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Background: Vaccination plays an essential role in controlling SARS-CoV- 2 pandemics. Due to initial concerns about hypersensitivity reactions (HR) to these new vaccines, our department, in articulation with Primary Healthcare Services (PHS) has developed several strategies to support COVID-19 vaccination. This work aims to describe those strategies and report the results. Method(s): The strategies developed for COVID-19 vaccination, from March to December 2021, included: 1) telephone support for health professionals (TS for HP) from the Vaccination Centres (VC), 2) priority appointments (PA) of patients classified as a higher risk for HR, 3) hospital vaccination of high-risk patients as defined by the national health authority. A retrospective and descriptive analysis of the support activity developed and from the data of patients vaccinated at the hospital in the same period were performed. Result(s): During the considered period, our department screened 1618 patients: 420 (26%) through telephone support for HP (TS for HP) from VC and 1198 (74%) at priority appointments (PA). After TS for HP, community vaccination (CV) was recommended in 87% (n = 364) of cases and a PA was advised in 13% (n = 56). Of the patients evaluated in PA, 80% were recommended CV, with restriction of the vaccine to administer in 28% of them. We always found an option to vaccine all. At the hospital were vaccinated 178 patients, 83% (n = 147) women, median age (P25-75) 61 (46-76) years. Hospital vaccination criteria were: past history of multiple drug HR (n = 93;52%), HR to vaccines (n = 46;26%), HR to the 1st dose of anti-SARS- CoV- 2 vaccine (n = 30;17%), idiopathic anaphylaxis (n = 10;6%) and systemic mastocytosis (n = 2;1%). 15% of patients (n = 26) performed skin tests with vaccines, which were negative in 25 and inconclusive in 1 case. 145 (82%) were first shots, 32 (18%) second shots, and one booster shot. Only one patient had a mild immediate reaction (2nd booster vaccination), promptly treated with antihistamine and corticosteroid. Conclusion(s): The collaboration strategies adopted by our department allowed the vaccination of 1618 patients and avoided vaccination delays in most of the VC contacts. In our sample, hospital vaccination of patients at higher risk for HR was safe.
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In this study, we evaluated the differences between national and local newspapers coverage of the COVID-19 pandemic in Spain using a dataset of 421,438 Facebook posts. We assessed the trends in the interest in COVID-19 of local and national newspapers, measured as the proportion of COVID-19 news;and also, the trends in the interest of their readers, measured as the proportion of interactions related to COVID-19. While the overall interest in COVID-19 in local and national newspapers was similar and high, some differences were observed between several of the pandemic phases. National news media interest was higher during the long central phases of the pandemic, but certain news fatigue was observed by the end of 2021. Local news media interest seemed more constant throughout the pandemic. Surprisingly, the overall interest of national and local newspapers was consistently lower than the interest of their readers. Our study also shows homogenous responses among local newspapers during the key phases of the pandemic and heterogeneous responses in the remaining phases. Finally, we found that in the case of local media, their news and interactions were more correlated with the national epidemiological indicators (i.e., cases and deaths) than with the local indicators. © 2023 Informa UK Limited, trading as Taylor & Francis Group.
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Background: Coronavirus disease 2019 (COVID-19) was classified by WHO as a global pandemic, and has gone on to affect millions of people worldwide with severe social and economic consequences. Purpose(s): Due to the global crisis the international community has been facing, many people leave their homes to have access to the medicines they needed. Moreover, many Portuguese households lost their source of income, being in a very difficult situation. Abem: Emergency COVID-19 aims to help the economic deprived citizens to have access to the medicines, health products and healthcare services they need. Method(s): Citizens in an unexpected situation of economic shortage due to the COVID-19 pandemic could be referred by local entities (Municipalities and Institutions of Social Solidarity) to be given access to their medications from local pharmacies. The beneficiaries belonging to risk groups received the medicines at their homes, through an articulation between our partners: pharmacies and local referral entities. Its transportation, articulated by pharmacies, was paid for by this initiative. The medicines and healthcare services were paid for by a Solidary Fund, to which many companies and citizens have contributed. Result(s): The Abem: Emergency COVID-19 are putting efforts in place to present effective results by the time we present the poster at the FIP Virtual 2020. Conclusion(s): This support shows the importance of pharmacies in their communities, as well as their synergic involvement with other partners, such as referral entities (Municipalities and Institutions of Social Solidarity), ANF, AFP, APIFARMA, ADIFA, Plataforma Saude em Dialogo and other local entities helping citizens in need.
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Introduction: SARS-CoV-2 infection may lead to the development of the novel coronavirus disease (COVID-19). Scarce data is available regarding safety and efficacy of SARS-CoV-2 vaccination in IBD patients, which may present differences between subgroups. Lower immunological response could require an additional booster injection. Aims & Methods: Prospective study including adult patients with IBD after complete vaccination against SARS-COV-2 infection with BioNTech vaccine. Patients with previous SARS-COV-2 infection were excluded. A control group with healthy individuals matched for age and sex was also analyzed. Blood samples were collected 30 days after complete vaccination to quantify IgG antibody titers against SARS-CoV-2 in both groups. Result(s): Final sample included 81 IBD and 32 non-IBD patients, 55(48.7%) of them females, with a mean age of 40.2+/-13.0 years. From IBD patients, 58(71.6%) had CD and 23(28.4%) UC. IBD patients had significantly lower median anti-SARS-COV-2 IgG levels when compared to the control group (6479, IQR-10053 vs 13061, IQR-15539 AU/mL;p=0.003). Regarding IBD medication, significant lower levels of SARS-COV-2 IgG antibodies when compared to controls where observed in patients under thiopurines (5423, IQR-10260 AU/mL;p=0.011);methotrexate (834, IQR-4155 AU/mL;p=0.002);infliximab (5294, IQR-10392 AU/mL;p=0.001);and corticosteroids (548, IQR-n/a AU/mL;p=0.001). The incidence of SARS-CoV-2 infection after vaccination was also significantly higher in each of these treatments - healthy controls 25% vs thiopurines 50% (p=0.025), infliximab 43.8% (p=0.048), methotrexate 75% (p=0.041) and corticosteroids 100% (p=0.027). Conclusion(s): IBD patients under Immunomodulators, infliximab and corticosteroid treatment presented significantly lower anti-SARS-COV-2 IgG levels 30 days following complete vaccination when compared to healthy controls. These findings could support the benefit of an additional booster injection in this population.
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Background: The severe acute respiratory syndrome coronavirus, 2 (SARS-COV-2) infection may lead to the development of the novel coronavirus disease, 2019 (COVID-19). Currently, little to no data is available regarding safety and efficacy of SARS-COV-2 vaccination in Inflammatory Bowel Disease (IBD) patients, which may present differences between subgroups, as these patients may exhibit impaired innate and adaptive immune system responses. Lower immunological response could, in this specific population, require an additional booster injection. Methods: We conducted a prospective study including adult patients with Crohn's disease (CD) and Ulcerative Colitis (UC) who have undergone complete vaccination against SARS-COV-2 infection with BioNTech® vaccine. Patients with previous SARS-COV-2 infection were excluded. Medical data regarding age, sex, IBD classification and current medication for IBD were collected. A control group with healthy individuals matched for age and sex was also analyzed. Blood samples were collected, 30 days after complete vaccination to quantify IgG antibody titers for SARS-COV-2 in both groups (IBD and non-IBD). Results: Our final sample included, 81 IBD and, 32 non-IBD patients, 55 (48.7%) of them females, with a mean age of, 40.2±13.0 years. From the IBD patients, 58(71.6%) had CD and, 23(28.4%) had UC. IBD patients had significantly lower anti-SARS-COV-2 IgG levels when compared to the control group (8950±9366 vs, 14834±11679 AU/mL;p=0.003). Regarding IBD medication, significant lower levels of SARS-COV-2 IgG antibodies when compared to control patients were found in patients under thiopurines (9074±9779 AU/mL;p=0.011);methotrexate (1987±2568 AU/mL;p=0.002);infliximab (7208±7276 AU/ mL;p=0.001);and corticosteroids (1065±933 AU/mL;p=0.001). Additionally, patients under combined therapy (infliximab plus thiopurines) presented with significantly lower antibodies titers when compared to patients treated with thiopurines in monotherapy (8130±11048 vs, 10563±5680 AU/mL;p=0.039). No significant differences were found in IBD patients under salicylates (10195±7371 AU/mL;p=0.226);adalimumab (15644±21467 AU/mL;p=0.336);vedolizumab (10464±9087 AU/mL;p=0.286) and ustekinumab (11366±10016 AU/mL;p=0.390). Conclusion: IBD patients presented with significantly lower anti- SARS-COV-2 IgG levels, 1 month after complete vaccination against SARS-COV-2 infection compared to healthy controls. Thiopurines, methotrexate, infliximab and corticosteroid treatment were associated with significantly lower antibodies levels. These findings may express the benefit of an additional booster injection in this population.
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TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: COVID19 leads to Acute Respiratory Failure (ARF) with dyspnea and respiratory exhaustion, ultimately progressing to Acute Respiratory Distress Syndrome (ARDS). The authors present a case of an awake proning/reposition (APR) strategy in a patient with COVID19-ARF. CASE PRESENTATION: A 65-year-old man was admitted for severe COVID19 in February, 2021. At presentation, he was dyspneic on the 10th disease day, had mild hypoxemia and mild systemic inflammation. Immediately, dexamethasone 6mg qd, prophylactic anticoagulation and conventional oxygen therapy (COT) were started. In the first 48 hours, ARF kept worsening and increasing COT demand was needed. APR was started, leading to hypoxemia and polypnea improvement. The patient was ultimately transferred to the Intensive Care Unit (ICU), where non-invasive-ventilation (NIV) and APR were maintained for one week and invasive ventilation (IV) avoided. After twenty days of hospitalization, the patient was discharged without COT. DISCUSSION: Proning position (PP) is an already largely diffused strategy in ICU patients, which improves ARF and prevents ARDS and IV. Supine position leads to dorsal alveoli atelectasis by causing direct (compression) and indirect (over-inflation of ventral alveoli) pressure, which ultimately leads to V/Q mismatch. PP improves V/Q mismatch, reduces shunt and recruits posterior alveoli. APR is a PP strategy in awake/conscious patients, which improves oxygenation and dyspnea, and maybe prevents IV. APR can be autonomously achieved, which can be relevant during a pandemic context. CONCLUSIONS: APR leads to oxygenation and respiratory comfort improvement, possibly improving COVID19 prognosis and avoiding IV. Moreover, it may become a standard of care in ARF by other acute respiratory diseases. DISCLOSURE: Nothing to declare. KEYWORD: Awake proning
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Background: According to current evidence, the lungs are the most affected organ in SARS-CoV-2 infection. Recent data shows impairment of carbon monoxide diffusing capacity, decreased total lung capacity, and restrictive ventilatory defect in COVID-19 adult patients. Data in children are lacking. Our goal was to characterize clinically and demographically the pediatric population with asthma that tested positive for SARS-CoV-2 in our hospital during 2020 and evaluate the pulmonary function after the infection. Method: Cross-sectional study performed in Hospital Dona Estefânia, from March 2nd to December 31st, 2020. All pediatric asthmatic patients (<18 years) who tested positive for SARS-CoV-2 (RT-PCR test) were included. Asthma diagnosis was based on a previous physician's diagnosis or parent-reported history. A convenience sample of the asthmatic patients performed spirometry and carbon monoxide diffusing capacity (DLCO). Results: We were able to identify 20 asthmatic patients [50% male;median age: 10.5 years old (P25- 75: 9- 14.5)]. Atopic comorbidities were present in 75% ( n = 15) (rhinitis the most frequent). According to GINA, 11 (55%) had mild and 9 (45%) moderate asthma. Five patients (25%) needed hospital admission because of COVID-19 infection, 3 had asthma exacerbation, and 3 had COVID-19 pneumonia. Nine of the 20 patients performed spirometry and DLCO after COVID-19 infection. Respiratory function was performed few months after the infection [median=3 months (P25- 75: 2- 6.5)]. In our sample, we found 2 patients with obstructive ventilation impairment and small airway dysfunction. We didn't find any statistically significant difference between de FVC, FEV1, FEV1/FVC ratio, FEF25- 75, and peak expiratory flow (PEF) before and after COVID-19 infection. There were 2 asthmatics with impaired DLCO (65.1% and 64.7%). Conclusion: Two patients showed obstructive ventilation, but it could be due to the variable airflow limitation of asthma, and 2 had DLCO impairment. We didn't find any statistically significant difference between respiratory function before and after COVID-19 infection. However, this is a small sample, and further evaluations with larger populations are needed.
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Purpose: This study aims to provide a better understanding of the behaviour of wine consumers in a completely new and unexpected setting, that is, a forced lockdown due to the COVID-19 pandemic. It seeks to explain consumer decisions and the probability of changes occurring in wine expenditure compared to a normal situation. Design/methodology/approach: The empirical analysis, conducted on a representative sample of Iberian consumers and based on the random utility theory, consists in the application of a multinomial logit model, setting the “usual” pattern of expenditure as a baseline category. Findings: The results show that the coronavirus pandemic could have changed alcohol drinking habits. Consumers generally spent less on wine during the lockdown, maybe due to the uncertainty regarding their future income and professional situation. Those people more likely to spend more on wine were those who increased their wine consumption during the lockdown, those who drank for romantic purposes, those who purchased less wine in supermarkets but more online, those who used a wine app and those living in urban areas. The increased consumption of other alcoholic beverages also increases the probability of spending less than usual on wine. Additionally, the absence of certain reasons for drinking wine other than social purposes, such as wine and food pairing, its taste and relaxing effects, together with the previous consumption pattern leads to a decrease in the probability of spending less per bottle. Originality/value: This paper makes a significant contribution to the understanding of the determinants of wine consumption in a very abnormal setting, an imposed lockdown and provides important policy implications. The findings show that managers and policymakers should pay attention to the different influence of variables related to behaviour and consumption patterns that may contribute to an increase in the demand for less expensive wines. Specifically, they should focus on new consumption patterns that may arise, adapting the supply chain and defining appropriate marketing strategies to fill new market segments. © 2021, Emerald Publishing Limited.
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Introducao: A pandemia da Covid-19 pelo novo coronavirus (SARS-CoV-2) tem se apresentado como um dos maiores desafios sanitarios deste seculo. A falta de conhecimento cientifico sobre o virus, sua alta velocidade de disseminacao e capacidade de provocar mortes em populacoes vulneraveis geram incertezas sobre quais seriam as melhores estrategias a serem utilizadas para o enfrentamento da epidemia em populacoes com condicoes clinicas especificas. Pacientes com doenca falciforme (DF) sao considerados grupo de risco para desfechos desfavoraveis, devido a asplenia funcional e pelo risco de desenvolverem lesoes de isquemia-reperfusao em varios orgaos. Alem disso, a complicacao aguda mais grave e com alta taxa de mortalidade e a sindrome toracica aguda (STA), que pode ocorrer associada a infeccoes respiratorias. Nesse contexto, relatamos a nossa experiencia com oito pacientes que foram atendidos no Hospital das Clinicas de Ribeirao Preto - SP. Objetivo: Descrever o comportamento da infeccao por SARS-CoV-2 em pacientes falciformes. Materiais e metodos: Foram realizados revisao de prontuario e analise descritiva do desfecho da infeccao por Covid-19 em oito8 pacientes que fazem seguimento em nosso servico. Resultados: Dos oito pacientes avaliados, seis eram do sexo feminino (75%), apresentam mediana de idade de 30,5 (variando de 28 a 45 anos), quatro pacientes apresentavamm genotipo SS (50%), dois com genotipo SC (25%), um com genotipo SBETA0 (12,5%) e um com genotipo SBETA+ (12,5%). Em relacao ao tratamento da doenca de base, quatro pacientes (50%) estavam em uso de hidroxiureia, dois (25%) estavam em regime de transfusoes cronicas, um (12,5%) participava de estudo clinico e um realizava apenas seguimento ambulatorial. Dos oito pacientes, quatro (50%) tinham antecedente de STA e crises vaso-oclusivas, dois (25%) de vasculopatia cerebral e um (12,5%) apenas com antecedente de crises vaso-oclusivas. Todos os pacientes foram diagnosticados com infeccao por Covid-19 por meio de swab nasal com realizacao de RT-PCR. Foi necessario internacao em sete casos (87,5%), dos quais apenas um (14,2%) paciente precisou de Unidade de Terapia Intensiva e ventilacao mecanica. Porem, esse unico paciente realizou tres RT-PCRs para SARS-CoV-2 durante internacao, sendo apenas o ultimo positivo, no contexto de extubacao e melhora clinica, podendo se tratar de falso-negativo ou paciente ter adquirido Covid-19 durante a internacao ocasionada por STA. O tempo de internacao apresentou mediana de cinco dias (variando de 4 a 10 dias). Em relacao ao tratamento, seis (75%) receberam suplementacao com oxigenio, quatro (50%) receberam corticoide e seis (75%) receberam antibioticoterapia. Dentre as internacoes, cinco pacientes (71,4%) receberam transfusao sanguinea, e todos receberam hidratacao intravenosa e anticoagulacao profilatica. Durante a evolucao do quadro, cinco (62,5%) pacientes preencheram criterios para STA e tres (37,5%) pacientes apresentaram apenas crise vaso-oclusiva;um dos pacientes com STA evoluiu com tromboembolismo pulmonar bilateral durante a internacao. Nao houve nenhum obito. Discussao: Ao contrario do que todos esperavam, visto contexto de inflamacao cronica e imunossupressao nessa populacao de pacientes, a nossa experiencia mostrou que a infeccao por Covid-19 nos doentes falciformes parece apresentar uma evolucao benigna, com baixa mortalidade. Conclusao: Sao necessarios mais estudos clinicos para que possamos entender melhor a evolucao da infeccao por Covid-19 em pacientes com doenca falciforme.Copyright © 2020
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Aim of study: This study aims to analyse how psychological factors related to the Covid-19 lockdown affected the frequency of wine consumption among Iberian consumers. Area of study: To achieve this goal, we used data collected from an online survey in Europe comprising 4489 observations from Portuguese and Spanish samples. Material and methods: Using an ordered probit model, we analysed the wine consumption frequency as a function of a set of explanatory variables related to psychological factors and also sociodemographic variables, motivation-related variables and consumption characterisation. Main results: For Spanish respondents the fear of isolation was a decisive factor in increasing the probability of a higher frequency of wine consumption. Meanwhile, in Portugal, the fear of an economic crisis was the psychological factor leading to a higher consumption frequency. Research highlights: In both countries, psychological factors influenced the frequency of wine consumption during the lockdown due to Covid-19. However, the impact of the Covid-19 crisis has been felt differently in Spain and Portugal. Differences can be observed in both psychological and behavioural attitudes that have influenced the frequency of wine consumption and could also indicate significant cultural differences.
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Aims An outbreak of coronavirus disease 19 (COVID-19) has altered the dynamic of endoscopic practices. Many guidelines, questionnaires have been published addressing service resumption during the pandemic. Curious about the situation indifferent endoscopic units across the globe, the study was designed to evaluate different aspects of practice resumptionworldwide and their adherence to guidelines. Methods An online questionnaire was created and distributed by national/regional representatives and societies. Redcapplatform was used as the interface;afterwards, Microsoft Excel 2016 and Prism 5 were utilized for data analysis. Results From a total of 307 responses from 47 countries/regions was collected, 290 valid answers were analyzed. Almosthalf (47 %) were in post-peak period by August, 2020. Many units were not designated to be COVID-oriented facility. About15.5 % of centers remained unrecovered, mainly in North and South America;those were recovered, training was still withheld significantly. Nevertheless, opened centers kept safety measurements strictly. Patient load was decreased by 37 %,but waiting list was increased 0-25 %. Among many surveillance methods, body temperature, PCR and chest CT were themost common. 74.8 % increased post-procedural disinfection time and 68.2 % increase in per-case inspection were noted.PPE usage was implemented highly and shortage of these posed as one of the resumption barriers. Post-procedural patientsurveillance was not reinforced. Conclusions The study represented real-time global endoscopic service's adaptation to COVID-19 pandemic. Previouslypublished barriers upon practice resumption remained. Despite Delphi consensus' emphasis on post-procedural surveillance, application was not widely reinforced, raising concerns in disease control.
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The world is facing a pandemic of unseen proportions caused by a corona virus named SARS-CoV-2 with unprecedent worldwide measures being taken to tackle its contagion. Person-to-person transmission is accepted but WHO only considers aerosol transmission when procedures or support treatments that produce aerosol are performed. Transmission mechanisms are not fully understood and there is evidence for an airborne route to be considered, as the virus remains viable in aerosols for at least 3 h and that mask usage was the best intervention to prevent infection. Heating, Ventilation and Air Conditioning Systems (HVAC) are used as a primary infection disease control measure. However, if not correctly used, they may contribute to the transmission/spreading of airborne diseases as proposed in the past for SARS. The authors believe that airborne transmission is possible and that HVAC systems when not adequately used may contribute to the transmission of the virus, as suggested by descriptions from Japan, Germany, and the Diamond Princess Cruise Ship. Previous SARS outbreaks reported at Amoy Gardens, Emergency Rooms and Hotels, also suggested an airborne transmission. Further studies are warranted to confirm our hypotheses but the assumption of such way of transmission would cause a major shift in measures recommended to prevent infection such as the disseminated use of masks and structural changes to hospital and other facilities with HVAC systems.