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1.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925412

ABSTRACT

Objective: To describe the baseline characteristics and interim treatment outcomes of registry participants with generalized myasthenia gravis (gMG) treated with eculizumab in real-world clinical practice in the USA. Background: Clinical trials have shown that eculizumab improves clinical outcomes in individuals with refractory gMG. The Alexion-sponsored gMG Registry collects real-world data on treatment patterns and effectiveness of eculizumab in gMG. Design/Methods: Adults with gMG who had ever received eculizumab enrolled in the Alexion-sponsored gMG Registry (NCT04202341) from December 2019. After consent, demographic data, Myasthenia Gravis (MG) activities of daily living (ADL) total scores, MG Foundation of America (MGFA) classification and serious adverse events (SAEs) were collected from medical records at two time points: before eculizumab initiation (within prior 6 months) and at Registry enrollment (first Registry assessment during eculizumab treatment). Results: As of February 28, 2021, 59 adults with gMG had enrolled in the Registry (male, 54.2%;mean [range] age at MG diagnosis, 58.3 [16.0-84.0] years). Mean (range) time from eculizumab initiation to Registry enrollment was 697.1 (7.0-2435.0) days. Mean (standard deviation) MG-ADL total score decreased with eculizumab, from 8.3 (3.71) before eculizumab to 3.1 (3.43) at first Registry assessment during treatment (n=38). MGFA classification improved with eculizumab (n=32): before eculizumab, MG was class I (0.0% of patients), II (40.6%), III (53.1%) or IV (6.3%);at first Registry assessment during treatment, MG was class I (25.0%), II (62.5%), III (12.5%) or IV (0.0%). SAEs (lung adenocarcinoma, respiratory failure, atrial fibrillation, heart failure, colostomy closure, COVID-19, death) were reported in six patients. There were two deaths (unrelated to eculizumab). No meningococcal infections were reported. Conclusions: Initial analyses of Registry data showed that MG-ADL total score and MGFA classification improved with eculizumab, and that eculizumab was generally well tolerated. These findings provide additional evidence of the effectiveness of eculizumab for treating gMG in real-world clinical practice.

2.
Vox Sanguinis ; 117(SUPPL 1):223, 2022.
Article in English | EMBASE | ID: covidwho-1916309

ABSTRACT

Background: Acute Transverse Myelitis (ATM) is a very uncommon neurological syndrome, characterized by acute or subacute spinal cord dysfunction that can lead to paresthesias, sensory/autonomic impairment and paralysis. The aetiology is often unclear, but infectious, para-infectious, systemic autoimmune diseases, paraneoplastic, ischemic diseases and drugs are potential causes. Vaccine administration can also trigger an immune response and induce an autoimmune response;however, ATM has rarely been reported as a complication of COVID-19 infections or vaccination. The treatment mainly consists of steroids and plasmapheresis, which often reverses any neurologic symptoms. The therapeutic plasmapheresis is a highly complex procedure. It separates the patient's blood components replacing the plasma removed by solution that can be fresh frozen plasma or albumin, allowing the removal of the autoantibody, immune complex, lipoprotein or endotoxin that's causing the pathology. Aims: Clinical case report. Methods: A 46-year-old male patient, with personal history of hypertension and obesity, 3 weeks after COVID-19 vaccination, presented to the emergency department due to urinary complaints (urgency and pollakiuria), progressive numbness, paresthesias and decreased muscle strength in the lower limbs and decreased sensibility in the perineal region. Physical examination revealed total gait disability, decreased sensation and strength in the right lower limb, loss of sensation and plegia in the left lower limb and urinary incontinence. Initial laboratory workup and CT imaging of the brain, cervical, dorsal and lumbar spine were normal. The patient was admitted to Neurology internment for further study and treatment. During hospitalization, lumbar puncture and MRI of the dorsal and lumbosacral neuraxis were performed, but only allowed us to exclude infectious and compressive etiologies. The inflammatory aetiology was assumed as the most probable, so acute therapy with pulses of methylprednisolone was initiated. In the remaining study, weakly positive anti-MOG (Myelin Oligodendrocyte Glycoprotein) antibodies were detected in the serum. Therapeutic plasmapheresis using a cell separator (which use centrifugal force to separate components according to their density) was proposed as additional therapy. Seven sessions were performed without intercurrences. Results: During acute therapy, there was a partial improvement in sensitivity and strength in lower limbs. The patient started a rehabilitation program with favourable neurological recovery. At the time of hospital discharge, he still needed crutch support for walking and had muscle strength grade 4-/5 bilaterally. Summary/Conclusions: Although the patient maintained some functional limitation and there was not a complete resolution of the neurological symptoms, he showed a good response to acute therapy. The plasmapheresis, by permitting the antibody to be removed faster than would occur by its endogenous clearance, proved to be fundamental in the clinical recovery of the patient. No relationship between COVID-19 vaccination and the event was established.

3.
Salud Publica de Mexico ; 64:14-21, 2022.
Article in English | Scopus | ID: covidwho-1912502

ABSTRACT

The Covid-19 pandemic has brought to the fore many issues that will impact public health for years to come –one such impact is on the nexus between transportation and health. Promoting safe, active transport is an activity that has many physical and mental health benefits. During lockdowns, many cities in Latin America imposed infrastructural and legislative changes in order to abide with public health and social measures to reduce virus spread. These ranged from additional bike lanes to reduced speed limits or incentives to purchase bicycles. These cities showed reduced motorized transport, improved air quality and increased active transport, all of which have multiple health and equity benefits. As countries “build back better”, promoting active transport offers the most value for investment and improves health and well-being while continuing to offer social distancing. Quantified case studies are needed to have a more comprehensive understanding of the impact of active transport in various contexts © 2022. Salud Publica de Mexico.All Rights Reserved.

4.
Information Technology & People ; : 24, 2022.
Article in English | Web of Science | ID: covidwho-1816410

ABSTRACT

Purpose This research aims to analyse difficulties experienced by Brazilian managers in coordinating teams working from home during the coronavirus disease (2019) COVID-19 pandemic. Design/methodology/approach The methodological strategy used was a survey with 39 managers who led teams working from home during the COVID-19 pandemic. Seven difficulties indicated by current literature were analysed using a fuzzy scale. First, a hierarchical cluster analysis (HCA) approach was used to group managers according to managers' similarities and capacity to infer the difficulties. Responses of each group identified were weighted considering the capacity to assess the theme. In the sequence, data were analysed via frequencies and the fuzzy technique for order of preference by similarity to ideal solution (TOPSIS) approach and difficulties were ordered. Findings Comparatively, the main difficulties evidenced are (1) to reconcile personal and professional life tasks in the same place;(2) to motivate collaborators in a period when social isolation affect employee's mental health and (3) to keep team members integrated and working within the activities scope in a virtual environment. Originality/value The findings present in this paper contribute to theory and practice. For theory, this article contributes to the knowledge on WFH and leadership, evidencing in a comparatively way the difficulties that are experienced by managers during the COVID-19 pandemic. Researchers in future studies can better analyse these difficulties. For practice, managers who conduct managers' teams remotely can use the information to analyse teams' practices and improve performance critically. This was an atypical moment of humanity, and different aspects need to be considered by managers compared with previous periods.

5.
Giovanetti, M.; Slavov, S. N.; Fonseca, V.; Wilkinson, E.; Tegally, H.; Patané, J. S. L.; Viala, V. L.; San, J. E.; Rodrigues, E. S.; Vieira Santos, E.; Aburjaile, F.; Xavier, J.; Fritsch, H.; Ribeiro Adelino, T. E.; Pereira, F.; Leal, A.; Campos de Melo Iani, F.; de Carvalho Pereira, G.; Vazquez, C.; Mercedes Estigarribia Sanabria, G.; de Oliveira, E. C.; Demarchi, L.; Croda, J.; Dos Santos Bezerra, R.; Oliveira de Lima, L. P.; Martins, A. J.; Dos Santos Barros, C. R.; Marqueze, E. C.; de Souza Todao Bernardino, J.; Moretti, D. B.; Brassaloti, R. A.; de Lello Rocha Campos Cassano, R.; Drummond Sampaio Corrêa Mariani, P.; Kitajima, J. P.; Santos, B.; Proto-Siqueira, R.; Cantarelli, V. V.; Tosta, S.; Brandão Nardy, V.; Reboredo de Oliveira da Silva, L.; Astete Gómez, M. K.; Lima, J. G.; Ribeiro, A. A.; Guimarães, N. R.; Watanabe, L. T.; Barbosa Da Silva, L.; da Silva Ferreira, R.; MP, F. da Penha, Ortega, M. J.; Gómez de la Fuente, A.; Villalba, S.; Torales, J.; Gamarra, M. L.; Aquino, C.; Martínez Figueredo, G. P.; Fava, W. S.; Motta-Castro, A. R. C.; Venturini, J.; do Vale Leone de Oliveira, S. M.; Cavalheiro Maymone Gonçalves, C.; Debur Rossa, M. D. C.; Becker, G. N.; Presibella, M. M.; Marques, N. Q.; Riediger, I. N.; Raboni, S.; Coelho, G. M.; Cataneo, A. H. D.; Zanluca, C.; Dos Santos, C. N. D.; Assato, P. A.; Allan da Silva da Costa, F.; Poleti, M. D.; Chagas Lesbon, J. C.; Mattos, E. C.; Banho, C. A.; Sacchetto, L.; Moraes, M. M.; Tommasini Grotto, R. M.; Souza-Neto, J. A.; Nogueira, M. L.; Fukumasu, H.; Coutinho, L. L.; Calado, R. T.; Neto, R. M.; Bispo de Filippis, A. M.; Venancio da Cunha, R.; Freitas, C.; Leonel Peterka, C. R.; Rangel Fernandes, C. F.; de Araújo, W. N.; do Carmo Said, R. F.; Almiron, M.; Campelo de Albuquerque, E. Melo C. F.; Lourenço, J.; de Oliveira, T.; Holmes, E. C.; Haddad, R.; Sampaio, S. C.; Elias, M. C.; Kashima, S.; de Alcantara, L. C. J.; Covas, D. T..
PubMed; 2022.
Preprint in English | PubMed | ID: ppcovidwho-332259

ABSTRACT

Brazil has experienced some of the highest numbers of COVID-19 cases and deaths globally and from May 2021 made Latin America a pandemic epicenter. Although SARS-CoV-2 established sustained transmission in Brazil early in the pandemic, important gaps remain in our understanding of virus transmission dynamics at the national scale. Here, we describe the genomic epidemiology of SARS-CoV-2 using near-full genomes sampled from 27 Brazilian states and a bordering country - Paraguay. We show that the early stage of the pandemic in Brazil was characterised by the co-circulation of multiple viral lineages, linked to multiple importations predominantly from Europe, and subsequently characterized by large local transmission clusters. As the epidemic progressed under an absence of effective restriction measures, there was a local emergence and onward international spread of Variants of Concern (VOC) and Variants Under Monitoring (VUM), including Gamma (P.1) and Zeta (P.2). In addition, we provide a preliminary genomic overview of the epidemic in Paraguay, showing evidence of importation from Brazil. These data reinforce the usefulness and need for the implementation of widespread genomic surveillance in South America as a toolkit for pandemic monitoring that provides a means to follow the real-time spread of emerging SARS-CoV-2 variants with possible implications for public health and immunization strategies.

6.
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.

8.
Brazilian Journal of Infectious Diseases ; 26, 2022.
Article in French | EMBASE | ID: covidwho-1693860

ABSTRACT

Introdução/Objetivos: A hanseníase é uma doença infecciosa causada pelo Mycobacterium leprae. No Brasil, é um importante problema de saúde pública, sendo de notificação compulsória e investigação obrigatória. O objetivo deste trabalho é analisar os casos de hanseníase notificados e relacionar a prevalência com características sócio-econômicas. Metodologia: Dados referentes às notificações de hanseníase, publicados no SINAN-DATASUS (Doenças e Agravos de Notificação), entre 2015 a 2020, foram tabulados, analisados, e comparados com os publicados em trabalhos científicos relacionados ao tema. Resultados: Entre os anos de 2015 e 2020 foram notificados 195.429 casos de hanseníase no Brasil. As maiores notificações ocorreram em 2018 (20,45%). As regiões Nordeste (42,3%), Centro-Oeste (21,2%), e Norte (14,4%) se destacam. As maiores prevalências foram observadas nas regiões Centro-Oeste (52,3/100.000 hab) e Norte (41,8/100.000 hab), em 2018. A região Sul apresentou o menor número de notificações (3,24%), bem como, a menor prevalência (2,1/100.000 hab, em 2020). A análise da distribuição dos casos por ano demonstra uma importante queda em 2020. A região Norte, por exemplo, apresentou queda de 46% entre 2019 e 2020, passando de 38,1/100.000 hab para 20/100.000 hab. A pandemia de COVID-19, bem como, as medidas de isolamento implantadas para seu controle, podem ter refletido na menor busca por atendimentos em saúde. Análise de casos por sexo demostra predominância do sexo masculino em todos as regiões e anos analisados. A hanseníase é considerada uma doença negligenciada, sendo esse conceito atribuído às doenças de maior ocorrência em países em desenvolvimento. Condições de vida precárias, pobreza, baixa escolaridade e fome são fatores de risco. Além disso, diferentes trabalhos associam a endemicidade de hanseníase à migração populacional. A baixa renda per capita das regiões Norte e Nordeste, bem como, dados referentes à pobreza podem explicar a alta prevalência de hanseníase nessas regiões. Movimentos migratórios associados ao crescimento econômico, ocorrido em cidades da região Centro Oeste, nos últimos anos, também são responsáveis pela sua endemicidade. Conclusão: Podemos concluir que, embora o tratamento preconizado para hanseníase seja disponibilizado no SUS e, o mesmo seja eficaz, sua prevalência ainda não apresenta uma queda satisfatória. Regiões com baixa renda per capita e cidades que apresentaram alterações demográficas importantes, são endêmicas.

9.
Circulation ; 144(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1632168

ABSTRACT

Introduction: Coronavirus disease 2019 (COVID-19) has become one of the more dramatic health problems in the century. This disease has enormous consequence for the health care worldwide. In addition to high mortality rate, patients recovered from COVID-19 present short and long-term cardiovascular sequelae including chest pain, myocardial dysfunction, arrhythmia, dyspnea, breathlessness, postural tachycardia syndrome, and thrombotic complications. The explanations for these clinical manifestations are still uncertain but can involve a constellation of physiological alterations. Hypothesis: To test if COVID-19 survivors have augmented sympathetic outflow, diminished endothelial function, elevated aortic stiffness, and reduced physical capacity compared to healthy individuals. Methods: Nineteen COVID-19 survivors [age: 47.0±2.3 years, BMI: 30.1±1.2 Kg/m2] and eighteen well-matched healthy controls (age: 44.0±2.0 years, BMI: 28.4 ±1.2 Kg.m2] were included in study. COVID-19 survivors were evaluated within 6 months of original diagnosis by RT-PCR. Muscle sympathetic nerve activity (MSNA) from fibular nerve (Microneurography), brachial artery flowmediated dilation (BAFMD;Doppler-Ultrasound), carotid-femoral pulse wave velocity (cf-PWV;Complior), beat-to-beat blood pressure (Peripheral BP;Finometer), heart rate (HR;Electrocardiography) and peak oxygen uptake (VO2peak, Cardiopulmonary exercise testing) were measured in both groups. Results: MSNA was higher in COVID-19 survivors compared to controls (33.0±1.0 vs. 22.0±1.0 bursts/min, p=0.001). Both BAFMD and VO2peakwere lower in COVID-19 survivors compared to controls (4.6±0.7 vs. 8.2 ±0.8%, p=0.005 and 22.2±1.5 vs. 29.7±1.6 mL/Kg/min p=0.001, respectively). Although COVID-19 survivors had greater cf-PWV than controls (8.6±0.5 m/s vs. 7.4±0.4 m/s, p=0.03), BP and HR were not different between groups. Conclusions: Our study revealed that patients recently recovered from COVID-19 have abnormal neurovascular control, vascular alterations and reduced physical capacity. These findings strongly indicate the need of further long-term investigations to uncover cardiovascular sequelae provoked by COVID-19.

10.
European Journal of Public Health ; 31:525-525, 2021.
Article in English | Web of Science | ID: covidwho-1609725
11.
Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):484-485, 2021.
Article in English | EMBASE | ID: covidwho-1570404

ABSTRACT

Background: COVID-19 vaccines are being administered all over the world, but information is lacking about the frequency and type of allergic reactions associated to these new vaccines. Method: Retrospective study of health care professionals (HCP) from our hospital who received COVID 19 vaccine Comirnaty, between 29/12/2020 and 20/2/2021. We reviewed clinical data, particularly the immediate reactions after the administration (<6h), skin tests (ST) and graded vaccine administration. Following national guidelines, all HCP with previous history of food, drug or hymenoptera venom allergy or idiopathic anaphylaxis (IA) were first evaluated by an allergist. Vaccination was postponed if HCP had previous history of IA and/or recurrent anaphylaxis (RA), severe allergic reactions to vaccines and mast cell activation syndromes. ST to the vaccine (prick and intradermal) were performed in HCP with IA and/ or RA, severe allergic reactions to vaccines and HCP with immediate reactions to the 1st dose. Graded administration of the vaccine (0.1+0.2cc after 30') was performed in the postponed HCP and the ones with immediate reactions to the 1st dose. Results: From 3073 HCP who received the vaccine, 74.2% were female, mean age 40.2 years-old ± 13.4, 316 (10.3%) were evaluated by an allergist and 4 (1.3%) postponed the administration and performed allergy investigation. 2955 HCP (97%) were able to receive the 2 doses of the vaccine. 118 employees received only one dose: 98 had COVID-19 meanwhile, 7 got pregnant, 13 due to other conditions. Adverse reactions to the vaccine with possible hypersensitivity mechanisms, occurred in 17 (0.6%) HCP, 12 on the 1st dose and 5 on the 2nd dose. Observed reactions were 6 (0.2%) urticaria, 5 (0.16%) pruritus with or without flushing, 2 (0.07%) anaphylaxis (mild), 2 (0.07%) flushing and hoarseness, 1 (0.03%) flushing and nausea and 1 (0.03%) asthma exacerbation. ST with the vaccine were performed in 4 HCP, all negative in the immediate reading and 1 positive in non-immediate reading. 7 HCP undertook the graded administration with the vaccine: 6 tolerated, but one reproduced the immediate urticaria with 0.1cc of the vaccine (0.03% vaccine allergy). Conclusion: In the evaluated sample, suspicious allergic reactions to COVID19 vaccine Commirnaty were rare and allergy was only confirmed in one HCP. The allergist initial evaluation was essential for a safe risk stratification and permitted the non-exclusion of a considerable number of HCP from the vaccination program.

12.
European Journal of Public Health ; 31, 2021.
Article in English | ProQuest Central | ID: covidwho-1515080

ABSTRACT

Falls are one of the most common mechanisms of injury namely at home and in leisure time reaching one of the most vulnerable groups of the population such as the older ones, with expression in morbidity and mortality. The pandemic context we are experiencing it has had effects on the physical, mental and social wellbeing of populations but also on the use of health care whose magnitude and reasons are subject of discussion. The aim of this study is to understand the evolution of falls episodes in victims aged 65 and over, which needed attendance in the emergency room of the Health National Service Hospitals in Portugal based on hospital records, through EVITA system, between 2017 and 2020. A descriptive analysis of the data was performed, with the determination of absolute and relative frequencies (percentages). Bivariate comparisons were performed using Pearson's chi-square test with a significance level of 5%. In this analysis, the statistical program SPSS V.24 was used. In the four years between 2017 and 2020 the older people aged 65 and over represented 27% of the total of attendances in the emergency room. Considering the total of ED attendances in this age group 10% occurred due to fall at home or during leisure time. In the last four years there were 462 953 falls in people victims aged 65+, constituting 46% of hospital ED attendances by fall. From march to december 2020, falls episodes have remained below the values of similar periods in the previous four years (p < 0,01). The largest percentage decrease in falls in 2020 compared to the same period in 2019 occurred in april, with a decrease of 41%. Most of this falls in the study population occurred at home (61%), followed by falls in outdoor spaces (11%). Globally, this reality regarding to the decrease of the ED attendances during this pandemic context is not exclusive to Portugal. Key messages The older people represented 27% of the total of attendances in the emergency room in the four years in analysis. 10% of ED attendances occurred due to fall at home or during leisure time. From march to december 2020, was observed a significant decrease of falls episodes compared with the previous four years.

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