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Objectives: COVID-19 is an acute respiratory infection caused by the new coronavirus that has spread around the world, becoming an international public health emergency. Studies have shown a high prevalence of psychiatric symptoms such as depression, anxiety and post-traumatic stress disorder in patients after the infection, a situation that can be evenmore pronounced in patients with chronic diseases such as Immune-mediated rheumatic diseases (IRMD). The aim of this study is to evaluate the psychological impact of the COVID-19 infection and pandemic on patients with IRMD as well as to describe the epidemiological profile of the selected population. Method(s): A longitudinal cohort observational study was carried out with a comparison group, based on the analysis of data from patients of Project Reumacov, organized by de Brazilian Society of Rheumatology, in Manaus/ Amazonas. Data regarding the psychological impact was obtained through the application of DASS-21 forms, which evaluated levels of depression, anxiety and stress. Possible answers were divided into four categories according to the frequency of the symptoms presented, such as Not applicable;Present for a short time;Present for a significant amount of time or Present most of the time. Result(s): In total, 283 patients were included in the study. The mean age was 44 years and the majority of the patients were female. The most frequent diagnosis was systemic lupus erythematosus, followed by rheumatoid arthritis. Of the patients included, 270 answered the DASS-21 questionnaire, being 152 in the Case group (patients with COVID-19) and 118 in the Control group (patients without COVID-19). There was a significant statistic correlation between high levels of depression, anxiety and stress and the presence of COVID-19 related symptoms. Conclusion(s): Our study demonstrated that high levels of stress, depression and anxiety were associated to the coronavirus infection. It is, however, difficult to determine whether this scenario is a result of a physiological response to the infection or a consequence of the social context of a pandemic. This knowledge may contribute to a better understanding of COVID-19 infection and its repercussions as well as to highlight the necessity of a multidisciplinary approach aimed at the mental health of patients with rheumatic diseases.
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Objectives: Patients with immune-mediated rheumatic diseases (IMRD) constitute an important subgroup of immunosuppressed patients at risk of developing severe infections. Since coronavirus 19 infection (COVID-19) is an international public health emergency, it is necessary to observe the relationship between this viral infection and the development or intensification of the clinical course of IMRD and the persistence of new associated symptoms. The aim of this study is to trace this population's epidemiological profile and evaluate the frequency of chronic fatigue syndrome in patients with IMRD and COVID-19 compared to uninfected patients. Method(s): This is a descriptive cross-sectional observational study with a comparison group. The sociodemographic, clinical, and FACIT-F Fatigue Scale data were from patients with IMRD of Project Reumacov, organized by the Brazilian Society of Rheumatology, locally inManaus/Amazonas. The statistical analysis was performed through the inferential method to demonstrate the prevalence. Result(s): 268 patients were evaluated, those who had contact with COVID-19 had fatigue according with the fatigue assessment scale compared to unexposed patients. There was a statistically significant correlation between fatigue post-COVID-19 infection in the patients studied. Conclusion(s): Clinically relevant fatigue was a prevalent and commonly reported symptom in the post-COVID-19 period in the evaluated population. These data should direct attention to the reported manifestations as they affect the functioning of individuals' socioeconomic and health well-being throughout the pandemic period and beyond.
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Introduction: The aim of our study is to evaluate the relationship between dexmedetomidine (DEX) use as a sedative agent in mechanical ventilated ICU patients and 28-day mortality. DEX, a selective alfa-2 adrenergic receptor agonist, widely used for its sedative and analgesic properties, has been linked to increasing parasympathetic tone, reducing the inflammatory response and oxidative stress [1]. Since severe COVID-19 is associated with an hyperinflammatory state, it is hypothesized that DEX might improve outcomes in these patients. Method(s): This is a retrospective observational study of mechanically ventilated patients admitted with COVID-19 pneumonia in the ICU of a tertiary center in Portugal, between March 2020 and December 2021. Logistic regression analysis was performed to evaluate the association of DEX use and 28-day mortality from time of intubation. Result(s): A total of 277 patients were analyzed, 151 in the DEX group and 126 in the no DEX group. Patients in the DEX group were younger (53.3 vs. 63.3 years, p < 0.001), had less comorbidities (2.8 vs. 3.5, p = 0.01), lower SOFA at admission (6.2 vs. 7.1, p = 0.01) but had a prolonged ICU stay (21.4 vs. 15.9, p < 0.001). Male gender (65.6 vs. 69.0, p = 0.54), incidence of obesity (56.3 vs. 46.8, p = 0.12), coronary artery disease (4.0 vs. 7.9, p = 0.16) and atrial fibrillation (4.0 vs. 7.1, p = 0.25) were similar between groups. PaO2/ FiO2 ratio at admission (111.1 vs. 108.1, p = 0.61), days spent in RASS < 3 (13.7 vs. 12.4, p = 0.31) and opioid use (14.8 vs. 13.1, p = 0.16) were also similar. From time of intubation, 28-day mortality in the cohort receiving DEX was 14.7% compared to 59.5% in the no DEX group (OR 0.12;95% CI 0.07-0.21;p = 0.01). Conclusion(s): Use of DEX was associated with lower 28-day mortality in COVID-19 critically ill patients requiring invasive mechanical ventilation in our study analysis. Considering the limitations of a retrospective observational study, RCTs are needed to confirm the results.
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Introduction: The aim of this study is to identify the factors associated with an increased risk of developing nosocomial infections (NI) in COVID-19 patients admitted with pulmonary involvement in the ICU. NI in COVID-19 ICU population are an important cause of morbidity and mortality worldwide and its prompt identification might lead to its prevention and better outcomes. Method(s): This is a retrospective observational study of patients admitted with COVID-19 pneumonia in the ICU of a tertiary center in Portugal, between March 2020 and December 2021. We considered NI as any infection acquired > 48 h post ICU admission. Clinical, analytical and baseline patient data were evaluated. Logistic regression analysis was performed to correlate patient related variables with the development of NI. Result(s): A total of 338 patients were enrolled, from which 167 (47.9%) presented with NI. Baseline characteristics are described in Table 1. In the logistic regression analysis, older age (OR 1.13;95% CI 1.03-1.25;p = 0.013), coronary artery disease (CAD) (OR 28.7;95% CI 1.92-429;p = 0.02), obesity (OR 3.14;95% CI 0.86-11.42;p = 0.008), chronic liver disease (CLD) (OR 104.33;95% CI 1,.04-1008.49;p = 0.04), use of dexamethasone (OR 21.89;95% CI 3.04-157.85;p = 0.002) and days in RASS < 3 (OR 1.4;95% CI 1.05-1.86;p = 0.02) were associated with an increased risk of developing NI in the ICU. Surprisingly, SOFA at admission, days of invasive mechanical ventilation, days of sedation and PaO2/ FiO2 ratio at admission, although statistically significantly different between groups, did not correlate with the risk of infection. Conclusion(s): We identified prolonged deep sedation, corticosteroid use, and patient characteristics (CAD, obesity, CLD, older age) as independent risk factors for NI development in COVID-19 critically ill patients. It is also noteworthy to point out for the presence of confounding variables, including the excessive workload in the ICU during this period, leading to an increase in NI numbers.
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Introduction: Our goal is to describe outcomes of critically ill COVID-19 patients submitted to renal replacement therapy (RRT), in particular the association of RRT with mortality. Multi-system organ failure or direct kidney injury caused by SARS-CoV-2 is associated with the development of acute kidney injury (AKI) which subsequently increases the need for RRT and may affect the outcomes. Method(s): This is a retrospective observational study of 338 critically ill patients admitted with COVID-19 pneumonia in the ICU of a tertiary center in Portugal, between March 2020 and December 2021. Clinical, analytical and baseline patient characteristics were evaluated. Logistic regression analysis was performed to correlate patient data with the need for RRT and ICU mortality. Result(s): From a total of 338 patients, 5% required RRT (n = 16), 25% of which received intermittent hemodialysis (n = 4) and 87,5% continuous veno-venous hemofiltration (n = 14). Baseline characteristics are described in Table 1. In our sample, 61 patients (18%) presented with acute AKI, from whom 14 (23%) were submitted to RRT. From all the patients receiving RRT, 10 (62.5%) did not have pre-existing chronic kidney disease. In the logistic regression analysis, AKI (OR 45.4;95% CI 7.7-269.5;p < 0.001), higher SOFA (OR 1.24;95% CI 103-1.51;p = 0,03), creatinine (OR 2.01;95% CI 1.4-3.0;p < 0.001) and C-reactive protein (OR 1.09;95% CI 1.02-1.16;p = 0,01) on admission were associated with the need for RRT. Additionally, ICU mortality associated with RRT was 75% compared to 28.3% in the group not submitted to RRT (OR 7.6;2.4-24.2;p = 0.001). Conclusion(s): The need for RRT in critically ill COVID-19 patients is associated with an increased mortality rate in our study. We were also able to identify AKI, higher SOFA, creatinine and C-reactive protein at admission as risk factors for RRT. However, due to the retrospective nature of our analysis and our small sample size, more studies on this topic are needed to confirm these results.
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Introduction. In the context of the COVID-19 pandemic, which required urgent responses from health systems, and ongoing decision making in a context of limited and evolving evidence, modeling played a significant role in supporting public policy making. Nonetheless, particularly in low and middle-income countries, modeling groups are scarce, and usually not routinely involved in supporting public health policy making. We aimed to appraise COVID-19 modeling work in Brazil during the pandemic. Methods. We performed a scoping review following PRISMA guidelines to identify groups conducting COVID-19 modeling to support health decision-making in Brazil. Search strategies were applied to MEDLINE, LILACS, Embase, ArXiv, and also included National data repositories and gray literature. We excluded reports of models without modeling results. Titles, s, data repository descriptions and full-text articles identified were read and selected by two reviewers. Data extracted included modeling questions, model characteristics (structure, type, and programming), epidemiologic data sources, main outcomes reported, and parameters. To further identify modeling groups that might have not yet published results, snowball sampling was performed, and a short survey was sent electronically. Investigators and policymakers were invited to an online interview, to obtain further information on how they interacted, communicated, and used modeling results. Results. We retrieved 1,061 references. After removing duplicates (127), 1,016 s and titles were screened. From an initial selection of 142 s, 133 research groups were identified, of which 67 didn't meet the eligibility criteria. Of these, 66 groups were invited for an interview, of which 24 were available, including 18 modeling groups from academic institutions, and four groups from State Health departments. Most models assessed the impact of mitigation measures in cases/hospitalization/deaths and healthcare service demand. Interaction and communication with decisionmakers were not well established in most groups. Conclusions. Despite a large number of modeling groups in Brazil, we observed a significant gap in modeling demand and communicating its results to support the decision-making process during the COVID-19 pandemic.
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Introduction. Modeling is important for guiding policy during epidemics. The objective of this work was to describe the experience of structuring a multidisciplinary collaborative network in Brazil for modeling coronavirus disease 2019 (COVID-19) to support decisionmaking throughout the pandemic. Methods. Responding to a national call in June 2020 for proposals on COVID-19 mitigation projects, we established a team of investigators from public universities located in various regions throughout Brazil. The team's main objective was to model severe acute respiratory syndrome coronavirus 2 transmission dynamics in various demographic and epidemiologic settings in Brazil using different types of models and mitigation interventions. The modeling results aimed to provide information to support policy making. This descriptive study outlines the processes, products, challenges, and lessons learned from this innovative experience. Results. The network included 18 researchers (epidemiologists, infectious diseases experts, statisticians, and modelers) from various backgrounds, including ecology, geography, physics, and mathematics. The criteria for joining the network were having a communication channel with public health decision-makers and being involved in generating evidence for public policy. During a 24-month period, the following sub-projects were established: (i) development of a susceptible-exposed-infected-recovered-like, individual-based metapopulation and Markov chain model;(ii) projection of COVID-19 transmission and impact over time with respect to cases, hospitalizations, and deaths;(iii) assessment of the impact of non-pharmacological interventions for COVID-19;(iv) evaluation of the impact of reopening schools;and (v) determining optimal strategies for COVID-19 vaccination. In addition, we mapped existing COVID-19 modeling groups nationwide and conducted a systematic review of relevant published research literature from Brazil. Conclusions. Infectious disease modeling for guiding public health policy requires interaction between epidemiologists, public health specialists, and modelers. Communicating modeling results in a nonacademic format is an additional challenge, so close interaction with policy makers is essential to ensure that the information is useful. Establishing a network of modeling groups will be useful for future disease outbreaks.
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Objetivos: Analise e identificacao de tendencias de doadores cadastrados para transplante de medula ossea no Brasil no sistema REDOME nas diferentes regioes brasileiras. Materiais e metodos: Inquerito epidemiologico baseado na distribuicao e no perfil do doador cadastrado para transplante de medula ossea no Brasil de 2015 a 2022. Realizado a partir de dados divulgados pelo Registro Nacional de Doadores Voluntarios de Medula Ossea (REDOME). Foi realizada uma analise comparativa dos dados obtidos, juntamente com pesquisa complementar em literatura recente. Resultados: O transplante de medula ossea e um tratamento preconizado para diferentes doencas, e exige uma grande organizacao dos sistemas de saude para identificacao de um doador compativel e para cooperacao entre diferentes servicos. No Brasil, o REDOME e o banco responsavel por esta logistica, sendo considerado o terceiro maior do mundo. Com base nos dados registrados de 2015 ate o mes de maio de 2022, o registro dispoe de 5.522.346 doadores cadastrados, sendo 650 a media de pacientes em busca de doadores nao aparentados. A faixa etaria com maior numero de cadastros e de 35 a 39 anos, representando 18,2% do total. Mulheres representam 57,1% dos doadores cadastrados. Doadores que se identificam como brancos correspondem a 53,9% dos cadastrados. Em relacao a distribuicao por regiao, observa-se que o maior numero dos doadores encontra-se no Sudeste (44,1%), enquanto o menor numero de doadores encontra-se no Norte (7%). A regiao Nordeste representa a terceira regiao com maior numero de doadores (18,2%). Observou-se um aumento de 155.9% no numero de cadastros de doadores voluntarios entre os anos de 2010 a 2019. Ja em 2018 e 2019, houve um crescimento de 12,9% do numero de voluntarios, enquanto em 2020 e 2021 esse acrescimo foi de 7,8%. Discussao: Com os dados nacionais apresentados, e possivel identificar um aumento significativo de cadastros de novos doadores entre 2010 e 2019. Esse aumento de novos cadastros acompanha o crescimento do numero de transplantes de medula ossea no Brasil, observado a partir de dados fornecidos pelo Registro Brasileiro de Transplantes (RBT). Em 2019 e 2020, observou-se, como base em dados do RBT, uma reducao no numero de transplantes em relacao aos anos anteriores, que pode ser associada a crise sanitaria gerada pela pandemia da SARS-CoV-2. Neste sentido, destacam-se as dificuldades impostas pela pandemia a logistica necessaria para realizacao de transplantes de medula ossea, incluindo, possivelmente, impactos na realizacao de novos cadastros de doadores. A concentracao de doadores cadastrados por regiao, sobretudo nas regioes Sudeste e Sul, destaca a demanda de recrutamento de novos cadastrados nas outras regioes. A regiao Nordeste, em comparacao, mesmo concentrando a segunda maior parcela da populacao brasileira, representa apenas a terceira regiao em numero de doadores cadastrados. Assim, e premente a captacao de novos doadores de populacoes subrepresentadas, garantindo maior variabilidade e capacidade de atender a populacao que carece desse procedimento. Conclusao: O transplante de medula ossea e uma terapia que envolve uma logistica complexa e bem alinhada para identificacao de doadores compativeis e realizacao do procedimento. Diante da complexidade imposta, destaca-se a importancia de estrategias publicas para divulgacao e acesso aos servicos de cadastro, a fim de aumentar o numero de doadores voluntarios cadastrados e, possivelmente, de procedimentos realizados. Copyright © 2022
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Background: Covid-19 is associated with an increased risk of pulmonary embolism (PE) therefore, should the cut off d-dimer value be adjusted for these patients? Material(s) and Method(s): Retrospective and observational study to understand if there is a d-dimer cut-off that could guide clinics to perform a thoracic computed tomography angiography (CTA) in patients with covid-19. The population was covid-19 patients admitted to covid-19 dedicated wards of a University Hospital Centre for one year. Result(s) and Conclusion(s): 725 (52%) patients with covid-19 had a d-dimer value dosed during the first 5 days of the disease. Those, 63 (9%) did a CTA with a diagnosis of 16 (25%) PE. Gender was equally represented, median age was 70 years (ID=3.49) and the majority (94%) survived. Thirteen (81%) patients with PE had a d-dimer value above 2500 ng/mL (OR=9.244, 95% CI 2.248-9.837), with 7 (54%) with values over 10000 ng/mL, but in 3 (9%) it was under 1500 ng/mL. Seventy-three (63%) of patients with a d-dimer over 1500 ng/mL did not had a thoracic CTA performed. In our population PE was not a frequent outcome. The results are influenced by the low number of thoracic CTA performed because, even tough the cut-off d-dimer value used at our hospital to perform a thoracic CTA to exclude PE is 1500 ng/mL, most patients with that d-dimer value did not take the exam and so PE could not be excluded. Although in most PE cases the d-dimer value was above 2500 ng/mL, the results of our study cannot verify if that is a better cut-off value.
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Background: Lifestyle changes are crucial to preventing diabetes and its cardiovascular complications, including maintaining a physically active lifestyle. Morever, patient education is essential to promote diabetes self-management and health condition control. However, programs that combine physical exercise and lifestyle education are still poorly implemented in low- and middle-income countries, such as Brazil. The Diabetes College Brazil Study is a pioneer randomized clinical trial (RCT) designed to promote behavioral changes in adults with diabetes and prediabetes. PURPOSE: To test the feasibility, acceptability, and preliminary effectiveness of Diabetes College Brazil Study interventions (Exercise (Ex) vs. Exercise and Lifestyle Education (ExLE)) as part of the preparation for the development of the RCT. Methods: This pilot randomized trial (NCT03914924) had two parallel arms: ExLE program (12 weeks of exercise and educational interventions) and Ex program (12 weeks of exercise intervention only) (Figure 1). Feasibility (eligibility, recruitment, retention, completeness of RCT variables measures and participation rates), acceptability (satisfaction with interventions), and preliminary effectiveness of interventions (comparison of RCT variables measured in pre-and post-assessments) were evaluated. The preliminary effectiveness of the interventions was analyzed from the values of the difference between post-and pre-intervention measures (Δ post-pre) using both per-protocol (PP) and intention to treat (ITT) analysis for the comparison between groups (Ex vs. ExLE). The value 0 was imputed to replace the missing data in the analysis that followed the ITT principle. The results were reported as estimates of effect (95% confidence interval (CI) of the difference) for variables with normal distribution. RESULTS: Thirty-seven individuals participated in the study (ExLE: n = 18, 56.9±9.5 years old, 55.6% female, 5.6% prediabetes;Ex: n = 19, 59.5±7.3 years old, 52.6% female, 21.1% prediabetes). Eligibility, recruitment and retention rates were 16%, 100% and 82% respectively. The completeness of RCT variables measures was higher in the pre-intervention assessment. Missing data in the post-intervention assessment were mainly related to modifications in research procedures due to the COVID-19 pandemic. Participation rates in supervised exercise sessions and education classes were 76% and 71%, respectively (total sample). Interventions were highly acceptable to participants. There was a trend towards better results in the ExLE than Ex for most variables, mainly for physical activity level and quality of life (Table 1). Conclusion: The interventions are feasible and acceptable to participants. The results of this trial indicate the potential clinical benefit of lifestyle educational intervention associated with exercise intervention for people with diabetes and prediabetes. (Figure Presented).
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Introdução: A doença coronavírus 2019 (COVID-19) é uma infecção respiratória causada pelo coronavírus 2 da síndrome respiratória aguda grave (SARS-CoV-2), com uma gravidade dos sintomas que varia de uma doença leve a uma pneumonia viral grave que leva à síndrome do desconforto respiratório agudo potencialmente fatal. Os sintomas mais comuns são: febre, tosse, dispneia, mialgia e cansaço. A taxa de letalidade é baixa nas faixas etárias mais baixas e aumenta após os 60 anos de idade. Alguns estudos apontam que o vírus SARS-CoV-2 pode sobreviver em superfícies por vários dias, dependendo do tipo, temperatura ou umidade do ambiente. Os serviços de saúde, enquanto serviços essenciais, devem ter o cuidado excepcional para evitar a contaminação dos equipamentos, pacientes e profissionais. Em tempos de pandemia, tomar medidas que garantam a prevenção, a minimização ou a eliminação de riscos à saúde é fundamental. Por décadas, as normas relativas à biossegurança foram negligenciadas, mas, com o advento da COVID-19, medidas básicas estão sendo reconsideradas, principalmente no que diz respeito aos cuidados necessários para a minimização dos riscos biológicos ao profissional da saúde. A Agência Nacional de Vigilância Sanitária (ANVISA) define a Biossegurança como um conjunto de medidas técnicas que são de suma importância durante a manipulação de agentes e materiais biológicos. Inúmeras são as ações de controle que estão sendo reforçadas a partir das experiências de outros países e da experiência de saúde acumulada em tratamento de outras doenças respiratórias que apresentam meios de transmissão semelhante ao da COVID-19. Objetivo: Descrever as medidas de biossegurança utilizadas para prevenção da Covid 19;Contribuir com a construção de conhecimento sobre a Covid 19. Metodologia: Assim, baseados nestas experiências, faremos um relato de experiência das ações que foram tomadas para mitigar o efeito da COVID-19 em profissionais de saúde de um Hemocentro de Fortaleza. As medidas de enfretamento ao Covid 19 foram correlacionadas em cinco tópicos: Biossegurança e Trabalhador, Comunicação, Portas de Entrada, Doadores/ Pacientes e Insumos e EPIs. Conclusão: Os estudos e autoridades sanitárias de saúde mundial, nacional, estadual e municipal ainda não indicam um período para finalização da pandemia provocada pelo novo coronavírus. A importância de elaborar um Plano de Biossegurança veio garantir a segurança dos profissionais bem como pacientes/ doadores que precisam de atendimento no serviço. O trabalho de educação em saúde deve ser permanente visto que a doença vem sendo estudada e que pouco se sabe. As novas evidências apontam para cepas variantes fazendo com que as medidas de precauções não cessem e que os cuidados sejam redobrados, contínuos e regados de conscientização acerca das medidas sociais de minimização de contaminação.
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Introdução: Anemias carenciais são patologias de alta prevalência dentre as doenças da série vermelha, o qual a Deficiência de Vitamina B12 se destaca na sua pluralidade de sintomas clínicos. Objetivos: Relatar caso de paciente internada por Covid-19 com quadro clínico grave de anemia, paraparesia e psicose por Deficiência de B12. Relato de caso: Paciente sexo Feminino, 45 anos, sem comorbidades prévias, internada em junho/2021 em enfermaria Covid-19 devido sintomas respiratórios altos com teste Rápido sorológico por método imunocromatográfico positivo. Iniciou há 08 meses quadro progressivo de astenia, parestesia de membros inferiores, evoluindo progressivamente para paraparesia, associado nos últimos 02 meses com quadro de embotamento, alucinações visuais e sonoras, déficit cognitivo e retenção urinária. Em hemograma prévio a internação apresenta resultado: HB 6,0. Ht 17,9%, VCM 111,9. HCM 37,5;CHCM 37,5;RDW 18,5%;Leucócitos: 2800;BAST: 2%;SEGMEN: 40%;LINF 56%;EOSI 1%;MONO: 1%;PLAQ 149.000;DHL 1.920U/L;PCR 12,7. FERRITINA 339 ALT: 23, AST: 31. MAGNÉSIO 1,7. SÓDIO 146. POTASSIO 4,5;FOSFORO 3,49;CALCIO TOTAL: 8,61;CLORO: 98;UREIA 25. CREAT 0,46. Foi solicitado dosagem de VIT B12 e ácido fólico, demonstrado seguintes resultados: Acido fólico sérico >20 ng/mL. Vitamina B12 sérica: < 50,00 pg/mL. Foi iniciado reposição na primeira semana com Cobalamina 15.000ui divididas em 03 doses em dias alternados, posteriormente com 5.000ui/semana. Sua resposta ao tratamento na primeira semana foi a normalização da contagem de plaquetas e de leucócitos (177.000 e 5050 respectivamente), melhora dos sintomas psiquiátricos e neuro cognitivo, e breve melhora da parestesia e paraparesia de membros inferiores. A paciente foi encaminhada para Endoscopia Digestiva Alta e Ressonância Magnética de Coluna Lombossacra em sua alta da enfermaria Covid-19 para investigação etiológica Discussão: Diante do contexto da Pandemia Covid-19, a investigação de sinais e sintomas clínicos não compatíveis com a infecção em uma internação, torna-se importante para o atendimento integral ao paciente, reconhecendo e investigando diagnósticos diferenciais que podem coexistir. Em meio aos sintomas psiquiátricos e neurológicos, a investigação de Deficiência de Vitamina B12 entra como importante hipótese diagnóstica diante de alterações hematológicas associado ao quadro clínico. Conclusão: no contexto da Pandemia, vários diagnósticos podem ser elucidados em meio a coexistência de infecção por Covid-19.
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The COVID-19 pandemic has affected people's lives as well as the economies of several countries, the health, education, and transportation sectors, among others. To try to contain the spread of the virus, several countries have implemented health barriers at airports, bus stations, stations, company entrance halls, and other shared spaces to detect patients with any symptom of the viral infection. Since fever is one of the most recurrent symptoms of the disease, a rush to the markets for devices to measure body temperature has begun. Thermal imaging cameras, also known as thermal imagers, are other devices used to measure temperature, employing technology known as infrared thermography, a non-invasive, fast and objective tool. In this study, we applied machine learning transfer on YOLO to detect the hottest regions of the human face in thermographic images, allowing the identification of feverish state in humans. To do this, the artificial intelligence algorithms detect the regions of interest in thermographic images, which are: the eyes, forehead and ears, and then the temperatures in these regions are analyzed. The developed software showed excellent performance in detecting the established regions of interest, which adequately indicates the maximum temperature within the regions of interest, and that the choice of the maximum temperature method was adequate.
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The social isolation instituted as a way of narrowing the transmission of Covid-19 is closely related to the increase in cases of domestic violence. The elaborated article aims to highlight factors that favor violent acts in the pandemic, with no intention of justifying any type of crime. The groups most affected by the context of confinement and violence are children, women and the elderly, as the existing fragility has gained elements susceptible to oppression, among them, the distance from the support network. The method included bibliographic searches in several databases, mainly in articles published from 2020 associated with Covid-19. In short, it highlights the need for information on actions capable of minimizing or extinguishing abusive acts in vulnerable populations.
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Covid-19's pandemic expansion to more than 100 countries around the world has prompted several governments to enact restrictive social mobility measures, known as 'social isolation'. Associated with this fact, a disease with the possibility of causing serious complications generates fear, anxiety and stress. This new scenario, as a side effect, could cause the development or worsening of several psychiatric syndromes. The entire population is touched by the context of a pandemic, but the frontline professionals is a group at risk for the development of psychopathologies associated with exhaustion, frustrations and feelings of helplessness in the face of the increased demands imposed on the health area. Although the relationship between the pandemic and the repercussions for mental health proposed in this work is an extremely relevant topic, it is known that further studies are still needed. This information can be corroborated by the fact that it is still a new disease, which needs further studies in several aspects. Due to this lack, the present study searched for relevant information in several digital libraries, in order to integrate data on the theme addressed.
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Introduction: Pulmonary embolism (PE) is a recognized complication of SARS-COV2 infection due to hypercoagulability. Before the COVID era, the need for computed tomography pulmonary angiography (CTPA) to rule out PE was determined by clinical probability, based on Wells and Geneva scores, in association with D-dimer measurements. However, patients with SARS-COV2 infection have a pro-thrombotic and pro-inflammatory state which may compromise the usefulness of these algorithms to select patients for CTPA. Purpose: To evaluate the accuracy of the Wells and Geneva scores to predict PE in patients with SARS-COV2 infection. Methods: Retrospective study of consecutive outpatients with SARS-COV2 infection proved by positive PCR who underwent CTPA due to suspected PE. The Wells and Geneva scores were calculated and the area under the curve (AUC) of the receiver operating characteristic curve was measured. Results: We enrolled 235 patients (61% males, mean age 69.10 ± 16.69 years) and the incidence of pulmonary embolism was 15% (35 patients). In patients with PE, emboli were located mainly in segmental arteries (60%) and bilaterally (46%). Patients with PE were older (mean age 75.06 ± 2.23 vs. 68.06 ± 1.21 years, p = 0.022), and did not differ in sex or risk factors for thromboembolic diseases from the non- PE group. Patients with PE had higher D-dimer levels (median 15.41 mg/dl, IQR 1.17 - 20.00) compared to patients without PE (median 5.99 mg/dl, IQR 0.47 - 2.82, p < 0.001). There was no statically significant difference between the average Wells score in patients with PE and without PE (1.04 and 0.89 respectively, p = 0.733) and the AUC demonstrated that the Wells score had no discriminatory power (AUC = 0.52). Within patients with PE, 19 patients had a Wells score of zero. Regarding the Geneva score, there was also no difference between the average score in patients with and without PE (4.20 vs 3.93 respectively, p = 0.420). AUC for Geneva score was 0.54. Clinical probability combined with D-dimer measurement had a 100% sensitivity for both Wells and Geneva scores, but a specificity of 10% and 11%, respectively. Conclusion: PE diagnosis may be challenging in patients with SARS-COV2 infection since both conditions may have similar signs and symptoms and may be associated with increased D-dimers. According to our results, traditional clinical prediction scores have little discriminatory power in these patients and a higher D-dimer cut-off should be considered to better select patients for CTPA to minimize radiation exposure and contrast-related complications in COVID-19 patients.
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The design and production of protective equipment by makers was among the many actions undertaken by society in the fight against the COVID-19 pandemic. These decentralized initiatives sought to solve a low supply of medical inputs and individual protection devices by sharing these devices through online repositories. However, it is known that personal protective equipment may cause discomfort and pain in situations of prolonged use, even when they are designed and approved through traditional processes. In this context, this paper aims to analyze COVID-19-related protective equipment (PE) models and files shared in online repositories to understand to what extent aspects related to ergonomics, safety and manufacturing were considered in their design and sharing. This study takes an exploratory qualitative and comparative approach. The models’ analysis focused on their description and related information, looking specifically for mentions to ergonomics, safety and manufacturing (model printing and quality) aspects. One hundred models were analyzed, and of these, 60% presented information related to ergonomics and safety, while 80% presented information related to manufacturing. Specifically, the concern in describing the ergonomics and safety aspects was below those related to manufacturing, especially when considering the level of detail of this information. The findings show that developing and sharing solutions, in online, collaborative, and free to use platforms has a great potential to solve the lack of protective equipment, in face of extreme situations. However, this initiative should be better understood and directed to reduce possible comfort and effectiveness problems that may arise from poor information and design of the devices. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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In 2020, the world experienced its very first pandemic of the globalized era. A novel coronavirus, SARS-CoV-2, is the causative agent of severe pneumonia and has rapidly spread through many nations, crashing health systems and leading a large number of people to death. In Brazil, the emergence of local epidemics in major metropolitan areas has always been a concern. In a vast and heterogeneous country, with regional disparities and climate diversity, several factors can modulate the dynamics of COVID-19. What should be the scenario for inner Brazil, and what can we do to control infection transmission in each of these locations? Here, a mathematical model is proposed to simulate disease transmission among individuals in several scenarios, differing by abiotic factors, social-economic factors, and effectiveness of mitigation strategies. The disease control relies on keeping all individuals' social distancing and detecting, followed by isolating, infected ones. The model reinforces social distancing as the most efficient method to control disease transmission. Moreover, it also shows that improving the detection and isolation of infected individuals can loosen this mitigation strategy. Finally, the effectiveness of control may be different across the country, and understanding it can help set up public health strategies.
Asunto(s)
COVID-19/transmisión , Modelos Teóricos , Brasil/epidemiología , COVID-19/epidemiología , COVID-19/patología , COVID-19/virología , Análisis por Conglomerados , Humanos , Pandemias , Distanciamiento Físico , Salud Pública , Cuarentena , SARS-CoV-2/aislamiento & purificaciónRESUMEN
We investigate the spreading of SARS-CoV-2 in the state of Alagoas, northeast of Brazil, via an adaptive susceptible-infected-removed (SIR) model featuring dynamic recuperation and propagation rates. Input parameters are defined based on data made available by Alagoas Secretary of Health from April 19, 2020 on. We provide with the evolution of the basic reproduction number R-0 and reproduce the historical series of the number of confirmed cases with less than 10% error. We offer predictions, from November 16 forward, over the epidemic situation in the near future and show that it will keep decelerating. Furthermore, the same model can be used to study the epidemic dynamics in other countries with great easiness and accuracy.