Long-term functional outcome of severe COVID19 pneumonia treated with venovenous extracorporeal membrane oxygenation support - learnings from a single centre

Objectives: Implementation of venovenous extracorporeal membrane oxygenation (VVECMO) allowed survival of patients with severe respiratory failure associated with SARS-CoV-2 infection. However, VVECMO treatment is usually associated with long ICU stays, prolonged sedation, and neuromuscular blockage days. Functional disability, due to delirium and acquired muscle weakness, is frequently an inevitable burden causing long term disability. This study aims to analyse main characteristics of patients under ECMO due to COVID-19 pneumonia, their outcomes and functional status six months after ICU discharge. Method(s): Retrospective review of a prospectively collected database in an ECMO referral centre. All patients receiving VVECMO for SARS-CoV-2 infection were included. Epidemiological and clinical data were reviewed. Functional status at 6 months after ICU discharge was assessed with modified Rankin Scale (mRS). Result(s): Ninety-three patients were included (29% female). Median age was 54+/-12 years, mean SOFA was 5.7+/-2.9, mean SAPS II was 35.6+/-13.6. Mean time from intubation to cannulation was 5+/-5.6 days in 91 patients;awake-ECMO was performed in 2 patients. Mean ECMO run duration was 33.1+/-30 days (longest ECMO run was 194 days). A period of awake-ECMO was performed on 36.5% of patients, during 16.4+/-21.2 days. ICU-acquired weakness was diagnosed on 64.5% of patients and delirium on 63.4%. Mortality was 24.7% (23 patients) with only 1 patient deceased in hospital after ICU discharge. At 6 months follow-up, all patients were still alive and most of them (65.1%) were independent on all daily activities (mRS <= 2). Conclusion(s): Patients with severe COVID-19 treated with VVECMO support had very good functional outcomes at six-month follow-up. Despite long ICU length-of-stay, high incidence of delirium and acquired muscle weakness, full recovery at six-month post-ICU discharge was achievable in most patients.

Membrane dysfunction in patients with severe COVID-19 treated with venovenous extracorporeal membrane oxygenation - analysis from a pooled data from a single centre

Objectives: It is well known that severe COVID-19 is associated with complex immunological and inflammatory dysregulation. Both these physiopathological events translate to a high risk of major thrombotic or hemorrhagic events. In patients treated with venovenous extracorporeal membrane oxygenation (VVECMO), membrane dysfunction might affect systemic oxygenation and limit its duration-expectancy. This study aimed to assess the possible causes of extracorporeal membrane failure in COVID-19 patients and its impact on outcome. Method(s): Retrospective, single-center, observational case-control study involving adult COVID-19 patients admitted to an ECMO referral centre in a tertiary university hospital. All patients required VVECMO for acute respiratory failure, including 48 cases who needed one or more extracorporeal membrane exchanges and 45 controls (no membrane exchange). These two groups were compared for demographic characteristics, severity of the disease using validated scores (SAPS II and SOFA), duration of ECMO run, coagulation assessment, cumulative anticoagulation dose, associated complications, and outcomes (ICU and hospital mortality). Result(s): Most patients were males (71.0%) and younger than 50 years (79.5%). Median ECMO run duration was significantly longer in the case group (35.0 vs 14.0 days, p <0.001), as well as ICU length-of-stay (45.5 vs 28 days, p <0.001). Membrane exchange tended to be associated with sepsis (56% vs 33%, p=0.037), major hemorrhage (58% vs 43%, p=0.022), heparin-induced thrombocytopenia (25% vs 9%, p=0.054), higher D-dimer title (17.36 ng/dL vs 7.5 ng/dL, p=0.07) and lower platelet counts (133.000/muL vs 154.000/muL). Median SAPS II (32.0 vs 33.0, p=0.20) and the mortality (27% vs 24%, p >0.99) were similar between these groups. Conclusion(s): In patients with SARS-CoV-2 pneumonia and severe hypoxemia treated with VVECMO support the emergence of infection, coagulopathy and inflammation were associated with high risk of membrane dysfunction. No impact on mortality could be confirmed from these data. Anticoagulation monitoring and dosing strategies should be reinforced to promote membrane protection.

Determinants of death in patients with COVID-19 pneumonia treated with venovenous extracorporeal membrane oxygenation support

Objectives: Death from SARS-CoV-2 pneumonia resulted from progressive respiratory failure in most patients. Whenever accessible, venovenous extracorporeal membrane oxygenation (VVECMO) was implemented to rescue patients with refractory hypoxemia. Reported mortality in this population reached values from 20 to 50 percent, but the direct causes of death were not so widely acknowledged. The aim of our study was to characterize mortality in patients treated with VVECMO support. Method(s): Retrospective review of a prospectively collected database in an ECMO referral centre. All patients with diagnosis of SARS-CoV-2 infection treated with VVECMO support were included. Survivors and nonsurvivors were compared using t-student and chi2 methods. A Cox regression analysis was performed to identify predictors of mortality at admission. Result(s): Ninety-three patients were included (29% female). Median age was 54+/-12 years, mean SOFA was 5.7+/-2.9 and SAPS II was 35.6+/-13.6. Hospital mortality was 24.7%. Main causes of death were septic shock in 39.1% (9 patients), irreversible lung fibrosis 30.4% (7 patients) and catastrophic hemorrhage in 4.3% (4 patients). End-of-life care measures (withdrawal or withholding) were adopted in 65.2% of non-survivals. Patients who died were older (55 vs 48 years, p<0.05), had longer disease course (19 vs 15.3 days, p<0.05), longer invasive mechanical ventilation course before cannulation (8.5 vs 5 days, p<0.05), lower static lung compliance (25.5 vs 31.8 mL/cmH2O, p<0.05) and were ventilated with lower PEEP (8 vs 10 cmH2O, p<0.05) on cannulation. On a Cox-regression model, only prone ventilation before cannulation (HR 9,7;CI 95% 1,4- 68,6;p<0.05) and SAPS II (HR 1.04;CI 95% 1,001- 1,083;p<0.05) predicted mortality. Conclusion(s): Mortality in patients with severe SARSCoV-2 pneumonia treated with VVECMO was exceedingly low in our study, when compared with other series. Only one-third died from progressive lung disease, which suggests that protocol improvement can further reduce mortality.

Single centre, cross-sectional assessment of airway hemorrhage in a cohort of patients with COVID19-associated ARDS under Venovenous extracorporeal membrane oxygenation

Objectives: Airway hemorrhage (AH) frequently complicates extracorporeal membrane oxygenation (ECMO) treatment. Inflammation, coagulopathy and antithrombotic therapy are contributing factors. Patients with COVID-19- associated ARDS (CARDS) supported with ECMO present all these features. We aim to characterize the incidence and the clinical and prognostic impact of AH. Method(s): Review of a cohort of patients with CARDS treated with ECMO support at a single ECMO centre between March 2020-February 2022 (n=92). AH was defined as a clinically significant hemorrhage fit demanded interruption of anticoagulation, transfusional support or bronchoscopy. Univariate analysis was performed using GraphPadPrism. Result(s): One third (n= 31) of patients with CARDS treated with ECMO had clinically significant AH. Patients who developed AH had significantly longer ICU length-of-stay (LoS), ECMO run and invasive mechanical ventilation (IMV) duration. Significant differences in coagulation and inflammatory markers were detected between patients with early (<72h) versus late (>9 days) onset of AH (Table 1). Mortality at day 90, demographics, comorbidities, CT scan pattern and clinical severity indexes were similar between patients with and without AH (NAH). Conclusion(s): In patients with severe CARDS treated with ECMO support, the occurrence of airway hemorrhage leads to clinically important morbidity but does not increase mortality. Distinct pathways may be involved in the development of early v. late AH. (Table Presented).

Psychometric properties and measurement invariance of a European Portuguese version of the fear of COVID-19 scale

The novelty and uncertainty of the pandemic nourished a gener-alized fear of the COVID-19, which seems to have exacerbated the pan-demic's negative impact. It is thus relevant to monitor fear of COVID-19 and its association with individuals' mental health, well-being, and behav-iors. Valid and reliable measures of fear of COVID-19 are necessary for that purpose. This study aimed at assessing the psychometric properties of a European Portuguese version of the Fear of COVID-19 scale (FCV-19S-P). A secondary aim was to assess FCV-19S-P's multigroup measurement invariance (female vs. male). A sample of 572 Portuguese adults (72 % fe-male) completed the FCV-19S-P and measures of depression, anxiety, and stress. The study results supported this version validity and reliability (Cronbach's alpha = .84;Composite Reliability = .83), and a factorial struc-ture similar to the original version. Fear of COVID-19 was positively asso-ciated (.23 < r < .31) with depression, anxiety, and stress. Results of the multigroup invariance analysis supported the FCV-19S-P total scalar invar-iance and its partial residual invariance, suggesting that this measure may be used to reach valid conclusions in respect to gender comparisons in samples of Portuguese adults in regard to group observed composite means. © 2023, Universidad de Murcia Servicio de Publicaciones. All rights reserved.

Non-depolarizing neuromuscular blockade in patients with severe acute respiratory distress syndrome associated with COVID-19: profile of usage and potential deleterious impact on morbidity and mortality

Introduction: Nondepolarizing neuromuscular blockade (NDMB) is a key intervention to avoid ventilation-induced lung injury in acute respiratory distress syndrome (ARDS). In patients with moderatesevere ARDS associated with SARS-CoV-2 infection (CARDS), NDMB were used for prolonged periods of time, with high cumulative doses. We hypothesize that administration of NDMB might contribute to an increased incidence of risk factors later associated with long COVID-19. Method(s): We designed a non-interventional, retrospective study in a large university urban hospital. From January to December 2021, data related to prescription of NDMB, respiratory physiology, mechanical ventilation (IMV) and clinical outcomes were collected from patients' electronic records with a diagnosis of CARDS. Primary outcome was day-90 mortality. Secondary outcomes were ICU length of stay (LOS), ICU-acquired weakness and days of IMV. Mann-Whitney U test was used to compare continuous variables and logistic regression was used to evaluate the association of NDMB use with outcomes, adjusted or not for confounders. Result(s): 116 patients diagnosed with CARDS were included, 87% with severe ARDS and overall mortality was 37.1%. Median age was 57 years (IQ:47-67) and 65.5% were male. P:F ratio at day-1 was 86 (IQ:43). Ventilator-free days (VFDs) at 28 days was 13 (IQ:0-19) in survivors and ICU-LOS was 19 (IQ:10-36). Median time and cumulative dose of NDMB were, respectively, 117 h and 1177.468 mg in patients who survived (n = 70) compared to 197 h and 1898.775 mg in patients who died (n = 41). In addition to days of NDMB exposure (OR 1.05, CI 95% 1.00-1.11), the cumulative dose of cisatracurium, expressed in logs, was correlated with risk of mortality in the ICU, with odds ratio 1.49 (CI 95% 1.08-2.04). Conclusion(s): Patients with severe forms of CARDS received prolonged infusions of NDMB, with high cumulative doses. Both time of exposure and total doses were independently associated with higher risk of mortality.

COVID-19 in cancer patients: update from the joint analysis of the ESMO-CoCARE, BSMO, and PSMO international databases.

BACKGROUND: COVID-19 has significantly affected patients with cancer and revealed unanticipated challenges in securing optimal cancer care across different disciplines. The European Society for Medical Oncology COVID-19 and CAncer REgistry (ESMO-CoCARE) is an international, real-world database, collecting data on the natural history, management, and outcomes of patients with cancer and SARS-CoV-2 infection. METHODS: This is the 2nd CoCARE analysis, jointly with Belgian (Belgian Society of Medical Oncology, BSMO) and Portuguese (Portuguese Society of Medical Oncology, PSMO) registries, with data from January 2020 to December 2021. The aim is to identify significant prognostic factors for COVID-19 hospitalization and mortality (primary outcomes), as well as intensive care unit admission and overall survival (OS) (secondary outcomes). Subgroup analyses by pandemic phase and vaccination status were carried out. RESULTS: The cohort includes 3294 patients (CoCARE: 2049; BSMO: 928, all hospitalized by eligibility criteria; PSMO: 317), diagnosed in four distinct pandemic phases (January to May 2020: 36%; June to September 2020: 9%; October 2020 to February 2021: 41%; March to December 2021: 12%). COVID-19 hospitalization rate was 54% (CoCARE/PSMO), ICU admission 14%, and COVID-19 mortality 22% (all data). At a 6-month median follow-up, 1013 deaths were recorded with 73% 3-month OS rate. No significant change was observed in COVID-19 mortality among hospitalized patients across the four pandemic phases (30%-33%). Hospitalizations and ICU admission decreased significantly (from 78% to 34% and 16% to 10%, respectively). Among 1522 patients with known vaccination status at COVID-19 diagnosis, 70% were non-vaccinated, 24% had incomplete vaccination, and 7% complete vaccination. Complete vaccination had a protective effect on hospitalization (odds ratio = 0.24; 95% confidence interval [0.14-0.38]), ICU admission (odds ratio = 0.29 [0.09-0.94]), and OS (hazard ratio = 0.39 [0.20-0.76]). In multivariable analyses, COVID-19 hospitalization was associated with patient/cancer characteristics, the first pandemic phase, the presence of COVID-19-related symptoms or inflammatory biomarkers, whereas COVID-19 mortality was significantly higher in symptomatic patients, males, older age, ethnicity other than Asian/Caucasian, Eastern Cooperative Oncology Group performance status ≥2, body mass index <25, hematological malignancy, progressive disease versus no evident disease, and advanced cancer stage. CONCLUSIONS: The updated CoCARE analysis, jointly with BSMO and PSMO, highlights factors that significantly affect COVID-19 outcomes, providing actionable clues for further reducing mortality.

Superior Cerebellar Artery Dissection in a Patient Diagnosed with Reversible Cerebral Vasoconstriction Syndrome: A Case Report

Arterial dissection is an uncommon complication of reversible cerebral vasocon-striction syndrome (RCVS). We describe the case of a 35-year-old woman with a migraine history who presented with recurrent thunderclap headache and focal neurological signs, including right hemiataxia. She had been diagnosed with COVID-19 disease two weeks earlier. Neuroimaging revealed multifocal stenosis of the posterior circulation arteries and dissection of the right superior cerebellar artery. She improved significantly throughout her one-week hospitalization and maintained only mild ataxia. The interplay between COVID-19 disease, RCVS, and arterial dissection requires further investigation.Copyright © Author(s) (or their employer(s)) and Sinapse 2022.

What changed between the peak and plateau periods of the first COVID-19 pandemic wave? A multicentric Portuguese cohort study in intensive care

Objective: To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal. Methods: This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined. Results: Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39;p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136;p = 0.6), antibiotic therapy (57% versus 64%;p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%;p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5];p = 0.002) and presented a higher use of vasopressors (47% versus 36%;p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%;p < 0.001) at admission, prone positioning (45% versus 36%;p = 0.04), and hydroxychloroquine (59% versus 10%;p < 0.001) and lopinavir/ ritonavir (41% versus 10%;p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%;p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau. Conclusion: There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave. © 2023 Associacao de Medicina Intensiva Brasileira - AMIB. All rights reserved.

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.

Olfactory rehabilitation in non-severe COVID-19 patients: a randomized double-blinded clinical trial

Introduction: Olfactory loss is prevalent in SARS-CoV-2 infected patients. Some therapies have been tested to help patients, but both time to symptom recovery and prevalence of full recovery are unknown, and prospective studies testing any method of therapy are rare. Objective(s): Compare olfactory training effectivity in improving smell sense in COVID-19 patients with olfactory loss after acute disease. Method(s): subjects that had olfactory loss during confirmed COVID-19 performed Connecticut Chemosensory Clinical Research Center olfactory test. Those who presented with some grade of olfactory loss were invited to participate this trial, in which they were randomized in 2 groups (olfactory training versus a control group with olfactory training without smell sensation). Patients were evaluated monthly until full olfactory recovery or until 6 months of follow-up. Result(s): among 182 individuals, 149 presented with abnormal olfactory test. 123 patients finished the study (treatment: n=68;control: n=55). Both groups showed olfactory improvement along the follow-up period with significant statistical difference until the second reevaluation (1st-2nd test: p<.001;2nd-3rd test: p<.001;3rd-4th test: p=.08;4th-5th test: p=1;5th-6th test: p=1;6th-7th test: p=1). Olfactory test was significant better at control group at the beginning (p=.001) and persisted until the second reevaluation (p=.004 and p=.009, respectively), in which treatment group had similar test results (p>.05). Conclusion(s): Olfactory training demonstrated good results as treatment modality after COVID-19 smell loss, with significant improvement after 70 days of therapy.

Olfactory dysfunction in COVID-19 according to individuals' perception and olfactory test among health care workers

Introduction: Olfactory disfunction is a common marker for COVID-19 phenotype, mainly, during its acute phase. However, olfactory recovery is a controversial issue which requires further investigation. Objective(s): Verify olfactory dysfunction in health care workers with COVID-19 according to individual perception and Connecticut Chemosensory Clinical Research Center olfactory test (CCCRC OT). Method(s): A cross-sectional study was conducted in health care workers positive for SARS-CoV-2 RT-PCR or serological tests who perceived olfactory dysfunction. Epidemiological and clinical data were extracted, as well as time from loose, test and recovery of olfaction;and the degree of olfactory dysfunction was assessed using individual perception and CCCRC OT. Result(s): A total of 173 participants were included. CCCRC OT was performed approximately 45 days (45.08+/-20.21) after positive test. Participants were allocated into two groups according to CCCRC OT: (G1) 33/173 [19.1%] normal sense of smell;(G2) 140/173 [80.9%] altered sense of smell. The mean time of olfactory dysfunction was lower in the G1 than G2 group (9.42+/-4.99 days vs. 17.14+/- 3.74 days;P<.001);while there were no differences in the other measured moments. Full recovery was reported by 66 (38.2%) individuals, but only 33 (19.1%) individuals showed normal results at CCCRC OT. Conclusion(s): Time for initial olfactory recovery after SARS-CoV-2 infection has proved to be the best prognostic factor for complete recovery. Also, olfactory objective tests are essential for reliable assessment.

Detecting wildlife trafficking in images from online platforms: A test case using deep learning with pangolin images

E-commerce has become a booming market for wildlife trafficking, as online platforms are increasingly more accessible and easier to navigate by sellers, while still lacking adequate supervision. Artificial intelligence models, and specifically deep learning, have been emerging as promising tools for the automated analysis and monitoring of digital online content pertaining to wildlife trade. Here, we used and fine-tuned freely available artificial intelligence models (i.e., convolutional neural networks) to understand the potential of these models to identify instances of wildlife trade. We specifically focused on pangolin species, which are among the most trafficked mammals globally and receiving increasing trade attention since the COVID-19 pandemic. Our convolutional neural networks were trained using online images (available from iNaturalist, Flickr and Google) displaying both traded and non-traded pangolin settings. The trained models showed great performances, being able to identify over 90 % of potential instances of pangolin trade in the considered imagery dataset. These instances included the showcasing of pangolins in popular marketplaces (e.g., wet markets and cages), and the displaying of commonly traded pangolin parts and derivates (e.g., scales) online. Nevertheless, not all instances of pangolin trade could be identified by our models (e.g., in images with dark colours and shaded areas), leaving space for further research developments. The methodological developments and results from this exploratory study represent an advancement in the monitoring of online wildlife trade. Complementing our approach with other forms of online data, such as text, would be a way forward to deliver more robust monitoring tools for online trafficking. © 2023 The Author(s)

Associacao Do Grupo Sanguineo Abo E O Covid-19: Uma Revisao Dos Possiveis Mecanismos Subjacentes

Objetivo: Esta revisao narrativa tem como objetivo resumir a literatura sobre associacoes entre o Grupo sanguineo ABO e COVID-19. Metodologia: Foram selecionados 147 artigos pesquisados entre os anos de 2012 a 2022, usando multiplas combinacoes de palavras chaves nas bases de dados PubMed. Resultados: Dos 147 artigos;40 abordaram sobre grupo ABO e infeccoes;10 sobre a suscetibilidade a infeccao por SARS-CoV-2;25 sobre a gravidade da COVID-19 entre os grupos sanguineos;30 sobre a relacao genetica com suscetibilidade e gravidade;6 abordando a ligacao com o tipo sanguineo ABO e COVID-19 mostrando mecanismos e contribuicoes para a interpretacao de associacoes vistas;14 que relataram a iniciacao da proteina S e interacao das celulas hospedeiras com SARS-CoV-2;e 10 mostrando a relacao do grupo sanguineo ABO e risco cardiovascular em pacientes com COVID-19. Discussao: O grupo sanguineo ABO e conhecido por ser um fator que influencia a suscetibilidade a doencas infecciosas, e muitos estudos tem descrito associacoes entre tipos sanguineos ABO e infeccao e gravidade por COVID-19, com achados conflitantes. O tipo sanguineo O esta associado principalmente a taxas mais baixas de infeccao por SARS-CoV-2, enquanto o tipo sanguineo A e frequentemente descrito como um fator de risco. Embora os resultados sobre o risco de desfechos graves sao mais variaveis, o tipo sanguineo A e o mais associado a gravidade e mortalidade por COVID-19, enquanto muitos estudos descrevem o tipo sanguineo O como fator protetor para a progressao da doenca. Alem disso, associacoes geneticas com tanto o risco de infeccao quanto a gravidade da doenca foram relatados para o locus ABO. Alguns mecanismos subjacentes foram hipotetizados para explicar as associacoes relatadas, com dados experimentais incipientes. Tres hipoteses sao sugeridas: SARS-CoV-2 poderia transportar estruturas semelhantes a ABO(H) em suas glicoproteinas do envelope viral e seriam transmitidos assimetricamente devido a um efeito protetor dos anticorpos ABO. Os antigenos ABH poderiam facilitar a interacao do SARS-CoV-2 com as celulas do hospedeiro e a associacao de tipos sanguineos nao O com maiores riscos de eventos tromboembolicos poderia conferir aos pacientes com COVID-19 com tipo sanguineo O, um risco menor de desfechos graves. Os mecanismos hipoteticos afetariam distintos aspectos da historia natural do COVID-19, com distintas implicacoes potenciais para a transmissao da doenca e seu manejo. Conclusao: um levantamento da literatura de estudos epidemiologicos sugere que a ABO tipo sanguineo pode ser um fator de influencia para a infeccao por SARS-CoV-2 e gravidade da COVID-19. Embora os resultados sejam conflitantes e bastante variavel, o tipo sanguineo O esta associado principalmente ao menor risco de SARS-CoV-2 infeccao, enquanto o tipo sanguineo A, com maior risco. Apesar disso, ha poucos dados experimentais sobre este assunto, mais estudos sao necessarios para elucidar os mecanismos subjacentes as associacoes relatadas, que e fundamental para uma compreensao mais profunda da relacao entre o grupo sanguineo ABO e COVID-19 e se pode ou nao ser traduzido em estrategias de prevencao ou tratamento desta doenca. Copyright © 2022

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

Which effects had the pandemic in migrants’ health and well-being? A mixed-methods approach : Ana Gama

Background The COVID-19 pandemic affected populations’ health, with a disproportionate impact on those most socially vulnerable such as migrants. The way these populations experienced the pandemic lockdowns and its effects on daily life are yet to be known. This study aimed to understand the effects of the pandemic on health and well-being of migrants in Portugal. Methods In a mixed-methods approach, a survey was conducted with a community-based sample of 1126 migrants in the Lisbon Metropolitan Area, assessing sociodemographics, migration-related characteristics and the perceived impact of the pandemic on health. In addition, n = 12 migrants purposively recruited were invited to participate in a photovoice study, sharing photographs about their daily life during the lockdowns. Following semi-structured interviews were conducted. Quantitative data were analysed using multivariable analysis and qualitative data were analysed through content analysis. Results A fifth of the participants perceived having worse health condition since the pandemic, which was more likely among women (OR = 1.58, CI95% 1.13-2.20), those >45 years old (OR = 1.78, CI95% 1.02-3.16), with lower education (Basic education: OR = 1.57, CI95% 1.01-2.47) and with lower monthly income (<EUR 650: OR = 1.69, CI95% 1.18-2.44). Two themes emerged from the photovoice: effects of the pandemic lockdowns on daily life (routines, social relations, work) and on health and well-being (eating habits, physical exercise, leisure). Strategies to cope with the adverse effects included social activation and changes in lifestyles. Conclusions The pandemic had disproportionate effects on some migrant groups, intensifying social and health inequalities, with consequences for their well-being. Participatory methods can contribute to further understand migrants’ experiences while involving and empowering them for health promotion. Key messages • The pandemic had adverse effects on migrants’ health and well-being, disproportionately affecting most socially vulnerable migrant groups. • Participatory research methods as photovoice are valuable to gain access to individual experiences and perspectives, while involving and empowering participants.

Temporal analysis of meningitis and its sociodemographic risk factors in Brazil over the last decade

Background and aims: This paper aims to evaluate the risk factors for hospitalizations for meningitis in Brazil and whether COVID-19 has an influence on this process. Methods: The patients' data is from the Notifiable Diseases Information System of Brazil's Ministry of Health. The lethality and odds ratio analyses were performed in the OpenEpi software using the Taylor Series with an IC95%. The temporal analysis is from January 2010 to November 2021, collected from the Hospitals' Information System of the Unified Health System. The statistical modelling used Gretl software and the US Census Bureau's X-13-ARIMASEATS tool (1.1). The adjustment statistics were calculated using MS Excel. We also checked the influence of COVID- 19 on the subject. Results: Aetiology, age, ethnicity, region and municipal income were considered statistically significant risk factors for unfavourable outcomes in meningitis. The sex category did not show a significant difference in meningitis lethality (Table 1). Regarding the temporal analysis, the best ARIMA models were (0,1,1,) x (0,0,0) for the North region and (0,1,1) x (0,1,1) for the others regions. All models proved to be more efficient than the naive prediction (MASE <1;Theil's U<1) and obtained R2 above 85% (Table 2). The trend of hospitalizations has been negative since 2020. Least squares regression showed that the COVID-19 was statistically significant in reducing hospitalization values in all Brazilian regions. Conclusion: It is possible that the measures against Sars- CoV-2 have contributed to reducing the hospitalizations by meningitis. (Figure Presented).

SARS-CoV-2 variant strains and viral phylodynamics of ORF1a-1b genetic aspects in South America

Bioinformatics tools for online sequence analysis of variants have been used worldwide for the phylogenetic approach of SARS-Cov-2 and their variants. The purpose of this work is to contribute to the settlement of the SARS-CoV-2 genetic of the South America pandemic, presenting the ORF1a-1b evaluation. We proposed and reviewed two online bioinformatics pipelines for viral phylodynamic and phylogeographic analysis with an interactive visualization platform. The phylodynamics evaluation of South America shows a strong viral capacity to evoke immunity and an impressive multiplicity of variants in rapid expansion with mutations of potential importance, including ORF 1a-1b. They showed stately vital for infection and lethality, spreading and raising your frequency in South America from 1% to 20-30% in one year of pandemic occurrence. © 2021 IEEE.

Identification and Classification of Human Body Parts for Contactless Screening Systems: An Edge-AI Approach

Continuous monitoring of vital signs like body temperature and cardio-pulmonary rates can be critical in the early prediction and diagnosis of illnesses. Optical-based methods, i.e., RGB cameras and thermal imaging systems, have been used with relative success for performing contactless vital signs monitoring, which is of great value for pandemic scenarios, such as COVID-19. However, to increase the performance of such systems, the precise identification and classification of the human body parts under screening can help to increase accuracy, based on the prior identification of the Regions of Interest (RoIs) of the human body. Recently, in the field of Artificial Intelligence, Machine Learning and Deep Learning techniques have also gained popularity due to the power of Convolutional Neural Networks (CNNs) for object recognition and classification. The main focus of this work is to detect human body parts, in a specific position that is lying on a bed, through RGB and Thermal images. The proposed methodology focuses on the identification and classification of human body parts (head, torso, and arms) from both RGB and Thermal images using a CNN based on an open-source implementation. The method uses a supervised learning model that can run in edge devices, e.g. Raspberry Pi 4, and results have shown that, under normal operating conditions, an accuracy in the detection of the head of 98.97% (98.4% confidence) was achieved for RGB images and 96.70% (95.18% confidence) for thermal images. Moreover, the overall performance of the thermal model was lower when compared with the RGB model. © 2022, ICST Institute for Computer Sciences, Social Informatics and Telecommunications Engineering.