Last year challenge of Nuclear Medicine: medical radioisotopes supply

Aim/Introduction: 99mTc is used in about 80% of the convencional diagnostic nuclear imaging procedures and represent yearly approximately 30 million examinations/year worldwide a year in diagnostic tests in hospitals, among others by oncology, cardiology and neurology.The production of radiopharmaceuticals for use in Nuclear Medicine has a complex system. It involves carefully calculated production schedules that take into account supply, demand and many logistical operations.The aim of this study is to show how our nuclear medicine department manage the impact of the shortly 99Mo supply chain and consequently, in the 99mTc availability and other radiopharmaceuticals produced in nuclear reactora. Material(s) and Method(s): European nuclear medicine organizations had just pay attention to how the COVID-19 pandemic might affect different parts of the 99Mo supply chain when had to dealt again faced with a new problem;the shortness 99Mo production. There are only five nuclear reactors involved in the production of 99Mo on industrial scale. These aging reactors are subject to unscheduled shutdowns and longer maintenance periods making the 99Mo supply chain vulnerable. In the last few months at our nuclear medicine department we had to reinvent ourselves so as not to completely stop carrying out the previously scheduled exams and therapies. Result(s): The use of technetium generators in Europe represents about 17% - 25% of the worldwide consumption of 99Mo, representing 30,000 exams per day and about 1.1 million doses per month. The main consequences at the IPO-Porto was;Delays in diagnosis/staging, rescheduling exams, change of surgery dates (Sentinel Ganglion and Myocardial Perfusion Cardiacs), weeks of overbooking, delay in follow-up of Glomerular Filtration Rate in pre- or post-transplant patients, postponement of 131I Therapies, Scintigraphy and Whole Body Scintigraphy in patients who were already in hypothyroidism. we had to reinvent the use of 99mTc generators, change exams appointments times, reagroup exams types by defined days and other radiopharmaceutical management tools that were not commonly used. Conclusion(s): Approximately 2/3 of scheduled exams were postponed and we had to deal with weekly and daily stock updates. Our department suggest some measures and procedures that could help with future 99Mo shortages, in order to be ready in future situations and to avoid shortness of production: the creation of a centralized European radiopharmacy system, European policies to encourage long-term investment, homogenization of marketing specifications in the Member States, solid databases of radiopharmaceuticals used/ available in Europe and encouraging cooperation between other countries outside the European Union.

Last year challenge of Nuclear Medicine: medical radioisotopes supply

Aim/Introduction: 99mTc is used in about 80% of the convencional diagnostic nuclear imaging procedures and represent yearly approximately 30 million examinations/year worldwide a year in diagnostic tests in hospitals, among others by oncology, cardiology and neurology.The production of radiopharmaceuticals for use in Nuclear Medicine has a complex system. It involves carefully calculated production schedules that take into account supply, demand and many logistical operations.The aim of this study is to show how our nuclear medicine department manage the impact of the shortly 99Mo supply chain and consequently, in the 99mTc availability and other radiopharmaceuticals produced in nuclear reactora. Material(s) and Method(s): European nuclear medicine organizations had just pay attention to how the COVID-19 pandemic might affect different parts of the 99Mo supply chain when had to dealt again faced with a new problem;the shortness 99Mo production. There are only five nuclear reactors involved in the production of 99Mo on industrial scale. These aging reactors are subject to unscheduled shutdowns and longer maintenance periods making the 99Mo supply chain vulnerable. In the last few months at our nuclear medicine department we had to reinvent ourselves so as not to completely stop carrying out the previously scheduled exams and therapies. Result(s): The use of technetium generators in Europe represents about 17% - 25% of the worldwide consumption of 99Mo, representing 30,000 exams per day and about 1.1 million doses per month. The main consequences at the IPO-Porto was;Delays in diagnosis/staging, rescheduling exams, change of surgery dates (Sentinel Ganglion and Myocardial Perfusion Cardiacs), weeks of overbooking, delay in follow-up of Glomerular Filtration Rate in pre- or post-transplant patients, postponement of 131I Therapies, Scintigraphy and Whole Body Scintigraphy in patients who were already in hypothyroidism. we had to reinvent the use of 99mTc generators, change exams appointments times, reagroup exams types by defined days and other radiopharmaceutical management tools that were not commonly used. Conclusion(s): Approximately 2/3 of scheduled exams were postponed and we had to deal with weekly and daily stock updates. Our department suggest some measures and procedures that could help with future 99Mo shortages, in order to be ready in future situations and to avoid shortness of production: the creation of a centralized European radiopharmacy system, European policies to encourage long-term investment, homogenization of marketing specifications in the Member States, solid databases of radiopharmaceuticals used/ available in Europe and encouraging cooperation between other countries outside the European Union.

Life habits of school children during the covid- 19 pandemic: repercussions on body weight

This study sought to identify the repercussions of the pandemic on the body weight of adolescents during social isolation due to the COVID-19 pandemic and associated life habits. Materials and Methods: This is a cross-sectional and quantitative study, carried out with adolescents enrolled in elementary school II in public schools in the north of Minas Gerais. Data collection was performed in virtual format through Google Forms. Questions were collected about changes in body weight, sociodemographic profile, anthropometric data, self-perception of body image, physical activity, screen time, consumption of ultra-processed foods, sleep quality and self-perception of health status. Pearson's chi-square test was used for analysis. Results: A total of 287 adolescents participated in the study, with a mean age of 12.97 years SD & PLUSMN;1.30, 60.3% (n=173) were female and 39.7% (n=114) were male. When evaluating the impact of the pandemic on the body weight of adolescents through self-report, it was observed that 63.8% (n=183) increased, 27.5% (n=79) maintained, and 08.7% (n=25) decreased body weight during the period of social isolation. Significant associations were observed between age group, nutritional status, body image, practice, and changes in physical activity. Conclusion: It is concluded that the habits and life behaviors adopted by adolescents during social isolation had a negative impact on the adolescents' body weight. The practice of PA is insufficient and dissatisfaction with body image associated with weight gain. In addition, social isolation caused an increase in body weight in eutrophic adolescents.

Artificial Neural Networks and BPPC Features for Detecting COVID-19 and Severity Level

Since vaccination started, the COVID-19 scenario has improved. On the other hand, although the number of deaths has significantly dropped, the number of new cases is still a concern. Thus, patient tracking and follow-up are essential tasks, and chest X-ray examination is the first-order tool. While several studies using CXR and computing have been developed, they did not translate into clinical applications yet. One of the reasons is the computational effort required to run huge deep learning models and its high cost to be adopted in community clinics. Therefore, this work proposes a lightweight (few computational resources needed), fast (training and inference time), and reasoned solution for automatic COVID-19 detection and assessment of its severity. Our method is based on extracting features by Binary Pattern of Phase Congruency (BPPC) in segmented CXR images. Radiomic features are extracted from the segmented CXR image, and an SVM-based selection process is used to build two models of a shallow Feed-Forward network. The results surpass previous studies, with an average accuracy for COVID-19 detection of 98.71%. For images without evidence of infection but with a positive PCR test, an accuracy of 94.74% is reached. In a second task, the severity level of COVID 19 is estimated with an AUC of 98.92%. This high performance helps improve the speed and accuracy of diagnosis and severity assessment of COVID19 infection, proving to be a viable option in transitioning from a research field to a clinical environment. © 2022 IEEE.

The role of probiotics in maintaining immune homeostasis

The immune system is a complex architecture of a collective and coordinated network regulated by various pathways to thermodynamically maintain immune homeostasis. The gut microbiota plays a pivotal role that offers significant stimuli (i.e., gut-brain, gut-lung, and gut-liver axis) for both innate and adaptive immunity, mediating immune and metabolic homeostasis. An intricate correlation between changes in the gut microbiota (dysbiosis) and common diseases/disorders have been attributed to the invasion of pathogens, constant use of antibiotics, and hypercytokinemia—a hallmark of immune homeostasis imbalance. These factors contribute to the severity of inflammatory diseases such as cardiovascular diseases, neurological disorders, and of late the coronavirus disease, Covid-19. Probiotics (Lactobacillus spp. and Bifidobacterium spp.) have been considered as alternative and/or adjuvant therapeutic in restoring the balance of gut microbiota for maintaining immune homeostasis and integrity. The probiotics catalyze dietary fibers and proteins to generate short-chain fatty acids and tryptophan to promote antiinflammatory cytokines, reduce epithelium permeability, reinforcing immunity in the gut mucosa, and regulating the systemic immune response. Herein, we review our overarching understanding of current applications of probiotics in amelioration of gut microbiome, and the improvement of gut barrier function and maintaining immune homeostasis. We also highlight clinical trials on probiotics with reported results for the treatment of inflammatory diseases. Additionally, the looming global Covid-19 pandemic makes it prudent to highlight the role of probiotics in both the innate and adaptive human immune responses, especially amid the Covid-19 vaccination paradigm. © 2022 Elsevier Inc. All rights reserved.

Unexplained hypoxia requiring prone ventilation in a patient with acute disseminated encephalomyelitis

Introduction: Acute Disseminated Encephalomyelitis (ADEM) is a rare, immune-mediated, demyelinating disorder of the central nervous system characterized by acute encephalopathy with neurologic deficits and MRI findings consistent with multifocal demyelination requiring immunosuppression for therapy.1,2 Patients seldom develop hypoxia during the course of the illness, requiring prone ventilation to improve oxygenation which is the first line of therapy and a proven standard of care in patients with ARDS.3,4We would like to present a case of ADEM where a patient developed unexplained hypoxia requiring prone ventilation. Case description: A 35-year-old male with no significant past medical history presented to our neuro-specialist centre with one day history of severe lower back pain associated with lower limb weakness and numbness. His symptoms, which commenced 10 days post his Covid vaccination, rapidly progressed over 2 days of hospital admission to involve right upper limb & facial weakness. MRI scan of brain and spine showed features of ADEM and pulse Methylprednisolone was initiated. CT thorax and abdomen on admission was unremarkable. He was transferred to the critical care unit in view of progressive ascending paralysis and was intubated on his 5th inpatient day due to involvement of respiratory muscles. Following 4 cycles of plasma exchange with albumin (day 6,7,9 and 10 of hospital admission), he developed unexplained hypoxic episodes which eventually resulted in sustained hypoxia, requiring 100% oxygen. Airway pressures and lung compliance were within normal range. Bedside ultrasound demonstrated good lung sliding in all lung fields and good left ventricular contractility with no evidence of right ventricular dilatation. There was no evidence of pericardial/pleural effusion. CT thorax repeated on day 9 showed no features of acute thromboembolic disease and there were no signs of lung parenchymal involvement. Formal echocardiography with bubble test showed normal heart with no evidence of patent foramen ovale. Multi-disciplinary discussions involving cardiology, respiratory, neurology teams and regional ECMO centre could not explain the enigma of impaired oxygenation. The patient responded well to 16 hours of prone ventilation on day 10 with decreasing oxygen requirements. In the subsequent 3 months of his inpatient stay, he was weaned off oxygen and was tracheostomised in view of his neurological illness. He continues to receive physiotherapy and neuro rehabilitation which had led to clinical improvement. Conclusion: The possible reason for hypoxia could be impaired tissue oxygenation post plasma exchange. However, it could be a coincidental finding and there is not much literature to explain this phenomenon and warrants further research.5.

Bedside echocardiographic diagnosis of Pericardial effusion in the critically ill patient and prevention of catastrophic hemodynamic compromise

Introduction: In recent years, the use of ultrasound in critical care has revolutionized the bedside assessment of ICU patients. Though operator dependent, the advantage of repeatability and being relatively inexpensive makes it imperative for critical care physicians to stay updatedwith thismodality. The purpose of this report is to describe an incidental finding of pericardial effusion in a patent admitted with respiratory distress. Main body: A 26 years old female was admitted with shortness of breath and increase in oxygen requirements. She had a background of cerebral palsy, tracheostomized since 2009 after being operated for scoliosis and had a vagal nerve stimulator in situ. On admission, her 1st covid swab was negative. She normally required home ventilation only at night, however 2 days prior to admission, she required 24 hours of ventilator support. A large leak was noted on the ventilator and had a non-cuffed tracheostomy tube in situ, which was later changed to a cuffed one. A quick bedside FICE (Focused Intensive Care Echocardiography) revealed a large circumferential pericardial effusion with fibrin strands. There was no haemodynamic compromise on admission, however the large pericardial effusion could have been an attributing factor to her severe respiratory distress. She progressively started deteriorating hemodynamically, requiring intravenous fluids and vasopressor support. A definitive ECHO done by the cardiologist confirmed the findings of FICE. There was a rapid change in her condition post-pericardiocentesis. As per the institute protocol, a second covid swab was sent for her, which reported positive. Covid-19 RTPCR testing was not validated on pericardial fluid, hence was not undertaken. The culture of pericardial fluid revealed staphylococcus aureus, but there was a high index of suspicion of COVID and bacterial pericarditis was unlikely. Conclusion: Echocardiographic evaluation of Pericardial effusion is of paramount importance for timely and appropriate diagnosis. In view of quick bed side diagnosis with ultrasound, our patient was able to survive this life-threatening condition and treatment was initiated promptly. If left undiagnosed based on clinical presentation, it could have been catastrophic for a completely treatable cause. Brief description of ultrasound video: Pericardial effusion appears as an echo-free space between the 2 layers of pericardium. This video shows a 4-chamber echocardiographic view suggestive of a globular pericardial effusion with fibrin strands. An element of hemodynamic compromise was visible on 4-chambered view as well as para-sternal long axis view.

Expectation of proenvironmentalteaching behavior and genera ecological behavior in university students during the COVID-19 pandemic

The deep crises that threaten well-being and existence could raise people's awareness and lead them to develop more supportive behaviors, especially towards nature. During the COVID-19 quarantine, remote education promoted the rapprochement of teachers and students by sharing personal spaces through video calls. Hence, this research aimed to determine the influence that the pro-environmental behaviors of the teacher as a model influence their students after an online education approach in environmental psychology. For this purpose, a quantitative, cross-sectional study of correlational scope was conducted with 33 college students aged between 19 and 24 years (M=21.69;SD=1.70), 19 women and 14 men, chosen at convenience, to whom the instruments: General Ecological Behavior and Expectation of Environmental Behavior of Others, were applied. Obtained data indicate high pro-environmental behavior and intermediate values for the expectation of the teacher's pro-environmental behavior. In addition, a significant positive correlation between both variables (p < 0.001, r(s) = 0.54) was found. In conclusion, it can be stated that the higher the expectation of pro-environmental behavior of professors as perceived by students, the higher is their acquired pro-environmental behavior, which could mean a challenge for university institutions, and a commitment to achieve that indirect environmental education shows the expected results for the fulfillment of the environmental goals of the public agenda.

Emotional state and coping strategies amongst university students during COVID-19 pandemic lockdown

: Considering the vulnerability of young adults’ mental health, and the abrupt change to their routines as a result of the first lockdown decreed in Portugal due to the COVID-19 pandemic, in March of 2020, this study analyzed 1) the emotional state of a sample of university students during the first lockdown, 2) the coping strategies they reported during that period of time, 3) the mediating role of coping strategies in reported anxiety, depression and stress symptoms. Results show that, similarly to what has been found in other countries, women report higher levels of anxiety, depression, and stress. Women also report resorting more frequently to not only negative coping strategies, but also positive ones (such as social support). Strategies of Retreat and Refusal mediate the relation between the participant’s sex and their emotional state. Results point to reflecting on interventions for the promotion of young university students’ well-being. Copyright © 2022 Associação Portuguesa de Psicologia.

Analysis of the evolution of interleukin-6 in COVID-19 patients after being treated with dexamethasone

Background and importanceLevels of interleukin-6 (IL-6) in patients with coronavirus disease 2019 (COVID-19) are particularly relevant before treatment with tocilizumab. According to the protocol established in our centre, levels of IL-6 above 40 pg/mL are required to start treatment with tocilizumab. Assessing the role of dexamethasone in the evolution of IL-6 during the first hours of the patient’s hospital admission could help prevent premature use of tocilizumab.Aim and objectivesAssessing the evolution of IL-6 after the use of dexamethasone in patients diagnosed with COVID-19 and IL-6 >40 pg/mL.Material and methodsDescriptive, retrospective, observational study carried out between November 2020 and January 2021 in a second-level hospital. All patients with determinations of IL-6 were located. Those with IL-6 levels above 40 pg/mL were selected. Through a review of medical histories, COVID-19 patients who were treated with dexamethasone and with determination of IL-6 levels, both at the admission and within the following 96 hours, were chosen. Exclusion criteria: prescription of dexamethasone at least 24 hours before the first determination and use of tocilizumab before the first determination or between determinations. Data were subjected to Wilcoxon’s test.Results41 patients met the criteria. 28 of them were men (66.7%) with a median age of 64 years (IQR 23). The median time between determinations was 48 hours (IQR 48). The median level of IL-6 at the time of the hospital admission was 85.6 pg/mL (IQR 110.9) and after being treated with dexamethasone it was 24.2 pg/mL (IQR 33.1). The median of differences was –66.1 pg/mL (IQR 67.3) and 87.8% of the patients experienced a decrease, observing a statistical association (p<0.01). 75.6% of the patients showed levels below 40 pg/mL and 21.9% showed levels within the reference range (<7 pg/mL). 12 patients (29.3%) were finally treated with tocilizumab, of which 7 (58.3%) still presented levels of IL-6 >40 pg/mL.Conclusion and relevanceDexamethasone treatment reduced IL-6 levels to below 40 pg/mL in most patients in 48 hours.IL-6 monitoring after dexamethasone treatment could help prevent inadequate use of tocilizumab.It is necessary to research the benefits of tocilizumab for patients with low levels of IL-6.References and/or acknowledgementsConflict of interestNo conflict of interest

Therapeutic interventions for burnout syndrome in healthcare professionals during the COVID-19 pandemic: integrative reading review

OBJECTIVE: to analyze the scientific evidence available in the literature on therapeutic interventions applied to Burnout Syndrome in health professionals during the COVID-19 pandemic. METHOD: An integrative review was carried out between August and October 2021, in which the databases and portals PubMed, BVS, SciELO, Google Scholar and CAPES Journal Portal were consulted, resulting in eleven articles analyzed. RESULTS: The analysis of the articles included in the study showed that self-care and organizational interventions in health professionals contributed to the reduction of symptoms of Burnout Syndrome. The studies reported that the measures of therapeutic interventions that were implemented, including aromatherapy, music therapy, the application of EFT, LMX strategies, minimize the effects of factors that contribute to the increase in Burnout Syndrome in health professionals, as well as the reorganization of the working day and improvements in the work environment that favor a more positive perception of professional practice. CONCLUSION: The COVID-19 pandemic contributed to the increased prevalence of Burnout Syndrome in healthcare professionals. Thus, measures such as mental health education, as well as therapeutic interventions for those already affected by the disease, are essential for professionals to maintain their physical and mental well-being.

Molecular Docking Study of Antibiotics, Anti-Inflammatory Drugs and [Eu(TTA)3·AMX] Complex as COVID-19 Biomarker through Interaction of Its Main Protease (Mpro)

Coronavirus Acute Respiratory Syndrome (SARS-CoV-2) is a very recent viral infection and has generated one of the world's biggest problems of all time. There is no scientific evidence and clinical trials to indicate that possible therapies have shown results in suspected or confirmed patients other than the use of immunizations. Given the above, some substances are being studied to be applied to contain their spread and further damage. This work aims to perform an in silico study of amoxicillin, widely known as an antibiotic and used to prevent bacterial infections and a possible biomarker made from a complex with Europium (Eu). It was shown to have the ability to interact with the COVID-19 protein in Mproprotease as ligands. The study was conducted using the AutoDock Vina with Lamarckian genetic model algorithm (GA) combined with the estimation of grid-based energy in rigid and flexible conformation. Compared to affinity energy, amoxicillin presented â-7.7kcal/mol, which was better than its co-crystallized ligand in the study. The Europium complex, where its synthesis was also demonstrated in this work, presented energy of -6.3kcal/mol with hydrogen bonds and possible color change when UV light was applied. For the choice of the best poses in the simulation, the neural network parameter, NNScore2, was used. It can be affirmed that this study is still introductory but promising both in the treatment and identification of the virus. © 2021 Journal of Computational Biophysics and Chemistry. All Rights Reserved.

Screening of viral pneumonia and COVID-19 in chest X-ray using classical machine learning

Governments, civil society, health professionals, and scientists have been facing a relentless fight against the pandemic of the COVID-19 disease;however, there are already about 150 million people infected worldwide and more than 3 million lives claimed, and numbers keep rising. One of the ways to combat this disease is the effective screening of infected patients. However, COVID-19 provides a similar pattern with diseases, such as pneumonia, and can misguide even very well-trained physicians. In this sense, a chest X-ray (CXR) is an effective alternative due to its low cost, accessibility, and quick response. Thus, inspired by research on the use of CXR for the diagnosis of COVID-19 pneumonia, we investigate classical machine learning methods to assist in this task. The main goal of this work is to present a robust, lightweight, and fast technique for the automatic detection of COVID-19 from CXR images. We extracted radiomic features from CXR images and trained classical machine learning models for two different classification schemes: i) COVID-19 pneumonia vs. Normal ii) COVID-19 vs. Normal vs. Viral pneumonia. Several evaluation metrics were used and comparison with many studies is presented. Our experimental results are equivalent to the state-of-the-art for both classification schemes. The solution’s high performance makes it a viable option as a computer-aided diagnostic tool, which can represent a significant gain in the speed and accuracy of the COVID-19 diagnosis. © 2021 IEEE.

Automatic Orientation Identification of Pediatric Chest X-Rays

Chest radiography (CXR) is one of the first choices in epidemiological analyses such as tuberculosis, cancer, pneumonia, and, recently, COVID-19. It provides crucial information for decision making, treatment, and monitoring the evolution of clinical cases from small to high complexity. Thus, it is a valuable source of information for the study, training, research, and development of computational support to medical diagnoses. In this work, we introduce a new method for chest X-ray adjustment to identifying and correcting radiographic images orientation. So, they can be automatically rotated to a standard position. Our proposal uses structural characteristics and statistics of pixel intensity patterns of CXR images. Divided into three steps, our method begins with the preparation of the photos, followed by a feature extraction strategy, and it ends with the X-ray image orientation identification. We use three different databases that include pediatric and adult radiographic imaging. A result showed 99.4% accuracy in the databases in our experiments. The code prepared by the authors is publicly available. © 2020 IEEE.