Effectiveness of a multicomponent intervention to face the COVID-19 pandemic in Rio de Janeiro's favelas: difference-in-differences analysis.

INTRODUCTION: Few community-based interventions addressing the transmission control and clinical management of COVID-19 cases have been reported, especially in poor urban communities from low-income and middle-income countries. Here, we analyse the impact of a multicomponent intervention that combines community engagement, mobile surveillance, massive testing and telehealth on COVID-19 cases detection and mortality rates in a large vulnerable community (Complexo da Maré) in Rio de Janeiro, Brazil. METHODS: We performed a difference-in-differences (DID) analysis to estimate the impact of the multicomponent intervention in Maré, before (March-August 2020) and after the intervention (September 2020 to April 2021), compared with equivalent local vulnerable communities. We applied a negative binomial regression model to estimate the intervention effect in weekly cases and mortality rates in Maré. RESULTS: Before the intervention, Maré presented lower rates of reported COVID-19 cases compared with the control group (1373 vs 1579 cases/100 000 population), comparable mortality rates (309 vs 287 deaths/100 000 population) and higher case fatality rates (13.7% vs 12.2%). After the intervention, Maré displayed a 154% (95% CI 138.6% to 170.4%) relative increase in reported case rates. Relative changes in reported death rates were -60% (95% CI -69.0% to -47.9%) in Maré and -28% (95% CI -42.0% to -9.8%) in the control group. The case fatality rate was reduced by 77% (95% CI -93.1% to -21.1%) in Maré and 52% (95% CI -81.8% to -29.4%) in the control group. The DID showed a reduction of 46% (95% CI 17% to 65%) of weekly reported deaths and an increased 23% (95% CI 5% to 44%) of reported cases in Maré after intervention onset. CONCLUSION: An integrated intervention combining communication, surveillance and telehealth, with a strong community engagement component, could reduce COVID-19 mortality and increase case detection in a large vulnerable community in Rio de Janeiro. These findings show that investment in community-based interventions may reduce mortality and improve pandemic control in poor communities from low-income and middle-income countries.

Optimal dosing of heparin for prophylactic anticoagulation in critically ill COVID-19 patients a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: The optimal amount of anticoagulation for critically ill COVID-19 patients is controversial. Therefore, we aimed to evaluate the efficacy and safety of escalated doses of anticoagulation in critically ill patients with severe COVID-19. MATERIALS AND METHODS: We conducted a systematic search of three major databases, including PubMed, Cochrane Library, and Embase, from inception to May 2022. Randomized controlled trials (RCTs) were included comparing therapeutic or intermediate doses to standard prophylactic doses of anticoagulants in critically ill COVID-19 patients, with heparins as the only anticoagulation therapy considered. RESULTS: Out of the six RCTs, 2130 patients were administered escalated dose anticoagulation (50.2%) and standard thromboprophylaxis therapy (49.8%). The escalated dose showed no significant impact on mortality (RR, 1.01; 95% CI, 0.90-1.13). Although there was no significant difference in DVT (RR, 0.81; 95% CI, 0.61-1.08), the risk of PE was significantly reduced in patients receiving escalated dose anticoagulation (RR, 0.35; 95% CI, 0.21-0.60), with an increased risk of bleeding events (RR, 1.65; 95% CI, 1.08-2.53). CONCLUSION: This systematic review and meta-analysis fail to support escalated anticoagulation doses to reduce mortality in critically ill COVID-19 patients. However, higher doses of anticoagulants appear to reduce thrombotic events while increasing the risk of bleeding effectively.

Domestic violence: A cross-sectional study among pregnant and postpartum women.

AIM: To assess the prevalence of domestic violence/intimate partner violence, aggressors, types of violence and associated factors in women who attend an antenatal and postnatal care service in a public hospital in Brazil. DESIGN: Cross-sectional study. METHODS: We interviewed women attending antenatal and postpartum care services in a Brazilian public tertiary woman's hospital in Campinas, São Paulo, between July 2019 and September 2021. Data were collected through interviewer-administered questionnaires previously used in healthcare settings: Abuse Assessment Screen (AAS); Woman Abuse Screening Tool (WAST); Hurt, Insulted, Threatened with Harm and Screamed (HITS). We evaluated the relationship between the sociodemographic characteristics of women and domestic/intimate violence using bivariate and multivariable logistic regression analyses. RESULTS: Of the 600 pregnant and postpartum women interviewed, 138 (23%) had suffered any abuse. Some participants disclosed physical violence during pregnancy (2.3%) and during the last 12 months (5.3%). The partner was identified as the main aggressor in most of the cases (60%). When women had a partner, 3.5% reported domestic violence and 6.7% disclosed intimate partner violence during pregnancy or postpartum period. Women with non-white skin colour (OR = 1.53; 95% CI 1.01-2.34; p = .048), gestational age ≤ 13 weeks (OR = 3.41; 95% CI 1.03-11.25; p = .044) and in postpartum period (OR = 2.81; 95% CI 1.32-5.99; p = .008) were more likely to experience domestic violence at some time in their lives. Women interviewed before the COVID-19 pandemic were more likely to disclose that they had suffered any abuse. CONCLUSION: Experience of violence during pregnancy and postpartum period was more frequent in women with non-white skin colour, in their first gestational trimester and in the postpartum period, and was more reported before the COVID-19 pandemic. Antenatal and postpartum care services could be safe places to support violence survivors. IMPACT: Pregnant and postpartum women are a vulnerable group to experiencing domestic violence/intimate partner violence. Violence can negatively affect women's and children's health and well-being. Antenatal and postpartum care should be considered as a moment to routinely inquiry women about past and current violence experiences. Regular contact among healthcare professionals and women during this period offers a window of opportunities for implementing psychosocial interventions among women at risk of violence. Healthcare providers (i.e., physicians, psychologists, social workers, nurses and midwives) have an important role in identifying survivors, offering support and providing quality information to women.

COVID-19 vaccine antibody responses in community-dwelling adults to 48 weeks post primary vaccine series.

We report a decentralized prospective cohort study of self-reported adverse events and antibody responses to COVID vaccines derived from dried blood spots. Data are presented for 911 older (aged >70 years) and 375 younger (30-50 years) recruits to 48 weeks after the primary vaccine series. After a single vaccine, 83% younger and 45% older participants had overall seropositivity (p < 0.0001) increasing to 100/98% with the second dose, respectively (p = 0.084). A cancer diagnosis (p = 0.009), no mRNA-1273 vaccine doses (p <0 .0001), and older age (p <0 .0001) predicted lower responses. Antibody levels declined in both cohorts at 12 and 24 weeks increasing with booster doses. At 48 weeks, for participants with 3 vaccine doses, the median antibody levels were higher in the older cohort (p = 0.04) with any dose of mRNA-1273 (p <0 .0001) and with COVID infection (p <0 .001). The vaccines were well tolerated. Breakthrough COVID infections were uncommon (16% older cohort, 29% younger cohort; p < 0.0001) and mild.

COVID-19 Vaccine Antibody Responses in Community Dwelling Adults to 48 weeks Post Primary Vaccine Series

We report a decentralized prospective cohort study of self-reported adverse events and antibody responses to COVID vaccines derived from dried blood spots. Data is presented for 911 older (aged >70 years) and 375 younger (30-50 years) recruits to 48 weeks after the primary vaccine series. After a single vaccine, 83% younger and 45% older participants had overall seropositivity (p<0.0001) increasing to 100/98% with the second dose respectively (p=0.084). A cancer diagnosis (p=.009), no mRNA1273 vaccine doses (p<.0001) and older age (p <.0001) predicted lower responses. Antibody levels declined in both cohorts at 12 and 24 weeks increasing with booster doses. At 48 weeks, for participants with 3 vaccine doses, the median antibody levels were higher in the older cohort (p=.04) with any dose of mRNA-1273 (p<.0001) and with COVID infection (p<.001). The vaccines were well tolerated. Breakthrough COVID infections were uncommon (16% older cohort, 29% younger cohort;p<0.0001) and mild. Graphical abstract

Bibliometric Analysis of Global Scientific Production on COVID-19 and Vaccines.

This bibliometric analysis aims to analyze the global scientific production of COVID-19 and vaccines. First, a search for scientific articles was performed using the advanced query in the Web of Science™ database, more precisely in its core collection, on 18 February 2023. Data from 7754 articles were analyzed using the Bibliometrix R package and the Biblioshiny application. The evaluated articles were published mainly in 2022 (60%). The scientific journals that published the most about COVID-19 and vaccines were "Vaccines", "Vaccine" and "Human Vaccines & Immunotherapeutics". The University of Oxford was the most productive institution, with the authors of the articles mainly originating from the United States, China and the United Kingdom. The United States, despite having carried out the most significant number of collaborations, published mainly with local researchers. The 15 most cited articles and the KeyWords Plus™ evidenced the focus of the published articles on the safety and efficacy of vaccines against COVID-19, as well as on the evaluation of vaccine acceptance, more specifically on vaccine hesitancy. Research funding came primarily from US government agencies.

One-year follow-up of immediate postpartum contraceptive implant insertion in adolescents.

PURPOSE: Our study aimed to evaluate the acceptability, adverse effects and continuation rates among adolescents who accepted the etonogestrel (ENG) subdermal implant and compared to adolescents who chose other methods during the immediate postpartum period before hospital discharge, with one year follow-up up. MATERIALS AND METHODS: We conducted a cohort non-randomised study at the Women's Hospital, University of Campinas. All women up to 19 years of age, who gave birth at the hospital between July 2019 and April 2020, were invited to participate and were offered the ENG-implant or the routine contraceptive methods. They were followed for one year postpartum. RESULTS: We included 100 teenagers and 72 accepted the ENG-implant. Students are more likely to accept the ENG-implant than non-students (PR: 1.25 [95%CI 0.99-1.59]). Up to one year of follow-up, survival analysis showed that the time of adherence to the method was longer for the ENG-implant users (p = 0.0049). More than 90% of the adolescents were satisfied with the implant; however, five requested early removal due to menstrual irregularity and local discomfort. CONCLUSION: Provision ENG-implant for adolescents in the immediate postpartum demonstrated high acceptance and ensured effective contraception. After one year, most of them were satisfied, with a high continuation rate and without unplanned pregnancies.

Antimicrobial consumption and drug utilization patterns among COVID-19 and non-COVID-19 patients.

OBJECTIVES: To understand differences in antimicrobial use between COVID-19 and non-COVID-19 patients. To compare two metrics commonly used for antimicrobial use: Defined Daily Dose (DDD) and Days of Therapy (DOT). To analyse the order in which antimicrobials were prescribed to COVID-19 patients using process mining techniques. METHODS: We analysed data regarding all ICU admissions from 1 January 2018 to 14 September 2020, in 17 Brazilian hospitals. Our main outcome was the antimicrobial use estimated by the DDD and DOT (Days of Therapy). We compared clinical characteristics and antimicrobial consumption between COVID-19 and non-COVID-19 patients. We used process mining to evaluate the order in which the antimicrobial schemes were prescribed to each COVID-19 patient. RESULTS: We analysed 68 405 patients admitted before the pandemic, 12 319 non-COVID-19 patients and 3240 COVID-19 patients. Comparing those admitted during the pandemic, the COVID-19 patients required advanced respiratory support more often (42% versus 12%). They also had longer ICU length of stay (6 versus 3 days), higher ICU mortality (18% versus 5.4%) and greater use of antimicrobials (70% versus 39%). Most of the COVID-19 treatments started with penicillins with ß-lactamase inhibitors (30%), third-generation cephalosporins (22%), or macrolides in combination with penicillins (19%). CONCLUSIONS: Antimicrobial prescription increased in Brazilian ICUs during the COVID-19 pandemic, especially during the first months of the epidemic. We identified greater use of broad-spectrum antimicrobials by COVID-19 patients. Overall, the DDD metric overestimated antimicrobial use compared with the DOT metric.

Maré cohort-profile: a prospective cohort study based in a socially vulnerable community during the COVID-19 pandemic in Rio de Janeiro, Brazil

Background: Socially vulnerable populations were vastly affected by the COVID-19 pandemic. The pandemic significantly impacted Brazil, pressuring its healthcare system for several months, with high mortality rates, even among the youngest population. Cohort studies combining disease surveillance are essential for understanding virus circulation in the community, surrogates of protection, vaccine effectiveness, and demand for health resources. Methods: : Here, we present the protocol for a community-based prospective cohort study in the largest complex of favelas (slums) in Rio de Janeiro, Brazil (Complexo da Maré). The study participants are residents initially recruited during a massive vaccination campaign in the community. Five waves of data collection at approximately six-month intervals were planned. The first two waves have been completed at the time of writing this study protocol, and the third is underway. The protocol comprises interviews, blood sampling, and records linkage with secondary data to enrich the profiles of cohort participants and community information. We will describe COVID-19 seroprevalence, socio-demographic characteristics, and the burden of COVID-19, followed by estimating the association of socioeconomic factors and the burden of disease with seroprevalence. Discussion: The primary aims of the study are to assess COVID-19 clinical, epidemiological and genomic profiles and outcomes in residents from Maré, including vaccine effectiveness, surrogates of immune protection, virus transmission in households, and the overall burden of the pandemic.

Spiritual care in patients hospitalized with COVID-19: scoping review / Cuidado espiritual em pacientes hospitalizados com COVID-19: revisão de escopo

RESUMO Objetivo mapear evidências sobre o cuidado espiritual em pacientes hospitalizados com diagnóstico de COVID-19. Métodos trata-se de uma revisão de escopo, desenvolvida de acordo com os processos metodológicos do Joanna Briggs Institute, realizada com busca nas fontes de dados SCOPUS, Science Direct, MEDLINE, Web of Science, CINAHL, Google® acadêmico e busca reversa nas referências selecionadas. Incluíram-se estudos que abordassem evidências sobre a temática, publicados em qualquer idioma, sem recorte temporal. Resultados foram analisados 19 estudos, com o mapeamento de oito intervenções sobre o cuidado espiritual, a saber: ouvir a dor espiritual do paciente; suporte de luto; ferramentas de vídeos online com conteúdo sobre fé e resiliência; videochamada online para familiares; disposição de representante religioso; triagem espiritual; treinamento dos profissionais para o cuidado espiritual; e musicoterapia como instrumento de espiritualidade. Conclusão este estudo permitiu mapear as evidências sobre o cuidado espiritual em pacientes hospitalizados com diagnóstico de COVID-19, abordando estratégias para a inserção da espiritualidade no cuidado em saúde. Contribuições para a prática o estudo trouxe contribuições para o avanço da prática da Enfermagem relativo à espiritualidade e aos pacientes com COVID-19, fornecendo subsídios para a utilização da espiritualidade como ferramenta de suporte no cuidar, facilitando o enfrentamento de situações difíceis.

ABSTRACT Objective to map existing evidence on spiritual care for patients hospitalized with COVID-19. Methods scoping review developed in accordance with methodological processes developed by the Joanna Briggs Institute, carried out through a search in the data bases SCOPUS, Science Direct, MEDLINE, Web of Science, CINAHL, and Google Scholar®, in addition to a reverse search in the works selected. The review included studies with evidence on the topic at hand, which had been published in any language, in any time frame. Results 19 studies were analyzed, and 8 different spiritual care interventions were mapped, which were: listening to the spiritual pain of the patient; grief support; on-line video tools with content on faith and resilience; on-line calls with relatives; availability of religious representatives; spiritual triage; training professionals to provide spiritual care; and music therapy as an instrument of spirituality. Conclusion this review allowed mapping the evidence about spiritual care in patients hospitalized with a diagnosis of COVID-19, addressing strategies to bring spirituality into health care. Contributions to practice: this study contributes for the advancement of the practice of nursing regarding spirituality and patients with COVID-19, providing subsidies to use spirituality as a tool to support care and facilitate dealing with difficult situations.

COVID-19 breakthrough infections in vaccinated participants of the Safety and Efficacy of Preventative COVID Vaccines sub-study.

BACKGROUND: The rate of breakthrough infection in vaccinated Ontarians during the Omicron wave is unknown. METHODS: Active participants of the Safety and Efficacy of Preventative COVID Vaccines (STOPCoV) study (892 ≥age 70 years and 369 aged 30-50 years) were invited to participate in a sub-study evaluating breakthrough COVID-19 infection. Self-administered rapid antigen tests (RAT) were reported twice weekly and symptom questionnaires weekly for 6 weeks. The primary outcome was the proportion reporting a positive RAT. RESULTS: A total of 806 e-consented, and 727 (90%) completed ≥1 RAT, with total 7,116 RATs completed between January 28 and March 29, 2022. Twenty out of twenty-five participants with a positive RAT had a booster vaccine prior to the positive test. All cases were mild, none requiring hospitalization. Nineteen had positive dried blood spot analysis for IgG antibody to the receptor binding domain (RBD) prior to the positive RAT. The mean normalized IgG ratio to RBD was 1.22 (SD 0.29) for younger and 0.98 (SD 0.44) for older participants, values similar to corresponding ratios for those without positive RATs and those in the main cohort. One hundred and five participants reported one and 96 reported ≥2 possible COVID-19 symptoms despite negative RATs. The false negative RAT was low (4% to 6.6 %) compared with subsequent positive nucleoprotein antibody. CONCLUSIONS: Positive RAT for COVID-19 was infrequent (3.4%). We were unable to determine a protective antibody level against breakthrough infection. Our findings can inform public health COVID-19 restrictions guidelines. Our decentralized study provides a model for rapid institution of new questions during a pandemic.

HISTORIQUE: On ne connaît pas le taux d'infections postvaccinales pendant la vague Omicron chez les Ontariens vaccinés. MÉTHODOLOGIE: Les participants actifs de l'étude Safety and Efficacy of Preventative COVID Vaccines (STOPCoV; 892 de 79 ans ou plus et 369 de 30 à 50 ans) ont été invités à prendre part à une sous-étude évaluant les infections postvaccinales causées par la COVID-19. Les résultats des tests d'antigène rapides (TAR) autoadministrés ont été transmis deux fois par semaine et le questionnaire sur les symptômes, toutes les semaines pendant six semaines. Les résultats primaires correspondaient à la proportion ayant déclaré des TAR positifs. RÉSULTATS: Au total, 806 ont consenti par voie électronique et 727 (90 %) ont effectué au moins un TAR, pour un total de 7 116 TAR effectués entre le 28 janvier et le 29 mars 2022. Ainsi, 21 des 25 participants ayant obtenu un résultat positif au TAR avaient reçu une dose de rappel auparavant. Tous les cas étaient légers, et aucun n'a dû être hospitalisé. Dix-neuf ont obtenu une analyse des gouttes de sang séché positives aux anticorps des IgG du domaine de liaison des récepteurs (RBD) avant le résultat positif du TAR. L'écart-type moyen du ratio d'IgG normalisé au RBD était de 1,22 (ÉT = 0,29) pour les participants plus jeunes, et de 0,98 (ÉT = 0,44) chez les participants plus âgés, les valeurs étaient semblables aux ratios correspondants pour ceux dont le TAR n'était pas positif et ceux de la cohorte principale. Au total, 105 participants ont déclaré un symptôme possible de COVID-19 et 96 en ont déclaré au moins deux, malgré des résultats négatifs au TAR. Le taux de TAR faussement négatifs était faible (4 % à 6,6 %) par rapport à l'anticorps nucléoprotéique positif subséquent. CONCLUSIONS: Les résultats positifs des TAR à la COVID-19 étaient peu courants (3,4 %). Les chercheurs n'ont pas été en mesure de déterminer le taux d'anticorps protecteurs contre l'infection postvaccinale. Ces résultats peuvent éclairer les directives sur les restrictions sanitaires liées à la COVID-19. La présente étude décentralisée fournit un modèle pour l'adoption rapide de nouvelles questions pendant une pandémie.

Humoral and cellular immune responses to CoronaVac up to one year after vaccination.

Coronavac is a widely used SARS-CoV-2 inactivated vaccine, but its long-term immune response assessment is still lacking. We evaluated SARS-CoV-2-specific immune responses, including T cell activation markers, antigen-specific cytokine production and antibody response following vaccination in 53 adult and elderly individuals participating in a phase 3 clinical trial. Activated follicular helper T (Tfh), non-Tfh and memory CD4⁺ T cells were detected in almost all subjects early after the first vaccine dose. Activated memory CD4⁺ T cells were predominantly of central and effector memory T cell phenotypes and were sustained for at least 6 months. We also detected a balanced Th1-, Th2- and Th17/Th22-type cytokine production that was associated with response over time, together with particular cytokine profile linked to poor responses in older vaccinees. SARS-CoV-2-specific IgG levels peaked 14 days after the second dose and were mostly stable over one year. CoronaVac was able to induce a potent and durable antiviral antigen-specific cellular response and the cytokine profiles related to the response over time and impacted by the senescence were defined.

Vaccine effectiveness of ChAdOx1 nCoV-19 against COVID-19 in a socially vulnerable community in Rio de Janeiro, Brazil: a test-negative design study.

OBJECTIVES: To estimate vaccine effectiveness after the first and second dose of ChAdOx1 nCoV-19 against symptomatic COVID-19 and infection in a socially vulnerable community in Brazil when Gamma and Delta were the predominant variants circulating. METHODS: We conducted a test-negative study in the community Complexo da Maré, the largest group of slums (n = 16) in Rio de Janeiro, Brazil, from January 17, 2021 to November 27, 2021. We selected RT-qPCR positive and negative tests from a broad community testing program. The primary outcome was symptomatic COVID-19 (positive RT-qPCR test with at least one symptom) and the secondary outcome was infection (any positive RT-qPCR test). Vaccine effectiveness was estimated as 1 - OR, which was obtained from adjusted logistic regression models. RESULTS: We included 10 077 RT-qPCR tests (6,394, 64% from symptomatic and 3,683, 36% from asymptomatic individuals). The mean age was 40 (SD: 14) years, and the median time between vaccination and RT-qPCR testing among vaccinated was 41 (25-75 percentile: 21-62) days for the first dose and 36 (25-75 percentile: 17-59) days for the second dose. Adjusted vaccine effectiveness against symptomatic COVID-19 was 31.6% (95% CI, 12.0-46.8) 21 days after the first dose and 65.1% (95% CI, 40.9-79.4) 14 days after the second dose. Adjusted vaccine effectiveness against COVID-19 infection was 31.0% (95% CI, 12.7-45.5) 21 days after the first dose and 59.0% (95% CI, 33.1-74.8) 14 days after the second dose. DISCUSSION: ChAdOx1 nCoV-19 was effective in reducing symptomatic COVID-19 in a socially vulnerable community in Brazil when Gamma and Delta were the predominant variants circulating.

No Evidence of SARS-CoV-2 Infection in Neotropical Primates Sampled During COVID-19 Pandemic in Minas Gerais and Rio Grande do Sul, Brazil.

In 2019, a new coronavirus disease (COVID-19) was detected in China. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was capable to infect domestic and captive mammals like cats, tigers and minks. Due to genetic similarities, concern about the infection of non-human primates (NHPs) and the establishment of a sylvatic cycle has grown in the Americas. In this study, neotropical primates (NP) were sampled in different areas from Brazil to investigate whether they were infected by SARS-CoV-2. A total of 89 samples from 51 NP of four species were examined. No positive samples were detected via RT-qPCR, regardless of the NHP species, tissue or habitat tested. This work provides the first report on the lack of evidence of the circulation of SARS-CoV-2 in NP. The expansion of wild animals sampling is necessary to understand their role in the epidemiology of SARS-CoV-2 and other potentially zoonotic pathogens in natural environments shared by humans.

Plastic Surgery Away Rotations During the Coronavirus Disease Pandemic: A Virtual Experience.

BACKGROUND: Plastic surgery has traditionally been a specialty that places a strong emphasis on away rotations during the final year of medical school. These rotations allow the program and residency candidates to become better acquainted and are often crucial, as a large portion of applicants match at programs where they rotated. The coronavirus disease 2019 (COVID-19) pandemic forced many institutions to modify their educational curriculums when away rotations were canceled. We present our experience creating and implementing a virtual plastic surgery rotation. METHODS: Our virtual program was designed to mirror the in-person away rotations as much as possible. Prerotation and postrotation surveys from the students as well as feedback interviews with the students, residents, and faculty were used to gather information on the experience. RESULTS: We created a 2-week curriculum including approximately 20 hours of lecture time, 28 hours of operating room time, 2.5 hours of one-on-one mentorship, and 3 hours of social opportunities. Students reported that they learned more about plastic surgery and the residency program, but in contrast to this, some found it difficult to make an impression. CONCLUSIONS: We developed a novel 2-week virtual curriculum that provided visiting medical students from across the country an opportunity to learn more about plastic surgery and our residency program. Virtual learning is becoming a vital part of education, and our study provides pearls and pitfalls when structuring these experiences.

HDL proteome remodeling associates with COVID-19 severity.

BACKGROUND: Besides the well-accepted role in lipid metabolism, high-density lipoprotein (HDL) also seems to participate in host immune response against infectious diseases. OBJECTIVE: We used a quantitative proteomic approach to test the hypothesis that alterations in HDL proteome associate with severity of Coronavirus disease 2019 (COVID-19). METHODS: Based on clinical criteria, subjects (n=41) diagnosed with COVID-19 were divided into two groups: a group of subjects presenting mild symptoms and a second group displaying severe symptoms and requiring hospitalization. Using a proteomic approach, we quantified the levels of 29 proteins in HDL particles derived from these subjects. RESULTS: We showed that the levels of serum amyloid A 1 and 2 (SAA1 and SAA2, respectively), pulmonary surfactant-associated protein B (SFTPB), apolipoprotein F (APOF), and inter-alpha-trypsin inhibitor heavy chain H4 (ITIH4) were increased by more than 50% in hospitalized patients, independently of sex, HDL-C or triglycerides when comparing with subjects presenting only mild symptoms. Altered HDL proteins were able to classify COVID-19 subjects according to the severity of the disease (error rate 4.9%). Moreover, apolipoprotein M (APOM) in HDL was inversely associated with odds of death due to COVID-19 complications (odds ratio [OR] per 1-SD increase in APOM was 0.27, with 95% confidence interval [CI] of 0.07 to 0.72, P=0.007). CONCLUSION: Our results point to a profound inflammatory remodeling of HDL proteome tracking with severity of COVID-19 infection. They also raise the possibility that HDL particles could play an important role in infectious diseases.

Thrombosis of the right iliac, femoral, popliteal, and tibial arteries in a post-COVID-19 in adolescent.

BACKGROUND: Viral infection into lung, muscular, and endothelial cells results in inflammatory response, including edema, degeneration, and necrotic alterations. The involvement of the major arteries in adolescent with COVID-19 has been infrequently reported in the literature. The aim of the present study is to report thrombosis of the right iliac, femoral and tibial arteries and stenosis of left iliac artery in an adolescent with COVID-19 and to discuss the pathophysiological hypotheses. CASE PRESENTATION: We report the case of a 17-year-old female patient with COVID-19 infection. She was seen at the physician specialized general medicine in her hometown, was diagnosed with COVID-19 but did not require hospitalization. After 15 days, she had sudden pain in the left leg that has limited her ability to walk more than 10 met, associated with extremity cyanosis and coldness. Angiotomography revealed thrombosis of a portion of the iliac and popliteal arteries. Na emergency embolectomy was successfully performed, followed by full-dose heparinization with unfractionated heparin. CONCLUSION: Arterial thrombosis of large arteries may be associated with chronic inflammatory syndrome secondary to COVID-19 infection and the treatment with a late embolectomy was successful, even in a thrombotic event.

Maternal outcomes and risk factors for COVID-19 severity among pregnant women.

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease.