Distinct histopathological features of post-COVID-19 cholangiopathy (preprint)

Background: Cholangiopathy has been described in survivors of severe COVID-19, presenting significant clinical parallels to the pre-pandemic condition of secondary sclerosing cholangitis in critically ill patients (SSC-CIP).  Aim: Herein, we examined the liver histopathology of individuals with persistent cholestasis following severe COVID-19.  Methods: Post-COVID-19 cholestasis liver samples were subjected to routine staining techniques and cytokeratin 7 immunostaining, and the portal and parenchymal changes were semi-quantitatively analyzed.  Results: All ten patients, five men, median age 56, interquartile range (IQR) 51–60, requiring mechanical ventilation. The median and IQR liver enzyme concentrations proximal to biopsy were in IU/L: ALP, 605 (390–1,105); GGT, 925 (776–2,169); ALT, 92 (86–110); AST, 90 (68–108); and bilirubin, 3 (1–6) mg/dL. Imaging revealed intrahepatic bile duct anomalies and biliary casts. Biopsies were performed at a median of 203 (150–249) days after molecular confirmation of infection. Portal and periportal fibrosis, moderate-to-severe ductular proliferation, and bile duct dystrophy were found in all patients, while hepatocyte biliary metaplasia was observed in all tested cases. Mild-to-severe parenchymal cholestasis and bile plugs were observed in nine and six cases. Mild swelling of the arteriolar endothelial cells was observed in five patients. A thrombus in a small portal vein branch and mild periductal fibrosis were observed in one case each. One patient developed multiple small biliary infarctions. Ductopenia was not observed in any patient.  Conclusions: The alterations were similar to those observed in SSC-CIP; however, pronounced swelling of endothelial cells, necrosis of the vessel walls, and thrombosis in small vessels were notable.

COVID-19 infection and vaccination in patients with hereditary angioedema: a multicentric study.

Summary: Background. Due to similarities between the pathophysiological mechanisms of hereditary angioedema (HAE) and COVID-19, it has been hypothesized that SARS-CoV-2 infection may trigger HAE attacks or, alternatively, that HAE patients may experience different of COVID-19 disease severity. Furthermore, the potential for COVID-19 vaccination to trigger angioedema attacks in patients with HAE is still not completely defined. The objective is to characterize the exacerbations and clinical manifestations associated with COVID-19 infection and describe the adverse effects of COVID-19 vaccination in patients with HAE.Methods. Retrospective observational, descriptive, non-interventional, multicenter study conducted in four Allergy Units and Departments in Central Portugal between March 2020 and July 2022. HAE patient data were obtained from electronic medical records. Results. The study included 34 patients (67.6% female): 26 with HAE type 1, 5 with HAE type 2, and 3 with HAE with normal C1 inhibitor. Most patients with HAE type 1 and 2 were receiving long-term prophylaxis. Among the 32 patients who received COVID-19 vaccination, 86 doses, were administered with one angioedema attack (1.2%) associated with vaccination. A small increase in the average number of attacks was observed in the year following COVID vaccination (7.1 versus 6.2 in the previous year, p = 0.029), however, this difference is unlikely to be clinically significant, as the context of the COVID-19 pandemic likely introduced numerous confounders. During the study period, 16 HAE patients had COVID-19, all presenting with mild disease. Four out of 16 patients (25%) reported angioedema attacks during COVID-19, and 43.8% during the convalescence period (3 months after infection). Conclusions. Patients with HAE can safely receive COVID-19 vaccination. The severity of COVID-19 infection does not appear to be increased in HAE patients.

Tailored Approach for Persistent Olfactory Dysfunction After SARS-CoV-2 Infection: A Pilot Study.

OBJECTIVE: So far, no original studies explored non-randomized, standardized protocols for COVID-19 associated olfactory dysfunction. The main objective was to determine the efficacy of a new protocol for post-COVID olfactopathy while assessing the benefit of adding adjuvant therapies to olfactory training. METHODS: Patients suffering from long-lasting post-COVID-19 olfactory dysfunction were evaluated. A non-randomized protocol based on individual nasal endoscopy findings and patient's preferences was applied. Patients were assigned for olfactory training alone or olfactory training + adjuvant therapy. Participants performed olfactory objective and subjective evaluations at first consultation and 3 months after treatment, and results were compared. RESULTS: A total of 47 patients were enrolled. All groups showed significant improvement in olfactory thresholds at 3-month follow-up suggesting protocol effectiveness (olfactory training group alone showed a mean threshold difference of 2.9, P < .001; Olfactory training + Topical Corticosteroid showed a mean threshold difference of 4, P = .006; Olfactory training + Topical Corticosteroid + Vitamin B complex showed a mean threshold difference of 4.4, P = .006; Olfactory training + Intranasal Vitamin A and E showed a mean threshold difference of 4.4, P < .001). Olfactory training alone showed lower mean olfactory threshold improvement, when compared to patients undergoing olfactory training + adjuvant therapy (olfactory training alone mean improvement 2.9 ± 2.3 vs olfactory training + adjuvants mean improvement 4.3 ± 2.458, P = .03). CONCLUSIONS: This is one of the first studies to demonstrate results in the treatment of post-COVID-19 persistent olfactory impairment. A customized approach based on endoscopy findings and patient's preferences may be a valid option for the management of persistent post-COVID-19 olfactory disorder. Adjuvant therapy could be considered in addition to olfactory training, but further studies are needed in order to confirm their effectiveness in this setting. LEVEL OF EVIDENCE: 2c (outcomes research).

Interleukin-6 in SARS-CoV2 risk stratification

Introduction: Since the emergence of COVID19, a broad spectrum of presentation has been described, from the absence of symptoms to critical illness. Some studies show that increased levels of interleukin-6 (IL-6) are correlated with increased mortality and disease severity. Objective(s): To establish the value of IL-6 as an early predictor of severity in SARS-CoV2 infection. Method(s): Prospective study with IL-6 assay as part of the initial study of patients with SARS-CoV2 infection, between 20/10/2021 and 31/01/2022. Two groups were created (I: without hospitalization;II: with hospitalization). Exclusion criteria: chronic respiratory disease, rheumatologic disease and/or inflammatory bowel disease;time between dosing and hospitalization >=72h. Statistics (SPSS v28): Mann Whitney test, AUROC, Spearman correlation. Result(s): Sample of 117 patients (after excluding 10). Group I: 80 patients, 38 (47.5%) were male;mean age of 46.40 +/- 18.85 years old (18-88). Group II: 37 patients, 24 (64.9%) were male;mean age of 72.35 +/- 15.39 years old (29-96). Mean hospital stay of 19.49 +/- 17.02 days;9 (24.3%) were admitted to the ICU. Significantly higher IL-6 values in group II (p<0.001), showing good discriminating power regarding the probability of hospitalization (AUC=0.888;p<0.001) and a statistically significant (p=0.02) positive correlation (0.380) with the length of stay. The optimal cut-off value of IL-6 to establish the need for hospitalization, in our sample, was 12.4 pg/mL (Sensitivity: 97%;Specificity: 69%;Youden index: 0.66). Conclusion(s): IL-6 levels were significantly higher in patients requiring hospitalization and correlated with length of hospital stay. Larger studies are needed to validate its use in risk stratification.

Demystifying EFL Teachers' Experiences During the Pandemic: A Study of the Psychosocial Risks Resulting from COVID-19

This study aims to identify the main psychosocial risks that COVID - 19 has caused in Ecuadorian EFL teachers and determine the factors associated with developing these risks. This study employed a quantitative approach and a non-experimental cross-sectional design, with a sample of 980 teachers from different educational levels from Ecuador. The data analysis was done using Stata 16 statistical program and a multivariate binary logistic regression (LR). The results showed that teachers are emotionally drained, isolated, frustrated with teaching, and exhausted because of teaching during the pandemic, being the women the most affected. The main factors that increased the probability of suffering these psychosocial effects were extra activities beyond working hours, status in the teacher's institutions, and gender. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The PRINCOVID retrospective study - a predictive model of pressure injuries for critical COVID-19 patients.

OBJECTIVE: To characterize pressure injuries (PI), identify risk factors, and develop a predictive model for PI at intensive care unit (ICU) admission for critical COVID-19 patients. DESIGN: Retrospective analysis of a consecutive sample of patients admitted to ICU between May/2020 and September/2021. Inclusion criteria encompassed the diagnosis of Acute Respiratory Distress Syndrome due to SARS-CoV-2, requiring invasive mechanical ventilation >48 h. Several predictors were evaluated: socio-demographic characteristics, comorbidities, clinical and laboratory findings at ICU admission. The primary outcome was the presence of PI. RESULTS: 205 patients were included, mostly males (73%) with a mean age of 62 years old. PI prevalence was 58%. On multivariable analysis, male gender, hypertension, hemoglobin, and albumin at ICU admission were independently associated with PI, constituting the PRINCOVID model. The model reached an AUC-ROC of 0.71, surpassing the Braden Scale(p = 0.0015). The PRINCOVID score ranges from 0-15, with two risk groups: "at-risk"(≤7 points) and "high-risk"(>7 points). CONCLUSIONS: This study proposes PRINCOVID as a multivariable model for developing PI in critical COVID-19 patients. Based on four parameters (gender, hypertension, hemoglobin and albumin at ICU admission), this model fairly predicts the development of PI. The PRINCOVID score allows patients' classification into two groups, facilitating early identification of high-risk patients.

Dificuldades Encontradas Pelas Ligas De Hematologia Do Brasil

Introducao: As ligas academicas possuem papel decisivo na vida do estudante, pois, por meio delas, o individuo explora a sua autonomia, criticidade e comprometimento. Alem disso, o aluno procura as ligas tambem para suprir a necessidade de experiencia clinica e de qualificacao profissional. E notorio que muitas ligas enfrentam obstaculos em suprir as demandas dos participantes, seja em funcao da dificuldade de encontrar professores para ministrar aulas, da realizacao de pesquisas ou da disponibilidade de projetos de extensao. O objetivo desse trabalho e, portanto, discutir os principais obstaculos que as Ligas de Hematologia do Brasil enfrentam. Metodologia: Foi realizada uma pesquisa quantitativa por meio da aplicacao de questionarios online direcionados a ligas academicas de hematologia do Brasil, no ano de 2020. O questionario foi destinado a 44 ligas, sendo a taxa de resposta de 72,7%. Esta pesquisa foi aprovada pelo comite de etica da instituicao proponente sob o CAAE 24510719.2.0000.0029. Os dados foram analisados pela ferramenta Excel 2013, para analise descritiva e foram codificados, de forma a garantir o sigilo dos participantes. Resultados: Ao ser questionado as ligas sobre a publicacao de trabalhos em congressos, 78,1% afirmaram que fazem esse tipo de publicacao. Das 32 ligas analisadas, 75% possuem atividade de extensao, sendo 91,7% com contato direto com os pacientes. Alem disso, 71,9% possuem dificuldades em promover um projeto de extensao, por conta de diferentes motivos. Dessas ligas analisadas, 93,8% tem professor orientador e 40,6% tem dificuldades em encontrar professores dispostos a ministrar aulas sobre o assunto. Discussao: Na extensao universitaria, parte do tripe ensino-pesquisa-extensao, as Ligas de Hematologia conseguem desenvolver alguma atividade de extensao na grande maioria, no entanto encontram dificuldades na elaboracao dos projetos, possivelmente por falta de professores orientadores para auxiliar nas atividades e a necessidade de recursos e estrutura para a realizacao desses. A falta do professor orientador hematologista pode tambem estar relacionada ao menor numero de medicos especialista em hematologista no Brasil, que, apesar de terem aumentado nos ultimos anos de acordo com a Demografia Medica de 2018, ainda sao poucos em comparacao a outras especialidades. Para as atividades de ensino e pesquisa o advento das atividades online, durante a Pandemia da COVID-19, pode ter sido fator positivo que possibilitou as Ligas a realizacao de aulas online com especialistas de outras cidades e estados, alem de orientacao de trabalhos a distancia, mas, para confirmar tal relacao, novos estudos seriam necessarios. Conclusao: As Ligas, apesar de enfrentarem obstaculos, mantem atividades nos pilares de pesquisa, ensino e extensao, principalmente com regularidade de aulas e publicacoes cientificas, sendo, portanto, necessario mais estudos que possam analisar as causas especificas dos problemas. Copyright © 2022

Relato De Experiencia: Mutirao De Doacao De Sangue

Introducao: A doacao de sangue e essencial para manutencao dos bancos de sangue nos hospitais e servicos de saude. A transfusao sanguinea garante a seguranca e possibilidade da realizacao de procedimentos, sejam eles de urgencia ou eletivos, em que ha risco de hemorragias importantes ou hipovolemia, alem de constituir tratamento insubstituivel para inumeras patologias. Dessa forma, faz-se necessario incentivar o recrutamento de novos doadores, para que as reservas de sangue sejam supridas. Objetivos: O objetivo do trabalho e relatar o projeto de extensao entre a Liga Academica de Hematologia e Hemoterapia da Universidade Catolica de Brasilia (LiHema-UCB) em parceria com o Instituto Hemocentro de Brasilia (IHB), no ambito do componente curricular Projeto de Extensao I, oferecido ao 2degreesemestre do curso de Medicina desta Instituicao de Ensino Superior. Relato: Em parceria com a Universidade Catolica de Brasilia, em disciplina, Projeto de Extensao I, na qual os estudantes precisam propor e executar um projeto de extensao comunitaria, a Liga de Hematologia (LiHema UCB) realizou um mutirao de doacao de sangue em conjunto com o Hemocentro de Brasilia. Em parceria com a LiHema-UCB e a FHB, no 2degreesemestre de 2021, foi oferecida uma aula para a sensibilizacao dos estudantes sobre a necessidade da doacao de sangue. A partir disso, foi organizado um mutirao de doacao, com o apoio logistico da FHB. O Mutirao se deu em momento que o Hemocentro de Brasilia necessitava de reposicao em seus estoques, que sofreram queda expressiva desde a pandemia de COVID19. Foram oferecidas aulas que versavam sobre a importancia da doacao de sangue e cadastro para doacao de medula ossea, bem como material didatico digital. O Hemocentro de Brasilia forneceu transporte gratuito para grupos agendados previamente para os dias de doacao, tendo sido agendados 6 grupos, com um total de 76 doadores. Tambem foram realizados cadastros para doacao de medula ossea. Conclusao: A concretizacao desse projeto permitiu, atraves das inumeras doacoes, uma importante contribuicao para comunidade em periodo de grande necessidade. Ele permitiu aos estudantes perceberem o enorme potencial de transmissao de informacoes e educacao em saude, uma vez que a simples pratica de transmitir conhecimento foi capaz de transformar um numero significativo de pessoas nao doadoras em doadoras. Isso se refletiu na criacao de um novo projeto, com alunos do Centro Educacional Catolica de Brasilia, em que os membros da Liga serao encarregados de todos os anos realizarem aulas informativas sobre doacao de sangue e medula para o 3degreeano do ensino medio, como forma de incentiva-los a se tornarem doadores e, principalmente, se tornarem detentores de informacao que, se passada adiante, impacta de forma exponencial nossa comunidade em uma area de grande importancia. Copyright © 2022

LDL-C control according to risk: Is there a gender paradox?

Background and Aims : Background Low density lipoprotein cholesterol (LDL-C) treatment goals used for cardiovascular disease (CVD) prevention. Sex differences in CVD have been reported and women are less likely to receive statin therapy for secondary prevention. Nevertheless, little is known about gender according to risk categories Aims To assess the degree of LDL-C control in men vs women by CV risk levels and to report possible associations with clinical characteristics and lipid lowering therapies (LLT) in Portugal Methods: A non-interventional, cross-sectional study of patients regularly consulted for primary/secondary CVD in Portugal (1 hospital, 14 primary care centres). Data spanned a 12-year period (01/2008-12/2020) with index date for patient identification the 31/12/2020. CVD risk assessment was done according to 2019 ESC/EAS guidelines for the management of dyslipidaemias. Result(s): In our cohort of 129 764 patients with an overall median age of 53 years, 56.9% were women. 38.9% of men and 28.9% of women were classified as high/very high risk. History of previous CV hospitalization was present in 7.3% males and 5.0% females (table 1). LDL-C targets were attained more commonly in men for high and very high risk levels, although prescription of any LLT was more frequent in women (table 2). We found similar pattern in the two years prior to the COVID-19 pandemic. [Formula presented] [Formula presented] Conclusion(s): Women fail to achieve their LDL-C goals compared to men, although they are more frequent under LLT and have lower CV risk. The reasons and clinical associations require further research. More intensive therapies should perhaps be considered in women. Copyright © 2022

Dissociation and emotional dysregulation in pathological personalities related to the fear of SARS-COV-2: a case report

Introduction: The COVID-19 pandemic represented a serious strain on the mental health resilience worldwide. Implementation of restrictive rules implied the disruption of social networks, eliciting emotional exhaustion and intense response to fear. This was amplified by media spread of panic and fake news, representing risk factors for post traumatic stress disorder (PTSD). Fear can be dangerous, especially accounting premorbid psychopathological vulnerability, such as pathological personality traits. Emotional dysregulation increases fear levels, mediated by the relationship between emotional dysregulation and lack of tolerance. Objective(s): Clinical case presentation of patient who developed dissociative and behavioral symptoms following COVID-19 infection. Bibliographic research. Method(s): Bibliographic research using Pubmed. Clinical file consultation and patient interviews. Result(s): Heightened psychophysiological reactivity can result from the persistent fear experienced during a traumatic event and repeated memories related to it, leading to a sensitization of the response to fear. We present 57 year-old female patient, admitted to the COVID ward after trying to escape from home isolation due to positivity to COVID-19. In the hospital setting she developed dissociative symptoms, trying to escape from the ward and infect other people. Conclusion(s): Intense fear responses to COVID-19 are likely explained by poor emotion regulation capacities as well as dissociative mechanisms. Studies have shown that this pandemic was experienced as a real traumatic event and some studies have found that it may lead to the development of PTSD. Pathological personality is positively related to PTSD symptoms, attributable to higher levels of mood instability, cognitive/perceptual disorders, interpersonal dysfunctions and negative affection.

Critical COVID-19 and neurological dysfunction - a direct comparative analysis between SARS-CoV-2 and other infectious pathogens. / COVID-19 crítico e disfunção neurológica - uma análise comparativa direta entre o SARS-CoV-2 e outros agentes infecciosos.

OBJECTIVE: To evaluate whether critical SARS-CoV-2 infection is more frequently associated with signs of corticospinal tract dysfunction and other neurological signs, symptoms, and syndromes, than other infectious pathogens. METHODS: This was a prospective cohort study with consecutive inclusion of patients admitted to intensive care units due to primary infectious acute respiratory distress syndrome requiring invasive mechanical ventilation > 48 hours. Eligible patients were randomly assigned to three investigators for clinical evaluation, which encompassed the examination of signs of corticospinal tract dysfunction. Clinical data, including other neurological complications and possible predictors, were independently obtained from clinical records. RESULTS: We consecutively included 54 patients with acute respiratory distress syndrome, 27 due to SARS-CoV-2 and 27 due to other infectious pathogens. The groups were comparable in most characteristics. COVID-19 patients presented a significantly higher risk of neurological complications (RR = 1.98; 95%CI 1.23 - 3.26). Signs of corticospinal tract dysfunction tended to be more prevalent in COVID-19 patients (RR = 1.62; 95%CI 0.72 - 3.44). CONCLUSION: Our study is the first comparative analysis between SARS-CoV-2 and other infectious pathogens, in an intensive care unit setting, assessing neurological dysfunction. We report a significantly higher risk of neurological dysfunction among COVID-19 patients. As such, we suggest systematic screening for neurological complications in severe COVID-19 patients.

OBJETIVO: Avaliar se a infecção grave pelo SARS-CoV-2 está mais comumente associada a sinais de disfunção do trato corticoespinhal e outros sinais, sintomas e síndromes neurológicas, em comparação com outros agentes infecciosos. MÉTODOS: Este foi um estudo de coorte prospectivo com inclusão consecutiva de doentes admitidos a unidades de cuidados intensivos devido a síndrome do desconforto respiratório agudo infeccioso primário, com necessidade de ventilação mecânica invasiva por > 48 horas. Os doentes incluídos foram atribuídos aleatoriamente a três investigadores para a avaliação clínica, a qual incluía a pesquisa de sinais de disfunção do trato corticoespinhal. Os dados clínicos, incluindo outras complicações neurológicas e possíveis preditores, foram obtidos independentemente a partir dos registros clínicos. RESULTADOS: Foram incluídos consecutivamente 54 doentes com síndrome do desconforto respiratório agudo, 27 devido a SARS-CoV-2 e 27 devido a outros agentes infecciosos. Os grupos eram comparáveis na maioria das características. Os doentes com COVID-19 apresentavam risco significativamente superior de complicações neurológicas (RR = 1,98; IC95% 1,23 - 3,26). Os sinais de disfunção do trato corticoespinhal tendiam a ser mais prevalentes em doentes com COVID-19 (RR = 1,62; IC95% 0,72 - 3,44). CONCLUSÃO: Este estudo foi a primeira análise comparativa visando avaliar disfunção neurológica, entre doentes com infecção SARS-CoV-2 e outros agentes infecciosos, em um contexto de unidade de cuidados intensivos. Reportamos um risco significativamente superior de disfunção neurológica em doentes com COVID-19. Como tal, sugere-se o rastreio sistemático de complicações neurológicas em doentes com COVID-19 crítico.

At-home versus in-hospital initiation of non-invasive ventilation in obstructive sleep apnea patients

Introduction: The COVID-19 pandemic led to the development of numerous adaptations in the healthcare systems in order to minimize the risk of infection for patients and healthcare professionals. One of the main difficulties related to Sleep-related breathing disorders, namely Obstructive Sleep Apnea (OSA), was the initiation of noninvasive ventilation (NIV), as this procedure carries a high risk of transmission through aerosol generation. In our hospital, patients previously initiated NIV at the Sleep Disorders Clinic. However, due to the pandemic, this had to be suspended and NIV initiation began to take place at the patient's home. Our objective was to evaluate the difference in adherence to NIV when this therapy was initiated in-hospital or at home. Method(s): Retrospective study, evaluating the differences in NIV adherence between patients with OSA that initiated NIV in-hospital (previously to the pandemic) or at home (post-pandemic). Statistical analysis was performed using an independent samples t-test on SPSS Statistics version 27. Result(s): From the patients that had OSA diagnosed through polysomnography level 3, we selected 114, of which 60 initiated NIV inhospital and 54 initiated NIV at home. In both groups, the majority of patients were male (76,7% in the inhospital NIV initiation group and 70,4% in the home NIV initiation group), with a mean age of 60,9 +/- 10,4 years and 61,3 +/- 10,6 years, respectively. Most patients had severe OSAS (78,3% and 75,9%, respectively) and had a body mass index (BMI) >= 30 (76,6% and 81,5%, respectively). In the first-month post NIV initiation, mean adherence was 88,3% in patients that had in-hospital initiation and 85,0% in patients with home NIV initiation. In the sixth month was 89,2% and 85,9%, respectively, and after 1 year was 96,7% and 82,50%, respectively. No statistical difference was found between adherence in all periods (p > 0,05). Conclusion(s): Our work suggests that home initiation of NIV in OSAS patients has non-inferior results in terms of patients' adherence and is a possibility to maintain in the future. This will allow reallocation of human resources to other areas in Sleep Disorders that are understaffed.

Investigating Remote Teaching: How Google Meet and Zoom Affect Teachers and Students’ Experience

Due to the suspension of in-person classes caused by the COVID-19 pandemic, educational institutions had to adapt to remote teaching. Thus, videoconferencing tools were adopted to make it possible. However, using these tools can impact the remote teaching experience. In this paper, we present an investigation about the Google Meet and Zoom. We considered teacher and students profiles concerning Usability, a quality attribute that allows assessing the ease of use of user interfaces, and the User Experience (UX), which provides a holistic view focusing on subjective aspects such as affect and emotions. The purpose of Usability and UX is to understand the impacts of the tools on the quality of the remote teaching experience. Our results indicate that besides the tools, the interaction between teacher and student, in the context of synchronous classes, impacts the remote teaching experience, being an essential aspect of discussion and enabling further investigations within the technology-supported education community. Copyright © 2022 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved.

What is the impact of previous cerebrovascular disease on critical COVID-19 patients' mortality? A prospective cohort study.

OBJECTIVES: We aimed to evaluate the effect of previous cerebrovascular disease (CVD) on mortality rates of critically ill COVID-19 patients. MATERIALS & METHODS: A prospective cohort study was performed between May/2020 and May/2021, at a tertiary-care-center. We consecutively included adult patients admitted to intensive care units (ICU) having as primary diagnosis Acute Respiratory Distress Syndrome due to SARS-CoV-2, requiring invasive mechanical ventilation for >48 h. We considered as exposure the diagnosis of previous CVD and as main outcome the in-ICU mortality. RESULTS: The study sample included 178 patients: 74.2% were males, with a mean age of 63 ± 12.4 years-old(yo). Previous CVD was documented in 17 patients (9.6%). During the study period, the mortality rate at ICU was of 33.1% (n = 59). The proportion of mortality at ICU was higher in patients with prior CVD (58.8% vs 30.4%; p = 0.02). Also, older patients (66 ± 11.4 yo vs. 62 ± 12.7 yo, p = 0.04) and those with higher score at SAPSII at ICU admission (47.8 ± 15.4 vs. 40.7 ± 15.9; p = 0.01) had a higher ICU deathrate. Patients with previous CVD had a 2.70 (95%CI = 1.36-5.39) higher likelihood of dying compared to those who had no previous CVD. After adjustment (for gender, age, SAPSII and total length of stay), multivariate Cox analysis revealed that previous CVD remained a strong predictor for in-ICU death in critically ill COVID-19 patients (HR = 2.51; 95%CI = 1.15-5.51). CONCLUSIONS: Previous CVD was significantly associated to higher mortality in critical COVID-19 patients. We suggest that, in patients with previous CVD, prioritization of vaccination strategies should be implemented alongst with higher surveillance when infected with SARS-CoV-2.

TELE-ORAL MEDICINE: AN INNOVATION TO MAINTAIN CARE DURING THE COVID-19 PANDEMIC

Objectives The COVID-19 pandemic has affected all areas, including health. The high and rapid transmission of SARS-Cov-2 caused the need for professionals to innovate to keep in touch with their patients. This study aimed show the experience of the Tele-Oral Medicine at a referral service in the Jequitinhonha Valley, Brazil, during the COVID-19. Study Design This study included all queries made by the Tele-Oral Medicine from May 2020 to February 2021. Dentists or patients used a smartphone/computer to contact the stomatologists, via Skype or WhatsApp, by sending messages via chat with clinical data and photos of the oral lesions. Results A total of 125 patients were attended, and 63 health professionals were assisted through tele-consultations, from 29 cities in the Jequitinhonha Valley. Ninety-five cases required face-to-face consultation (76%), whereas in 24 cases the diagnosis was made virtually (19.2%), avoiding long-distance travel. Forty-two biopsies were performed (33.6%), with potentially malignant oral disorders/squamous cell carcinoma (11 cases, 26.2%), salivary gland pathology (8 cases, 19%), and reactive processes/infectious diseases (7 cases. 16.6%%) the most frequent diagnoses. Conclusions Tele-Oral Medicine allows the screening and diagnosis of oral cancer and should be incorporated in clinical practice to reduce on-site visits.

Metabolomic Profiling of Plasma Reveals Differential Disease Severity Markers in COVID-19 Patients.

The severity, disabilities, and lethality caused by the coronavirus 2019 (COVID-19) disease have dumbfounded the entire world on an unprecedented scale. The multifactorial aspect of the infection has generated interest in understanding the clinical history of COVID-19, particularly the classification of severity and early prediction on prognosis. Metabolomics is a powerful tool for identifying metabolite signatures when profiling parasitic, metabolic, and microbial diseases. This study undertook a metabolomic approach to identify potential metabolic signatures to discriminate severe COVID-19 from non-severe COVID-19. The secondary aim was to determine whether the clinical and laboratory data from the severe and non-severe COVID-19 patients were compatible with the metabolomic findings. Metabolomic analysis of samples revealed that 43 metabolites from 9 classes indicated COVID-19 severity: 29 metabolites for non-severe and 14 metabolites for severe disease. The metabolites from porphyrin and purine pathways were significantly elevated in the severe disease group, suggesting that they could be potential prognostic biomarkers. Elevated levels of the cholesteryl ester CE (18:3) in non-severe patients matched the significantly different blood cholesterol components (total cholesterol and HDL, both p < 0.001) that were detected. Pathway analysis identified 8 metabolomic pathways associated with the 43 discriminating metabolites. Metabolomic pathway analysis revealed that COVID-19 affected glycerophospholipid and porphyrin metabolism but significantly affected the glycerophospholipid and linoleic acid metabolism pathways (p = 0.025 and p = 0.035, respectively). Our results indicate that these metabolomics-based markers could have prognostic and diagnostic potential when managing and understanding the evolution of COVID-19.

How Did Children Learn in an Online Course During Lockdown?: A Piagetian Approximation

As the Covid pandemic forced educational institutions to close their doors and transit to an online mode, little is known of how children learnt under such conditions. This article reports on the learning behaviors displayed by 377 children aged 5–12 in a technology-mediated course on science and arts. Using an ex post facto design, we employed a multivariate analysis to unveil hidden factors in the learning processes of participants. Results show traces of theoretical constructs linked to the stages of development supported by Piaget which are presented in descending order of predominance. In the Science module, Practical Knowledge and Verbal reasoning stand out above others while in the Arts module, Reasoning and Creativity surpass other features of the same category. From a practical stance, these findings may have implications on future course designs where it is desirable to develop other abilities related to science and arts. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Factors that Contribute to Teachers’ Burnout During the COVID 19 Pandemic in Ecuador

The main purpose of this study is to identify the factors that contribute to teachers’ burnout during the COVID 19 pandemic in Ecuador. Additionally, the research aims to analyze teachers’ working conditions, determine the teachers’ health problems associated with the new working conditions, and establish the complementary activities that affect male and female teachers. This is stratified descriptive research based on a survey applied to 843 individuals who belong to different educational levels (preschool, elementary, secondary, technological institute, and university). As a result of the analysis, some significant findings are that teachers are working more hours with undefined schedules. Additionally, a percentage of teachers claimed to have some ailments. For instance, 38,2% have had neck pain and 32% have one or more ailments similar to those of carpal tunnel syndrome. Interestingly, women are more affected than men in relation to workload, housework, and childcare. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Portuguese immunoallergology clinical experience in patients with severe atopic dermatitis under dupilumab treatment

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.