Global overview of pharmacist and community pharmacy actions to address COVID-19: A scoping review.

Introduction: Pharmacists and community pharmacies play an important role in managing, identifying and preventing the spread of the COVID-19 outbreak. Objectives: To characterize the global panorama of action by pharmacists and community pharmacies in facing the COVID-19 pandemic. Methods: The scoping review was based on the search for scientific articles in the databases: PubMed; Scopus; ScienceDirect and Web of Science. The search was carried out on August 31, 2021. The selection process was divided into 3 phases: i) title analysis; ii) analysis of study abstracts; iii) analysis of the full texts of the studies selected in the previous step. Studies were independently selected by two investigators and discrepancies resolved by consensus during focus group discussions led by a third reviewer. Results: The final search yielded 36 articles for the review. The main strategies for coping with COVID-19 were grouped into 4 categories defined by consensus between the authors: (1) services for providing care to the patient; (2) product management; (3) infection prevention and control practices in community pharmacy; (4) preparation, sources of information used and training offered/received. Through these, the aim was to involve technical managerial, technical assistance and pedagogical technical actions adopted, as well as structure and process indicators that allowed the continuity of the offer of services. Conclusion: During the pandemic, pharmacists and community pharmacies have been providing essential health services to communities. The results of this review may help to identify the changes adopted to face the COVID-19 pandemic and may contribute to improving the quality of practices in these establishments during the pandemic and after it, in similar situations.

PVC containing silver nanoparticles with antimicrobial properties effective against SARS-CoV-2.

Poly (vinyl chloride) (PVC) is commonly used to manufacture biomedical devices and hospital components, but it does not present antimicrobial activity enough to prevent biofouling. With the emergence of new microorganisms and viruses, such as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) that was responsible for the global pandemic caused by Coronavirus Disease 2019 (COVID-19), it is evident the importance of the development of self-disinfectant PVC for hospital environments and medical clinics where infected people remain for a long time. In this contribution, PVC nanocomposites with silver nanoparticles (AgNPs) were prepared in the molten state. AgNPs are well-known as antimicrobial agents suitable for designing antimicrobial polymer nanocomposites. Adding 0.1 to 0.5 wt% AgNPs significantly reduced Young's modulus and ultimate tensile strength of PVC due to the emergence of microstructural defects in the PVC/AgNP nanocomposites, but the impact strength did not change significantly. Furthermore, nanocomposites have a higher yellowness index (YI) and lower optical bandgap values than PVC. The PVC/AgNP nanocomposites present virucidal activity against SARS-CoV-2 (B.1.1.28 strain) within 48 h when the AgNP content is at least 0.3 wt%, suitable for manufacturing furniture and hospital equipment with self-disinfectant capacity to avoid secondary routes of COVID-19 contagion.

Bioinspired Antimicrobial PLA with Nanocones on the Surface for Rapid Deactivation of Omicron SARS-CoV-2.

Bioinspired bactericidal surfaces are artificial surfaces that mimic the nanotopography of insect wings and are capable of inhibiting microbial growth by a physicomechanical mechanism. The scientific community has considered them an alternative method to design polymers with surfaces that inhibit bacterial biofilm formation, suitable for self-disinfectant medical devices. In this contribution, poly(lactic acid) (PLA) with nanocone patterns was successfully produced by a novel two-step procedure involving copper plasma deposition followed by argon plasma etching. According to reverse transcription-quantitative polymerase chain reaction tests, the bioinspired PLA nanostructures display antiviral performance to inactivate infectious Omicron severe acute respiratory syndrome coronavirus 2 particles, reducing the amount of the viral genome to less than 4% in just 15 min due to a possible combined effect of mechanical and oxidative stress. The bioinspired antiviral PLA can be suitable for designing personal protection equipment to prevent the transmission of contagious viral diseases, such as Coronavirus Disease 2019.

Different sleep patterns during the COVID-19 pandemic: association with mood, exercise and light exposure.

The aim was to evaluate the sleep-wake cycle pattern, mood, perceived stress and some behaviors, such as physical exercise and exposure to natural light of college students during the COVID-19 pandemic. This is a cross-sectional study conducted between June and August 2020 using an electronic form provided by Google. The sample consisted of undergraduate students aged between 18 and 30 years old and residents of the northeast region of Brazil. The students generally had sleepiness and poor sleep quality, high levels of anxiety, mild to moderate depressive symptoms and moderate perceived stress. Some of these aspects were worse in women. The college students showed three sleep patterns: one group had good sleep quality without excessive daytime sleepiness; another group had poor sleep quality, but no excessive daytime sleepiness; and a third group had high daytime sleepiness, and less expressive sleep quality impairment. Greater exposure to sunlight and practicing physical exercise predominated in individuals with better sleep quality, suggesting that they are protective factors. In addition, excessive daytime sleepiness and poor sleep quality were separately associated with higher anxiety, depression and stress perception levels, proving to be important aspects for care in order to favor mental health during the pandemic. In conclusion, it is suggested that the COVID-19 pandemic affected the sleep of college students in a heterogeneous way. The differentiated sleep patterns are associated with exposure to natural light and exercising.

How daily positive affect increases students' mental health, in mandatory quarantine, through daily engagement: the moderating role of self-leadership.

The COVID-19 crisis has had significant impacts on mental health. Students are dealing with an uncertain context, not only due to COVID-19 but also because most of them have never been involved with the challenges of online school. The COVID-19 situation presents daily challenges that require students to respond adaptively. However, little is known about how students handle their daily emotions, in such challenging settings. Drawing on the broaden-and-built theory, we developed a multilevel model arguing that daily-positive affect would enhance daily engagement, and this would be positively related to students' end-of-the-day mental health. We also predict that the mediating path would be stronger for students with higher levels of self-leadership. To achieve the goals, we conducted a 5-day diary study (n = 64∗5 = 320). Results from multilevel modeling showed that positive emotions trigger academic engagement which, in turn, increases mental health, both at the within and between-person level. Results also demonstrated that self-leadership strengthened the positive mediating path, for students with higher levels of self-leadership. Positive affect appears to be a significant predictor of mental health in higher education settings. Moreover, developing self-leadership is an added value, that may be conceived as a personal resource, and may protect students from the uncertainty triggered by the COVID-19 crisis.

Recursive state and parameter estimation of COVID-19 circulating variants dynamics.

COVID-19 pandemic response with non-pharmaceutical interventions is an intrinsic control problem. Governments weigh social distancing policies to avoid overload in the health system without significant economic impact. The mutability of the SARS-CoV-2 virus, vaccination coverage, and mobility restriction measures change epidemic dynamics over time. A model-based control strategy requires reliable predictions to be efficient on a long-term basis. In this paper, a SEIR-based model is proposed considering dynamic feedback estimation. State and parameter estimations are performed on state estimators using augmented states. Three methods were implemented: constrained extended Kalman filter (CEKF), CEKF and smoother (CEKF & S), and moving horizon estimator (MHE). The parameters estimation was based on vaccine efficacy studies regarding transmissibility, severity of the disease, and lethality. Social distancing was assumed as a measured disturbance calculated using Google mobility data. Data from six federative units from Brazil were used to evaluate the proposed strategy. State and parameter estimations were performed from 1 October 2020 to 1 July 2021, during which Zeta and Gamma variants emerged. Simulation results showed that lethality increased between 11 and 30% for Zeta mutations and between 44 and 107% for Gamma mutations. In addition, transmissibility increased between 10 and 37% for the Zeta variant and between 43 and 119% for the Gamma variant. Furthermore, parameter estimation indicated temporal underreporting changes in hospitalized and deceased individuals. Overall, the estimation strategy showed to be suitable for dynamic feedback as simulation results presented an efficient detection and dynamic characterization of circulating variants.

Delta SARS-CoV-2 inactivation and bactericidal performance of cotton wipes decorated with TiO2/Ag nanoparticles like Brazilian heavy-fruited Myrciaria cauliflora.

The current pandemic of Coronavirus Disease 2019 (COVID-19) raised several concerns about using conventional textiles for manufacturing personal protective equipment without self-disinfecting properties since the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is transmitted mainly by aerosols that can transpose cotton masks. Therefore, developing new cotton fibers with high self-disinfecting ability is essential to avoid a new pandemic due to new SARS-CoV-2 variants. Herein, we developed cotton wipes (CFs) with fibers coated by Ag, TiO2, and Ag/TiO2 hybrid nanoparticles like Brazilian heavy-fruited Myrciaria cauliflora by a sonochemical approach. Moreover, the coated CFs present high antimicrobial performance against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), being able to inactivate infectious SARS-CoV-2 (Delta variant) by the destruction of the spike, membrane, and nucleocapsid proteins while the viral RNA is not significantly affected, according to the molecular biological findings.

Questioning ZnO, Ag, and Ag/ZnO nanoparticles as antimicrobial agents for textiles: Do they guarantee total protection against bacteria and SARS-CoV-2?

Coronavirus Disease 2019 (COVID-19) occasioned global economic and health systems collapse. Also, it raised several concerns about using conventional cotton fabrics for manufacturing personal protective equipment without the antimicrobial capacity to inactivate viruses, such as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and its variants. Therefore, developing antimicrobial cotton fibers is crucial to avoid new global pandemics or the transmission of dangerous pathogens that remain on surfaces for long periods, especially in hospitals and medical clinics. Herein, we developed antimicrobial cotton fabrics with Ag, ZnO, and Ag/ZnO nanoparticles and evaluated their bactericidal activity against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), photocatalytic activity, and antiviral activity against Delta SARS-CoV-2. Although the antimicrobial fabrics are effective against these bacteria, they only reduce part of the SARS-CoV-2 virions during the first 15 min of direct contact via damage only to biological structures on the viral surface particle while the viral RNA remains intact.

Nicotine patches in patients on mechanical ventilation for severe COVID-19: a randomized, double-blind, placebo-controlled, multicentre trial.

PURPOSE: Epidemiologic studies have documented lower rates of active smokers compared to former or non-smokers in symptomatic patients affected by coronavirus disease 2019 (COVID-19). We assessed the efficacy and safety of nicotine administered by a transdermal patch in critically ill patients with COVID-19 pneumonia. METHODS: In this multicentre, double-blind, placebo-controlled trial conducted in 18 intensive care units in France, we randomly assigned adult patients (non-smokers, non-vapers or who had quit smoking/vaping for at least 12 months) with proven COVID-19 pneumonia receiving invasive mechanical ventilation for up to 72 h to receive transdermal patches containing either nicotine at a daily dose of 14 mg or placebo until 48 h following successful weaning from mechanical ventilation or for a maximum of 30 days, followed by 3-week dose tapering by 3.5 mg per week. Randomization was stratified by centre, non- or former smoker status and Sequential Organ Function Assessment score (< or ≥ 7). The primary outcome was day-28 mortality. Main prespecified secondary outcomes included 60-day mortality, time to successful extubation, days alive and free from mechanical ventilation, renal replacement therapy, vasopressor support or organ failure at day 28. RESULTS: Between November 6th 2020, and April 2nd 2021, 220 patients were randomized from 18 active recruiting centers. After excluding 2 patients who withdrew consent, 218 patients (152 [70%] men) were included in the analysis: 106 patients to the nicotine group and 112 to the placebo group. Day-28 mortality did not differ between the two groups (30 [28%] of 106 patients in the nicotine group vs 31 [28%] of 112 patients in the placebo group; odds ratio 1.03 [95% confidence interval, CI 0.57-1.87]; p = 0.46). The median number of day-28 ventilator-free days was 0 (IQR 0-14) in the nicotine group and 0 (0-13) in the placebo group (with a difference estimate between the medians of 0 [95% CI -3-7]). Adverse events likely related to nicotine were rare (3%) and similar between the two groups. CONCLUSION: In patients having developed severe COVID-19 pneumonia requiring invasive mechanical ventilation, transdermal nicotine did not significantly reduce day-28 mortality. There is no indication to use nicotine in this situation.

Hydroxychloroquine versus placebo in the treatment of non-hospitalised patients with COVID-19 (COPE - Coalition V): A double-blind, multicentre, randomised, controlled trial.

Background: Previous Randomised controlled trials (RCT) evaluating chloroquine and hydroxychloroquine in non-hospitalised COVID-19 patients have found no significant difference in hospitalisation rates. However, low statistical power precluded definitive answers. Methods: We conducted a multicenter, double-blind, RCT in 56 Brazilian sites. Adults with suspected or confirmed COVID-19 presenting with mild or moderate symptoms with ≤ 07 days prior to enrollment and at least one risk factor for clinical deterioration were randomised (1:1) to receive hydroxychloroquine 400 mg twice a day (BID) in the first day, 400 mg once daily (OD) thereafter for a total of seven days, or matching placebo. The primary outcome was hospitalisation due to COVID-19 at 30 days, which was assessed by an adjudication committee masked to treatment allocation and following the intention-to-treat (ITT) principle. An additional analysis was performed only in participants with SARS-CoV-2 infection confirmed by molecular or serology testing (modified ITT [mITT] analysis). This trial was registered at ClinicalTrials.gov, NCT04466540. Findings: From May 12, 2020 to July 07, 2021, 1372 patients were randomly allocated to hydroxychloroquine or placebo. There was no significant difference in the risk of hospitalisation between hydroxychloroquine and placebo groups (44/689 [6·4%] and 57/683 [8·3%], RR 0·77 [95% CI 0·52-1·12], respectively, p=0·16), and similar results were found in the mITT analysis with 43/478 [9·0%] and 55/471 [11·7%] events, RR 0·77 [95% CI 0·53-1·12)], respectively, p=0·17. To further complement our data, we conducted a meta-analysis which suggested no significant benefit of hydroxychloroquine in reducing hospitalisation among patients with positive testing (69/1222 [5·6%], and 88/1186 [7·4%]; RR 0·77 [95% CI 0·57-1·04]). Interpretation: In outpatients with mild or moderate forms of COVID-19, the use of hydroxychloroquine did not reduce the risk of hospitalisation compared to the placebo control. Our findings do not support the routine use of hydroxychloroquine for treatment of COVID-19 in the outpatient setting. Funding: COALITION COVID-19 Brazil and EMS.

How is the life without unicorns? A within-individual study on the relationship between uncertainty and mental health indicators: The moderating role of neuroticism.

The pandemic crisis of COVID-19 led to higher levels of uncertainty for individuals. Mental health has been outlined as a major key research priority to support and inform interventions. This study aimed to examine whether uncertainty influenced negative affect which in turn, resulted in worst levels of mental health, during the COVID-19 pandemic crisis, and test if neuroticism moderated the negative effect of uncertainty on mental health, via negative affect. To capture changes in daily uncertainty, negative affect and mental health, a daily design was adopted to test our model. We collected data through five consecutive days (N = 320), in the early "lockdown" stage of the pandemic. The multilevel results showed a significant mediation effect from daily uncertainty to daily mental health via daily negative affect. In addition, neuroticism moderated the mediated relationship, in such a way that the relationship between daily uncertainty on daily mental health, via daily negative affect was strengthened when neuroticism was higher. In sum, living without unicorns, or see the world though a black lens, is a factor that enhances the blackness of uncertainty.

Mobile vs. Non-Mobile Live-Streaming: A Comparative Analysis of Users Engagement and Interruption Using Big Data from a Large CDN Perspective.

Video streaming on the Internet is constantly changing and growing. New devices and new video delivery mechanisms generate huge gaps in the understanding of how video application works. From exploratory research of one among the largest streaming services in Brazil, this work presents a comparison between mobile and non-mobile users, in large-scale lives. This work focuses on metrics such as engagement, interruption, churn, and payload. This work also presents a report-overview of mobile-users, considering the operating system, geolocation, network access, interruption, and engagement. These results might offer potential information for streaming improvement, in addition to serving as a historical mark.

Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study.

BACKGROUND: In the Île-de-France region (henceforth termed Greater Paris), extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) was considered early in the COVID-19 pandemic. We report ECMO network organisation and outcomes during the first wave of the pandemic. METHODS: In this multicentre cohort study, we present an analysis of all adult patients with laboratory-confirmed SARS-CoV-2 infection and severe ARDS requiring ECMO who were admitted to 17 Greater Paris intensive care units between March 8 and June 3, 2020. Central regulation for ECMO indications and pooling of resources were organised for the Greater Paris intensive care units, with six mobile ECMO teams available for the region. Details of complications (including ECMO-related complications, renal replacement therapy, and pulmonary embolism), clinical outcomes, survival status at 90 days after ECMO initiation, and causes of death are reported. Multivariable analysis was used to identify pre-ECMO variables independently associated with 90-day survival after ECMO. FINDINGS: The 302 patients included who underwent ECMO had a median age of 52 years (IQR 45-58) and Simplified Acute Physiology Score-II of 40 (31-56), and 235 (78%) of whom were men. 165 (55%) were transferred after cannulation by a mobile ECMO team. Before ECMO, 285 (94%) patients were prone positioned, median driving pressure was 18 cm H2O (14-21), and median ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen was 61 mm Hg (IQR 54-70). During ECMO, 115 (43%) of 270 patients had a major bleeding event, 27 of whom had intracranial haemorrhage; 130 (43%) of 301 patients received renal replacement therapy; and 53 (18%) of 294 had a pulmonary embolism. 138 (46%) patients were alive 90 days after ECMO. The most common causes of death were multiorgan failure (53 [18%] patients) and septic shock (47 [16%] patients). Shorter time between intubation and ECMO (odds ratio 0·91 [95% CI 0·84-0·99] per day decrease), younger age (2·89 [1·41-5·93] for ≤48 years and 2·01 [1·01-3·99] for 49-56 years vs ≥57 years), lower pre-ECMO renal component of the Sequential Organ Failure Assessment score (0·67, 0·55-0·83 per point increase), and treatment in centres managing at least 30 venovenous ECMO cases annually (2·98 [1·46-6·04]) were independently associated with improved 90-day survival. There was no significant difference in survival between patients who had mobile and on-site ECMO initiation. INTERPRETATION: Beyond associations with similar factors to those reported on ECMO for non-COVID-19 ARDS, 90-day survival among ECMO-assisted patients with COVID-19 was strongly associated with a centre's experience in venovenous ECMO during the previous year. Early ECMO management in centres with a high venovenous ECMO case volume should be advocated, by applying centralisation and regulation of ECMO indications, which should also help to prevent a shortage of resources. FUNDING: None.

Impact of early low-calorie low-protein versus standard-calorie standard-protein feeding on outcomes of ventilated adults with shock: design and conduct of a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3).

INTRODUCTION: International guidelines include early nutritional support (≤48 hour after admission), 20-25 kcal/kg/day, and 1.2-2 g/kg/day protein at the acute phase of critical illness. Recent data challenge the appropriateness of providing standard amounts of calories and protein during acute critical illness. Restricting calorie and protein intakes seemed beneficial, suggesting a role for metabolic pathways such as autophagy, a potential key mechanism in safeguarding cellular integrity, notably in the muscle, during critical illness. However, the optimal calorie and protein supply at the acute phase of severe critical illness remains unknown. NUTRIREA-3 will be the first trial to compare standard calorie and protein feeding complying with guidelines to low-calorie low-protein feeding. We hypothesised that nutritional support with calorie and protein restriction during acute critical illness decreased day 90 mortality and/or dependency on intensive care unit (ICU) management in mechanically ventilated patients receiving vasoactive amine therapy for shock, compared with standard calorie and protein targets. METHODS AND ANALYSIS: NUTRIREA-3 is a randomised, controlled, multicentre, open-label trial comparing two parallel groups of patients receiving invasive mechanical ventilation and vasoactive amine therapy for shock and given early nutritional support according to one of two strategies: early calorie-protein restriction (6 kcal/kg/day-0.2-0.4 g/kg/day) or standard calorie-protein targets (25 kcal/kg/day, 1.0-1.3 g/kg/day) at the acute phase defined as the first 7 days in the ICU. We will include 3044 patients in 61 French ICUs. Two primary end-points will be evaluated: day 90 mortality and time to ICU discharge readiness. The trial will be considered positive if significant between-group differences are found for one or both alternative primary endpoints. Secondary outcomes include hospital-acquired infections and nutritional, clinical and functional outcomes. ETHICS AND DISSEMINATION: The NUTRIREA-3 study has been approved by the appropriate ethics committee. Patients are included after informed consent. Results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03573739.

COVID-19 Vaccine Acceptance among an Online Sample of Sexual and Gender Minority Men and Transgender Women.

Sexual and gender minority (SGM) populations are particularly vulnerable to poor COVID-19 outcomes and are more likely to experience stigma and medical mistrust that may impact COVID-19 vaccine acceptance. This study examined the prevalence of COVID testing and diagnosis and assessed COVID-19 vaccine acceptance among a large sample of SGM. Participants were recruited as part of an online cross-sectional study focused on an HIV biomedical prevention technology willingness in the United States at increased risk for HIV sero-conversion. Multivariate linear analysis was conducted to examine COVID-19 vaccine acceptance. The study sample included 1350 predominately gay (61.6%), Black (57.9%), cis-gender (95.7%) males with a mean age of 32.9 years. Medical mistrust and social concern regarding COVID-19 vaccine stigma were significantly associated with decreased COVID-19 vaccine acceptance, and altruism was significantly associated with increased vaccine acceptance. Black participants were significantly less likely to accept a COVID-19 vaccine, and Asian participants were significantly more likely to accept a vaccine, compared to White peers. As the planning of COVID-19 vaccine rollout efforts is conceptualized and designed, these data may inform equitable implementation strategies and prevent worsening health inequities among SGM populations.

Perspectives on glucocorticoid treatment for COVID-19: a systematic review.

Coronavirus disease 2019 (COVID-19) is a viral pneumonia that can lead to acute respiratory distress syndrome (ARDS). Until the commercialization of a vaccine, pharmacological treatment still represents an important strategy to fight against the ongoing pandemic. Glucocorticoids (GC) were widely used in the past coronavirus pandemics and have been used against the coronavirus 2 severe acute respiratory syndrome (SARS-CoV-2). This article aimed to review the studies that described the treatment with GC in COVID-19 patients. Randomized or nonrandomized clinical trials and retrospective or prospective-controlled longitudinal studies were screened for this systematic review. Studies in English, Portuguese, and Spanish published since 2019, with participants of any clinical status, geographic location, age, and sex were included. The most significant interest was related to the length of stay, radiological profile changes, viremia, and mortality. The research was done electronically on the Pubmed database using the following terms: "corticosteroids", "glucocorticoids", "dexamethasone", "methylprednisolone", "COVID-19", "SARS- CoV-2", "ADRS". We identified 6332 publications, and at the end, 14 retrospective observational studies that met all the inclusion criteria were selected. These studies included only patients infected with SARS-CoV-2 confirmed by RT-PCR, involving 2,713 participants. The results showed great heterogeneity in their designs and results, which precludes a reliable conclusion on the use of GCs in the treatment of COVID-19.