VIRAL DYNAMIC MODELS PROVIDE AN EXPLANATION FOR SARS-CoV-2 REBOUND AFTER NIRMATRELVIR

Background: A 5-day course of nirmatrelvir-ritonavir (N/R) can significantly reduce the hospitalization and death rates and the duration of infectiousness in high-risk SARS-CoV-2 patients. However, in a fraction of treated individuals virus rebounds following an initial recovery after treatment. The mechanism driving rebound is not well understood. We hypothesize that treatment with N/R near the time of symptom onset halts the depletion of target cells, but does not fully eliminate the virus, and thus can lead to viral rebound. Method(s): Previously, we and others have developed viral dynamic models and successfully used them to fit data on SARS-CoV-2 infection. Here we expand these models and incorporate N/R pharmacokinetic and pharmacodynamic effects and an adaptive immune response. Result(s): We fit this model to the data presented in Charness et al., NEJM (2022) where longitudinal quantitative PCR data is available for 3 individuals who experienced viral rebounds after taking N/R. We found that the model fit the data well. By varying model parameters from their best-fit values, we show the occurrence of viral rebound is sensitive to model parameters, and the time treatment is initiated, which may explain why only a fraction of individuals rebound. Finally, the model with its best-fit parameter values was used to test the therapeutic effects of treatment extended to 10 days or a second 5-day course of N/R initiated one day after symptoms reoccur. Conclusion(s): Our model fits predicted that virus is not fully eliminated during N/R treatment and supported our initial hypothesis that at the end of treatment target cells are available to allow viral resurgence. Simulating the effect of starting treatment later, we find the probability of viral rebound occurring decreases, suggesting that delaying treatment may be a strategy to reduce viral rebound. However, N/R treatment accelerates viral clearance and hence potentially can reduce viral transmission. Thus, delaying treatment may have a detrimental effect on public health and could also have impact on the severity of disease in the high-risk patients for whom N/R is recommended. Increasing treatment from 5 to 10 days continues to preserve target cells and thus may still allow viral rebound if viable virus is present at the end of treatment and sufficient adaptive immunity has not developed. Simulating giving a second course of treatment one day after symptoms reappear, did not prevent rebound.

Hate Speech Dynamics Against African descent, Roma and LGBTQ plus Communities in Portugal

This paper introduces FIGHT, a dataset containing 63,450 tweets, posted before and after the official declaration of Covid-19 as a pandemic by online users in Portugal. This resource aims at contributing to the analysis of online hate speech targeting the most representative minorities in Portugal, namely the African descent and the Roma communities, and the LGBTQ+ community, the most commonly reported target of hate speech in social media at the European context. We present the methods for collecting the data, and provide insightful statistics on the distribution of tweets included in FIGHT, considering both the temporal and spatial dimensions. We also analyze the availability over time of tweets targeting the aforementioned communities, distinguishing public, private, and deleted tweets. We believe this study will contribute to better understand the dynamics of online hate speech in Portugal, particularly in adverse contexts, such as a pandemic outbreak, allowing the development of more informed and accurate hate speech resources for Portuguese.

Sars-Cov- 2 Pandemic Impact in Rectal Cancer Patients in the South of Portugal (Algarve)

Aim: Since the early phases of the COVID-19 pandemic, health systems tried to adapt to ensure the continuity of care of oncological patients. This study aimed to describe the impact of SARS-CoV- 2 on rectal cancer screening and staging. Method(s): A two-year (March 2019 to March 2021) retrospective study concerning rectal cancer patients from a referral center was conducted. Patients clinical data from pre-COVID (March 2019 -February 2020) and COVID time (March 2020 -March 2021) was compared. Descriptive and inferential analysis was performed (Chi-Square test). Result(s): One hundred and sixty-five patients were discussed at the multidisciplinary meetings during the 2-year study period (mean age 69 years [+/- 11.1];M: 64%;F:36%). Upon comparative analysis both pre-COVID and COVID patients were found to have similar demographic characteristics, however during the pandemic a higher proportion of patients presented with low rectal cancers (36% vs. 42%;P = 0.1). Moreover, during the COVID period, fewer patients (minus 26%;npre-covid= 95 vs. ncovid = 70) were referred to the hospital, and a larger number of patients presented in Stage IV of the disease (17,9% (n = 17) in pre COVID period vs. 28,6% (n = 20) in COVID period (P = 0.07)). Lastly, the authors run a comparative sub-analysis between the above results and data from the 3 years prior to the pandemic (2017-2019) and still came across with lesser rectal cancer referrals during the pandemic year. Conclusion(s): Our data clearly shows that, during the COVID period, fewer patients received in-hospital care and a higher number were referred in Stage IV. This represents a red flag for the community and should alert the government to implement public health policies to reestablish colorectal cancer standard of care.

Severe Sars-Cov 2 Lung Infection in a 2-Year-Old Girl Undergoing Chemotherapy for Acute Lymphoblastic Leukemia: A Case Report

BACKGROUND AND AIM: Sars-CoV-2 infection can lead to severe pulmonary impairment at all ages, however, the best therapy in children is not established. Our objective is to discuss a severe pulmonary case in a pediatric oncology patient who presented good clinical evolution and the therapeutic measures chosen in its management. METHOD(S): Case report and literature review. RESULT(S): A 2-year-old girl undergoing chemotherapy for acute lymphocytic leukemia had received cytarabine and methotrexate one week before being admitted to the ward for febrile neutropenia, identified with Sars-Cov-2 infection by RT-PCR. Referred to pediatric intensive care on day 3 of symptoms when she was prostrate and antibiotics switched to a broader spectrum. On day 8 of symptoms she rapidly developed respiratory failure and required mechanical ventilation at high parameters, CT scan showed lesions in ground glass in 75% of the lung parenchyma. On day 9, she was still feverish and showed altered inflammatory tests, such as ferritin 4492 mcg/L D-dimer 5909 ng/dL CRP 28 mg/ dL. Cardiac, hepatic and renal functions remained stable. At that moment, the patient received gammaglobulin 2g/kg in a single dose and methylprednisolone 2mg/kg/day for 5 days. Substantial improvement was observed 48 hours after the introduction of anti-inflammatory therapy, allowing for weaning and extubation after 7 days of mechanical ventilation. 72 hours after extubation, she was discharged home, breathing normally on room air. CONCLUSION(S): Severe Sars-Cov-2 lung infection in a pediatric oncology patient with markedly high inflammatory tests was treated with anti-inflammatory therapies such as steroids and gammaglobulin, with rapid and favorable recovery (Figure Presented).

Analise Das Reacoes Transfusionais Em Um Hospital Geral

Objetivos: As Reacoes Transfusionais (RT) sao um efeito adverso da transfusao sanguinea (TS) que pode ser minimizado aplicando-se um protocolo transfusional (PT) especifico. O indice de RT e medido contabilizando o numero de RT ocorridas/numero de hemocomponentes (HCs) transfundidos X 100. O valor deste indice esta relacionado a pratica transfusional aplicada na instituicao. Segundo os boletins de hemovigilancia da ANVISA as RT ocorrem em 3 - 5 /1000 HCs transfundidos. As RT que ocorrem nas primeiras 24 horas da transfusao sao classificadas como imediatas. Objetivamos determinar o indice de RT transfusionais imediatas, a frequencia de cada tipo de reacao e o perfil de cada paciente. Material e metodos: No periodo de 01/01/2020 a 30/06/2022 foram avaliados o numero (No) e HCs e de pacientes transfundidos e o No de RT relacionando-as ao diagnostico e sexo do paciente e o HC transfundido. Os dados foram obtidos em planilhas proprias e no software de gerenciamento da agencia transfusional. Resultados: No periodo foram transfundidos 23982 HCs sendo 8262 (34,5%) concentrados de hemacias (CH), 14408 (60,1%) concentrados de plaquetas (CPlaq), 662 (2,7%) plasmas frescos (PF) e 649 (2,7%) crioprecipitados (CRIO) em 2894 pacientes. Foram detectados 74 episodios de RT imediatas em 61 pacientes. O No de HCs transfundidos ate o episodio da reacao foi de 1 a 256. Dos HCs envolvidos nas RT, 54 (47,8%) eram CH, 34 (30%) CPlaq 18 (16%) PF e 7 (6,2%) CRIO. Dos 61 pacientes, 33 (54%) eram do sexo masculino e 28 (46%) do sexo feminino. Quanto ao diagnostico 31 (51%) pacientes apresentavam doencas hematologicas, 6 (10%) Sepse, 4 (6,4%) neoplasias, 3 (5%) COVID, 2 (3,2%) HDA, 2 (3,2%) IRC, 2 (3,2%) cirurgia e 11 (18%) outras patologias. Quanto ao protocolo transfusional, 29 (47,5%) pacientes tinham o protocolo de HCs filtrados + fenotipados + irradiados, 22 (36%) HCs filtrados, 6 (10%) filtrados + fenotipados, 3 (5%) filtrados + irradiados e 1(1,5%) filtrado + pre-medicacao com corticoide. Cinquenta (82%) pacientes apresentaram apenas 1 unico episodio de RT, 10 (16,4%) apresentaram 2 e 1(1,6%) paciente apresentou 4 episodios. As RT foram assim distribuidas: Reacao Febril Nao Hemolitica (RFNH) 39 (52,70%), Reacao Alergica (RA) 25 (33,8%), Dispneia associada a transfusao 3 (4,05%), Hipotensao arterial 2 (2,70%), Sobrecarga circulatoria 2 (2,70%), Hipertensao arterial 1(1,35%), TRALI 1(1,35%) e 1(1,35%) caso de sintomas nao especificos. Em 47 (63,5%) casos a reacao se deu durante a transfusao e em 27 (36,5%) nas primeiras 24 horas. Na RFNH, em 31 (79%) casos o componente envolvido foi o CH seguido do CPlaq 8 (21%) e em 18 (46%) casos ela ocorreu durante a transfusao havendo interrupcao e descarte do HC. Na RA o componente eritrocitario representou 44% (11 casos), o plaquetario tambem 44% (11 casos) e o plasmatico 12% (3 casos). Em 19 (76%) casos as RT alergicas ocorreram durante a transfusao. Discussao: As 2 RT mais frequentes foram a RFNH (52,70%) e a RA (33,8%). A maior frequencia de RT foi em pacientes hematologicos (51%). O principal HC envolvido na RFNH foi o CH (79%) enquanto que na RA o CH e o CPlaq estavam relacionados cada um em 44% dos casos. Conclusao: O indice de RT foi 0,30 % e e um valor esperado segundo os boletins de Hemovigilancia. Embora tenhamos protocolos estabelecidos para prevencao das RT, estas ainda ocorrem demonstrando a complexidade do processo transfusional. Copyright © 2022

Epidemiological and Molecular Profile of Adult Patients with Acute Lymphoblastic Leukemia in Ceara

Objective: About 70% of cases of Acute Lymphoblastic Leukemia (ALL) affect children aged 1- 4 years. The incidence increases slightly again in adults over 50 years, characterizing a poor prognosis. According to data from the National Cancer Institute, for the year 2020 leukemias present in men as the fifth most frequent neoplasm in the Northeast Region with a risk of 8.20/100,000 inhabitants, occupying the fifth position. In the case of women, the risk in the Northeast region is 4.42/100,000 inhabitants and ranks tenth. This study aimed to identify the molecular and epidemiological profile of adult patients with ALL in the state of Ceara. Methodology: Sample collection was performed in patients with ALL treated at the General Hospital of Fortaleza (GHF), considered the main and largest hematology outpatient clinic in the metropolitan region of Fortaleza, as well as the State of Ceara. All patients participating in this study read and signed the informed consent form. Patients with other types of leukemias or other hematological diseases were excluded. This study was approved by the Research Ethics Committee of the Federal University of Ceara under protocol no. 38680520.9.0000.5054. Result(s): From July 2021 to July 2022, 25 patients with ALL were treated, of whom 9 are women and 16 are men. The mean age observed was 42.5 years. 44% of patients live in the capital (Fortaleza), while the other 56% of patients live in rural areas. Through immunophenotyping it was possible to verify that there were 22 patients (88%) compatible with ALL-B presenting CD19, CD10, CD45, CD38, CD22, CD79a, CD34, CD81 and CD58 as the main markers, while only 3 patients (12%) were compatible with ALL-T, expressing mainly CD3, CD45, CD5, CD7, CD2, CD11c and CD1a. Eleven patients (44%) had abnormal and complex karyotypes. Five patients had the BCR-ABL p190 mutation and two had the E2A-PBX1 mutation. A total of 9 patients died due to septic shock, COVID-19, or refractoriness to treatment. Discussion(s): The literature indicates a new peak of ALL cases after 50 years of age, however the highest incidence observed in the study participants was between 30 and 50 years. Studies indicate that immunophenotyping findings in patients with ALL B line are almost always CD19, CD79a, CD10, CD20 and CD22 positive, while T-strain ALL usually present CD7, CD3, CD1a and CD10 as the main markers, corroborating what was observed in the results. In addition, depending on the alteration observed in the karyotype, it may confer poor or good prognosis to the patient. The BCR-ABL1 and E2A-PBX1 mergers, for example, are alterations that give worse prognosis to patients and, therefore, may be targeted for treatment in an attempt to improve the survival of these patients. TEL-AML1 fusion, on the other hand, represents a good prognosis, being more incident in pediatric ALL. Conclusion(s): Epidemiological data from this preliminary study indicate that in the state of Ceara ALL is more common in male patients aged 30-50 years living in rural regions. In addition, the use of targeted therapies for patients with abnormal karyotypes as well as the adoption of stricter measures to prevent hospital infections may increase patient survival. Copyright © 2022

Epidemiological and Molecular Profile of Patients with Acute Mieloid Leukemia in Ceara

Objective: Acute myeloid leukemia (AML) is the second most common leukemia in adults and older patients represent most cases. The states of the Northeast of the country have stood out in the frequency of leukemia cases, and the frequencies are higher than the rate of 35% compared to other neoplasms, especially in the metropolitan regions of Fortaleza. In the State of Ceara, the number of cases of leukemia expected for the year 2020 is 6.17 cases/100,000 inhabitants in men and 4.29 cases/100,000 inhabitants in women. In view of this information, the aim of this study was to identify the molecular and epidemiological profile of patients with AML in the state of Ceara. Methodology: Sample collection was performed in patients with AML treated at the General Hospital of Fortaleza, considered the main and largest hematology outpatient clinic in the metropolitan region of Fortaleza, as well as the State of Ceara. All patients participating in this study read and signed the informed consent form. Patients with other types of leukemias or other hematological diseases were excluded. This study was approved by the Research Ethics Committee of the Federal University of Ceara under protocol no. 38680520.9.0000.5054. Result(s): From July 2021 to July 2022, 31 patients with AML were treated, of which 8 are women and 23 are men. The mean age observed was 50.4 years. 54.8% of patients live in the capital, while the other 45.2% of patients live in rural areas. Through immunophenotyping it was possible to verify that the main markers presented by LMA patients were CD33, CD13, CD117, CD45, MPO, CD34, CD64, HLA-DR, CD11c, CD11b e CD38. Thirteen patients (42%) had abnormal and complex karyotypes, of which six died. Five patients (16,1%) had the t(15;17)(q24;q21.3) corresponding to the PML-RARA fusion. Six patients (19,3%) had the FLT3 mutation that confers a poorer prognosis. During the clinical follow up, a total of 16 patients died due to septic shock, COVID-19, or refractoriness to treatment. Discussion(s): The incidence of cases of adults over 50 years of age with AML was 58%, as it corroborates the expected incidence of cases regarding the age described in the literature. Studies indicate that immunophenotyping is critical to the differential diagnosis among AML subtypes. AML is defined by the mainly expression of the markers MPO, CD117, CD13, CD33, HLA-DR and CD38, corroborating what was observed in the results. In addition, depending on the alteration observed in the karyotype, it may confer poor or good prognosis to the patient. The PML-RARA merger, for example, is known as M3 AML or acute promyelocytic leukemia (APL), a subtype of AML with a better prognosis for patients. The FLT3 mutation is present in 1 in 3 patients with AML. The presence of this altered gene may mean a worse prognosis and a greater possibility of recurrence but allows a specific and differentiated treatment. Conclusion(s): Epidemiological data from this preliminary study indicate that in the state of Ceara AML is more common in male patients aged 50-80 years. In addition, the use of targeted therapies for patients with abnormal karyotypes as well as the adoption of stricter measures to prevent hospital infections may increase patient survival. Copyright © 2022

The Importance of Health Information in Covid Pandemic Times - 19: Virtual Health Extension Project - Prevention within Your Home - Experience Report

This article aims to describe the experience of undergraduate nursing students as a fellow of the Virtual Health Extension Project - Prevention within their home, linked to the State University of Tocantins (Unitins), with a focus on virtual assistance to the general population, valuing clarifications from doubts and providing information, in the context of prevention, care and combating the pandemic by covid-19. Descriptive study, type of experience report. The activities were carried out from April to July 2020, virtually in collaboration with professionals in various training areas. It was noticed that the performance of the virtual health project with its diverse activities and work tools was satisfactory. The experience in the area of nursing and others with the project, resulted in a unique opportunity with the practices and actions carried out, actively collaborating for the unfolding of the pandemic moment and for the sum in individual / personal, group, as well as professional growth.

Reflections About Covid-19 and the Organization of the Recyclable Materials Collectors Organized in a Network: The Case of the Redesul Southwest Mg Network

The pandemic caused a global crisis with socioeconomic and public health consequences for the whole society. The collectors of recyclable materials are professionals at the forefront of the sanitation field and suffer economic impacts, in addition to being constantly at risk of contamination. The organization of the collectors of recyclable materials in networks is a strategy adopted by Associations and Cooperatives in search of strengthening and better working conditions and during the pandemic it has been fundamental for the socioeconomic maintenance for these workers. In this sense, this work seeks to present interdisciplinary reflections based on the analysis of the experiences of Redesul Southwest MG, the challenges and coping strategies adopted by that organization, as well as the articulations made with other actors in the recycling production chain in order to mitigate the losses caused by COVID - 19. A bibliographic survey and data collection was carried out through semi-structured interviews with the organization's representative, whose data were analyzed using the content analysis method. The results point to challenges in the area of health, financial maintenance, inefficiency of public policies and participation of the population. However, it was observed the power of the organization in the Network guided by the solidarity between the groups and the articulations with partners to face the challenges and fill the gaps left by the public power regarding the implementation of public policies.

Social Media Insights About COVID-19 in Portugal: A Text Mining Approach

The rapid spread of COVID-19 around the world had a significant impact on daily life. As in other countries, measures were taken in Portugal to combat the exponential increase of cases, such as curfews and the use of masks. Thus, in parallel with the direct consequences on health and the healthcare sector, the pandemic also caused changes in human behavior from a sociological viewpoint. The objective of this dissertation is to attain a perception of the reality concerning COVID-19. For this purpose, real-time data was extracted from three sources, two of them being social media platforms – Twitter and Reddit – and the other one being Público, a Portuguese online newspaper. The adopted approach, based on topic modelling and sentiment analysis, was validated within the Portugal context, concerning data over a period of one year, but it can equally be employed in similar situations and other countries and provide decision-making support. After the data extracting, it was prepared for application of natural language processing (NLP) tools specific to the Portuguese language, which can represent a challenge due to the lexical richness. With the gathered information, a dashboard was built, with the purpose of gaining insights on the COVID-19 pandemic in Portugal. It was concluded that the topics discussed on social media reflect the events related to the pandemic. In a final stage, these dashboards were evaluated by public health experts, who highlighted the potential of the results obtained. The data and dashboards will be made available to the scientific community upon request. © 2022 River Publishers.

Convalescent plasma therapy in COVID-19 patients: a non-randomized case-control study with concurrent control.

Convalescent plasma therapy has shown controversial results in coronavirus disease-19 (COVID-19) patients. We performed a non-randomized case-control study with contemporaneous controls in a hospital in southern Brazil. Patients were selected for treatment with convalescent plasma by medical decision and compared with patients who did not receive plasma and were hospitalized due to COVID-19 at the same time. The outcomes of interest were intensive care unit (ICU) admission and in-hospital death. Patients that received convalescent plasma had lower in-hospital mortality than patients that did not receive plasma (relative risk (RR) 0.48; 95% confidence interval (CI) 0.29 to 0.79) and these results were consistent after changing the subset of control patients. There were no differences regarding ICU admission between groups (RR=0.80; 95%CI: 0.47 to 1.35). In this study, patients that received convalescent plasma for COVID-19 had lower in-hospital mortality, but this finding requires further confirmation given the retrospective nature of the study.

The relative neglect of agriculture in Mozambique

This paper explores agricultural performance of Mozambique, its institutional weaknesses, and the underlying factors that underpin an unsatisfactory performance during many decades. We point to the role of systemic political instability and violence combined with challenges to state legitimacy. Regional divides and lack of market integration continue to influence in a critical and all-encompassing manner. Finally, the way in which the interests of the elite and the influence of donors have affected progress in the agriculture sector suggests the need for concerted reorientation in existing strategies, policies, and priorities. This is reinforced by future challenges, including the extractive industry;population growth and internal migration;national and international markets;climate change;and COVID-19. We highlight the need to place the future of agriculture in Mozambique within a long-term perspective, focusing on the adoption and stabilization of an institutional framework aimed at increasing agricultural productivity and preserving the environment.

Work Changes Due to COVID-19: Exploring Portuguese Workers’ Expectations Using IRaMuTeQ

The COVID-19 pandemic brought massive disruption, as it strongly impacted several dimensions of people’s life. All over the world, organizations were forced to stop presential activities and adopt teleworking, except for front-line workers, who had to continue their presential activity, hence being more vulnerable to the virus. As we adjusted ourselves to this new reality, many debates emerged regarding the impact that the COVID-19 pandemic will leave on our life, including our work lives. This study focuses on Portuguese workers’ expectations regarding changes in work associated with COVID-19. Data were collected via an online questionnaire between May and June 2020, requesting information regarding the confinement period during the first State of Emergency in Portugal. Expectations of change in work were assessed using an open answer question (i.e., “In your opinion, what will change in work contexts as a result of this pandemic?”). Overall, 207 Portuguese workers answered the questionnaire;here we focus on the 118 participants who answered the open question. Data were analysed using SPSS, IRaMuTeQ, and Thematic Analyses. Qualitative analysis shows that participants expect changes regarding the organization of work, namely the increase in the use of telework and digitization. They also expect changes in workload, working conditions and safety, and the relationship between managers/leaders and workers. This work contributes to the body of knowledge regarding the impact that the COVID-19 pandemic has had – and will continue to have - on our working lives and the areas associated. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

IMPACTO DA IMPLANTAÇÃO DO AGENDAMENTO DAS DOAÇÕES DE SANGUE EM PERÍODO DE EPIDEMIA DE COVID NOS INDICADORES DE QUALIDADE DO HEMONÚCLEO REGIONAL DE ARARAQUARA

Introdução: O Hemonúcleo Regional de Araraquara está situado na região central do estado de São Paulo e atende à regional de saúde DRS III com uma população de quase 1 milhão de habitantes. Atualmente, fornecemos hemocomponentes para 13 Agências Transfusionais localizados no município de Araraquara e região. Este serviço atende uma média de 11 mil candidatos à doação ao ano e, quando iniciou a pandemia do COVID-19, após reunião de 16/03/2020 entre os representantes da área de saúde com o Grupo de Gestão da Pandemia do município de Araraquara, teve que se adaptar para o atendimento dos candidatos à doação de sangue. A partir do mês de abril começamos a atender apenas por agendamento telefônico ou por Whats Zap, inicialmente, agendando 10 candidatos por hora e a partir da adequação do horário dos funcionários, até 12 candidatos por hora ou 62 agendamentos ao dia. Objetivos: Avaliar os indicadores de Inaptidão da Triagem Clínica e Tempo de Permanência após a implantação do agendamento dos candidatos à doação de sangue. Material e métodos: Para obter os dados utilizamos a Tela do Serviço Social do Sistema Hemovida e os indicadores de Inaptidão da Triagem Clínica e Tempo de Permanência dos períodos de 01/04/2019 a 31/03/2020 e 01/04/2020 a 31/03/2021. Resultados: Comparando os períodos 2019/2020 e 2020/2021 observamos que houve uma redução no número de candidatos à doação de 20,4% (11885 para 9455), mas a inaptidão na triagem passou de 29,2% para 25,0%. O indicador de Tempo de Permanência passou da média de 68,1 para 55,9 minutos. Discussão: Com a implantação do agendamento de doadores percebemos, que apesar da redução do número de candidatos à doação, houve uma melhora nos indicadores de inaptidão na triagem e aumento das bolsas coletadas. A meta deste indicador em 2019/2020 era 30% e em 2020/2021 reduzimos para 26%. Neste primeiro período tivemos meses com perda de 28% e, com o agendamento, tivemos mês com apenas 14,7% de inaptidão na triagem. A meta do indicador de tempo de permanência reduziu-se de 80 para 60 minutos. Os motivos como repouso insuficiente, jejum prolongado e uso de medicamentos, que eram as primeiras causas de inaptidão, reduziram em razão da orientação que cada doador recebia das funcionárias da recepção e captação na hora do agendamento. Com o agendamento por hora também evitamos o acúmulo de atendimento em determinados dias e horários o que reduziu o tempo de espera. Houve períodos em que o candidato à doação esperava até 150 minutos para passar por todo processo de doação e hoje, ele leva menos de 60 minutos para realizar todo este processo. Conclusão: Apesar da redução do número de candidatos à doação, percebemos uma perda menor destes na triagem clínica em razão das orientações individuais no momento do agendamento. O tempo de permanência reduziu-se consideravelmente e percebemos a melhora na qualidade do atendimento ao candidato à doação. Com estes resultados, pensamos em manter o atendimento por agendamento após o fim das restrições adotadas pela pandemia de COVID-19, tendo consciência, que num futuro próximo, deveremos nos adequar ao aumento da demanda de hemocomponentes com a liberação das cirurgias eletivas e aumento das emergências.

Second training workshop about community tourism and post coronavirus effects (COVID-19). (Dossi.. Turismo Sustent..vel e Pol..ticas P..blicas: Demanda cont..nua - artigos, ensaios e resenhas.) [Portuguese]

The main points contained in the "Second Training Workshop on Community Tourism and its Post Coronavirus Effects (COVID-19)" gave continuity to the objectives set out in the previous training event. In this session, it was emphasized that both workshops are part of the project "Economic development with identity: Strengthening traditional knowledge for resilience, based on tourism". This document summarizes the approach to the issues, the analysis and considerations on the next and possible challenges that the indigenous communities that develop community tourism in the Bolivian territory will have to face. The Salar de Uyuni and gastronomic culture were considered as the great attractions to be developed in a new tourist offer. The ongoing pandemic represents uncertainty and forces tourism ventures to strengthen their organizational system, create a new product offering aimed at a national market, and involve all relevant institutions in a new system that supports sustainable and resilient Community tourism.

First training workshop on community tourism and its effects post Coronavirus (COVID-19)

With the accelerated spread of COVID-19 and the growing impact of the economic crisis in the tourism sector, the Fund for the Development of Indigenous Peoples in Latin America and Caribbean has developed the first training workshop on Community Tourism and its effects post Coronavirus (COVID - 19). The workshop had the objective of developing training processes and training with organizations of women and young leaders on economic enterprises related to tourism and its effects post Coronavirus (COVID-19), based on traditional knowledge in order to strengthen management capacities in public policies. The main approaches focused on analyzing conventional tourism, the organizational crisis, historical resilience of the tourist activity, potentialities of the Bolivian community tourism and the current legislation among others. This context analysis, information, as well as the dialogue and reflection brought an initial conclusion that domestic tourism will be the option that guarantees the reactivation of the sector in the short term. Likewise, it was observed that for this, public and private institutions linked to the Bolivian tourism sector must invest, from now on, time and resources in order to guarantee compliance with the distancing and biosafety regulations, as well as redefining their tourism offer for the national market.

Early efficacy results of montelukast as add on treatment of hospitalized patient with COVID-19 pneumonia: An investigator-initiated open labelled randomized controlled ongoing clinical trial

Background: Leukotriene receptor antagonists might have a role in viral infections, either by improving lung injury and inflammation, or by acting on 3CL proteinase of the HCoV-19. Thus, we hypothesised that montelukast may be an adjuvant drug in HCoV-19 infection treatment. This study aims to evaluate the efficacy and safety of montelukast in the adjuvant treatment of COVID-19 pneumonia. Method: We are conducting a randomized, controlled, parallel, open-label trial involving hospitalized adult patients with confirmed COVID-19. Patients were randomly assigned in a 1:1 ratio to receive either montelukast 10 mg, once a day for 14 days, in addition to standard of care (SoC), or SoC alone. SoC follows the best practice for treating these patients, according to updated recommendations. The primary outcome is time to recovery. Participants are assessed using diary cards to capture data on treatment-related improvements in an 8-point ordinal scale (COVID-19 scale). Secondary endpoints include changes in NEWS (National Early Warning Score), respiratory and inflammatory parameters. Mann-Whitney U test for continuous variables and Ficher's exact test for categorical variables were used to compare differences between groups. This phase IV clinical trial takes place at the University Hospital of São João, Porto. EudraCT number: 2020-001747-21. Results: Eighteen patients (11 males, mean age 60 years, age range 42-89, table 1) enrolled and completed the trial. The trial is still open for the recruitment of participants. The participants from the active group spent less time hospitalized than control group [median (P25-75): 3.0 (3-6) vs 7.5 (4.75-17.75) days, p = 0.03]. The number of days to achieve 7 (not hospitalized, limitation on activities) or 8 points (not hospitalized, no limitations) in the COVID-19 scale was also statistically significant. The number of patients in need of supplemental high flux oxygen and the NEWS score followed the same trend (table 1). Conclusion: In conclusion, early efficacy results from this ongoing clinical trial suggest montelukast may have a role in treating COVID-19 patients as an adjuvant treatment by diminishing hospitalization days until discharge. Data were presented as median (25th percentile-75th percentile) unless otherwise states. Bpm: beats per minute;cpm: cycles per minute;NEWS: National Early Warning Score);SoC: standard of care. NEWS is based on 7 clinical parameters (respiration rate, oxygen saturation, any supplemental oxygen, temperature, systolic blood pressure, heart rate, level of consciousness), and is being used as an efficacy measure. Higher points represent higher risk of poor outcomes. COVID-19 scale is as follows: (1) Death;(2) Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO);(3) Hospitalized, on non-invasive ventilation or high flow oxygen devices;(4) Hospitalized, requiring supplemental oxygen;(5) Hospitalized, not requiring supplemental oxygen-requiring ongoing medical care (COVID-19 related or otherwise);(6) Hospitalized, not requiring supplemental oxygen-no longer requires ongoing medical care;(7) Not hospitalized, limitation on activities and/or requiring home oxygen;(8) Not hospitalized, no limitations on activities. (Figure Presented).