that acquired 17 mutations, including a trio in the spike protein (K417T, E484K and N501Y) associated with increased binding to the human ACE2 receptor. Molecular clock analysis shows that P.1 emergence occurred around early November 2020 and was preceded by a period of faster molecular evolution. Using a two-category dynamical model that integrates genomic and mortality data, we estimate that P.1 may be 1.4-2.2 times more transmissible and 25-61% more likely to evade protective immunity elicited by previous infection with non-P.1 lineages. Enhanced global genomic surveillance of variants of concern, which may exhibit increased transmissibility and/or immune evasion, is critical to accelerate pandemic responsiveness. One-Sentence Summary: We report the evolution and emergence of a SARS-CoV-2 lineage of concern associated with rapid transmission in Manaus.

16.
European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology ; 53:S592-S593, 2021.
Article in English | EuropePMC | ID: covidwho-1602243
17.
European Neuropsychopharmacology ; 53:S592-S593, 2021.
Article in English | EMBASE | ID: covidwho-1595781

ABSTRACT

Introduction: Evidence demonstrates that 25-33% of hospitalized patients with COVID-19 develop delirium [1,2], with rates up to 65% in critically ill patients [3]. Several potential reasons, including the use of deep sedation and invasive mechanical ventilation (IMV), as well as the restrictions to limit infection transmission, such as prohibition of family visits and minimal contact with health staff were identified [4]. Although factors and outcomes associated with delirium are well documented, limited data are available regarding severe COVID-19 patients. Aims: This study aims to estimate the rates of delirium in critically ill COVID-19 patients and to analyze factors that may be associated with its development, as well as to examine long-term outcomes. Methods: From March to May 2020 (in COVID-19 first wave), all adult patients (≥18y.o.) admitted due to COVID-19, in the Intensive Care Medicine Department (ICMD) of a University Hospital (CHUSJ), in Porto, Portugal, were assessed, unless they had a ICMD length of stay (LoS) ≤24h, terminal illness or major sensory loss or inability to communicate at the time of follow-up. Participants were evaluated during a scheduled telephone follow-up appointment with a comprehensive protocol, including: Six-item Cognitive Impairment Test (6CIT) (cognitive impairment);Patient Health Questionnaire (PHQ-9) (symptoms of depression);General Anxiety Disorder (GAD-7) (symptoms of anxiety);and EuroQol five-dimension five-level questionnaire (EQ-5D-5L) (health-related quality of life-HRQoL), which includes EQ-Visual Analogue Scale (EQ-VAS) (global health status patient perception). Data on acute illness severity, sedative/analgesic drugs use, respiratory support and major complications (including delirium, nosocomial infections and difficulty weaning from mechanical ventilation) during ICMD stay, were obtained from hospital electronic records review. Patients with and without delirium were compared, using Mann-Whitney test for continuous variables, and Chi-square or Fisher tests for paired categorical variables (significance level of 0.05). This study is part of an ongoing larger multidisciplinary research project (MAPA-Mental Health in Critically ill patients with COVID-19). Results: The sample included 59 patients (median age=65 years;66.1% male). Delirium was registered in almost half of the sample (49.2%). Patients with delirium were significantly older (median=72 vs. 62;p=0.010) and presented more nosocomial infections (82.8% vs 53.3%;p=0.032) particularly ventilator-associated pneumonia (75.9% vs. 33.3%;p=0.003). Also, they were significantly more likely to be deeply sedated (89.7% vs 60%;p=0.021), more often required IMV (89.7% vs 60%;p=0.021). Moreover, those with delirium stayed longer in the hospital (median=67 vs 37 days;p=0.014). Concerning HRQoL, assessed at follow-up appointment, patients who have developed delirium reported more problems in self-care (48.3% vs 10%;p=0.003) and in everyday activities (79.3% vs 53.3%;p=0.035) after hospital discharge. Nevertheless, no statistically significant differences were found for cognitive impairment, symptoms of anxiety and depression. Conclusions: Delirium was common in this critically ill COVID-19 sample, namely in older patients, who have been deeply sedated, invasively ventilated or had major ICU complications. It was associated with longer hospital stay and worse HRQoL. Recognizing potential associated factors will allow the identification of high-risk patients that should be targeted for early screening with preventive interventions to minimize the adverse outcomes associated to delirium in critical COVID-19 patients. No conflict of interest

18.
Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):465-466, 2021.
Article in English | EMBASE | ID: covidwho-1570398

ABSTRACT

Background: Dupilumab has been recently approved for treatment in patients with severe AD in Portugal-until now there is no published data regarding Portuguese experience in Allergy centers. Method: Cross sectional clinical and laboratory assessment of 33 patients (pts) with moderate to severe AD treated with dupilumab (dupi) for at least 16 weeks (W): prospective evaluation of severity scores (SCORAD-Scoring Atopic Dermatitis, EASI-Eczema Area and Severity Index, P-VAS-Pruritus Visual Analogic Scale), report of adverse events up to 52 weeks of treatment. SCORAD and EASI were assessed in 23 pts at W52, P-VAS in 21 pts at W52. Results: Of the 33 pts, 18 were female (55%) with a mean age (SD, range) of 35.3 years (13.2, 15-60). In 16 pts the age of onset was before 2 years old, mean (SD) disease duration 28.1 years (12);94% patients had a diffuse pattern of skin lesions;97% of pts had allergic rhinitis, 82% asthma, 52% conjunctivitis and 30% food allergy. Median total IgE at baseline was of 6313 U/ml (P25-P75: 2842-12491) with a 76% reduction at W52 in 16 pts. Median eosinophil count at baseline was 520 eosinophils/mm3 (P25-P75: 270-740). Before starting dupi 29 pts had been treated with cyclosporine. At the beginning, 15 pts were under oral corticosteroids, 14 under oral systemic immunosuppressive drugs (all pts but two stopped both until W12 of dupi) and 5 switched from omalizumab. At baseline, median SCORAD and EASI were 69.3 and 24.2 points. At W16, W36 and W52, median SCORAD was 27.4, 22.3 and 21.5, and median EASI 5.3, 4.1 and 2.1. At W16, the EASI-50, EASI-75 and EASI-90 were achieved by 91%, 61% and 18% pts, and at W52, by 87%, 70% and 52% pts. The mean percentage of SCORAD reduction at W16 and W52 was 55% and 73%;and of EASI was 76% and 82%. At W16 and W52, an improvement of ≥4 points in P-VAS was achieved by 77% and 95% pts. There was a mean reduction of P-VAS at W2, W4, W16 and W52 of 2.6;3.6;4.7 and 6.3 points, respectively. Conjunctivitis was reported in 10 (30%) pts, two of them with keratoconjunctivitis and blepharitis, without needing to interrupt treatment;two pts also had facial erythema. One patient had COVID, and dupilumab scheme treatment was maintained. Conclusion: The majority of AD patients had a significant and consistent improvement in all the severity scores, after one year of treatment with dupilumab. No relevant adverse events were reported.

19.
International Psychogeriatrics ; 33:98-99, 2021.
Article in English | Web of Science | ID: covidwho-1548478
20.
British Journal of Surgery ; 108:1, 2021.
Article in English | Web of Science | ID: covidwho-1539581
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