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Background: COVID-19 is responsible for a worldwide pandemic, causing more than 18,000 deaths to date in Portugal. Data already exists regarding the increased risk of adverse events in patients with cardiovascular diseases, however the impact of SARS-CoV-2 infection in patients (P) with congenital heart disease (CHD) is still under investigation. Purpose(s): To study the impact of COVID-19 in a adult patients with CHD Methods: Adult patients seen at the CHD outpatient's clinic at a tertiary centre, who became infected with SARS-CoV-2 infection up to December 2021 were included. Assessment of patients' symptoms, need for hospitalization and admission in an intensive care unit was assessed based on medical records. Result(s): We identified seventy-nine patients (pts) with COVID-19 infection. Symptoms were present in 67 (84%). The median age was 44 (15) years, 52% were females. Eight P (10%) had complex cyanotic disease;seven Tetralogy of Fallot;five (6%) transposition of great arteries;eight (10%) right ventricle obstacle;two (3%) atrioventricular canal defect;sixteen (20%) atrial septal defect;nine (11%) ventricular septal defect;eight (10%) aortic coarctation;two (3%) had Eisenmenger syndrome. 49% of P had previous surgery or percutaneous procedure. 63% of P were at New York Heart Association (NYHA) class of I and 30% at NYHA II. Mild symptoms were reported by 56 P (71%). Ten adults (7,9%) experienced moderate symptoms (dyspnea and hypoxia) that led to hospitalization for oxygen therapy, none required mechanical ventilation. One death was reported in an 83-year-old patient with non-corrected interventricular communication and compromised biventricular function. There was a significant association between the gravity of CHD and hospitalizations (p=0.02). Conclusion(s): Our pts had mainly mild to moderate symptoms and did not appear to have a disproportionately negative outcome;the need for hospitalization was more frequent in patients with higher CHD gravity. These findings are in line with the emerging data regarding COVID-19 in CHD P, and may be in part explained by the patient's young age and functional status.
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Using photovoice methodology, this study aimed to capture the perspectives of social workers from aged care services on how the pandemic impacted them at a professional level. This study comprised 12 social workers (aged 22–41 years;11 females) who worked in aged care facilities during the first year of the COVID-19 pandemic. Based on photovoice methodology, as a participatory visual research method focused on individual and community assets and co-creation of knowledge, participants were asked to take photographs and then share the photos and associated narratives in a group session on the topic "Me as a professional: One year of pandemic”. From the thematic analysis, four themes emerged: personal and professional growth (increased resilience, with new perspectives on life), responding to the pandemic (implementation of immediate actions to prevent the virus propagation), teamwork (union among staff), and eyes on the future (with a sense of uncertainty, yet supported by the good lessons learned). The coronavirus disease (COVID-19) pandemic has had a significant impact on aged care facilities, with social workers becoming frontline professionals in a public health crisis. These professionals faced "forced growth” during the pandemic that has transformed them both professionally and personally. © 2023 British Association of Social Workers.
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Local governments were on the front line in responding to the COVID-19 pandemic. They also had to rethink their action mode and carry out a swift digital transition. These changes affected the performance of local democracy, in particular, the nature of Local Executive-Opposition Institutional Relations (LEOIR). Using new survey data on the perceptions of local elected representatives, we run an ordered probit regression model to understand the perceived effect of exceptional measures in response to the COVID-19 pandemic on LEOIR in the Portuguese context. The results show, through the lenses of local key informants, that the Executive's capacity to explain to its constituents the exceptional measures adopted and its formal duty to communicate these decisions to the Municipal Assembly have aggravated the conflictual nature of LEOIR. This study contributes to local governance research by elucidating how accountability and communication practices can soothe or aggravate Executive-Opposition institutional tensions in extraordinary times. © 2022 Informa UK Limited, trading as Taylor & Francis Group.
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This qualitative exploratory study aimed to describe the experiences and practices of care facility directors regarding residents dying in Portuguese residential care facilities (RCFs) before and during the COVID-19 pandemic. Data was obtained from 17 care director facilities who participated in focus groups. The data analysis followed the interpretative phenomenological approach. Participants stated that practices surrounding the death of the residents in Portuguese RCFs changed significantly from before to during the pandemic, regarding both those who died from COVID-19 infection and from other conditions. Four themes emerged that illustrated the situation during the peaks of the pandemic. During the pandemic, practices and experiences quite different from the usual ones have emerged. These results support the importance of a good death, and dying with dignity in RCFs, and the need for policies, practices, and training on the death of residents in RCFs in Portugal.
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The COVID-19 pandemic is a continuing public health crisis, although it has lessened in its intensity since the start of worldwide vaccination programs. In aged care facilities, gerontological social workers have become frontline professionals facing multiple challenges and demands. One year after the first COVID-19 case in Portugal, during the second major lockdown in the country, and with vaccination starting in these facilities, a photovoice program to identify the experiences of these professionals was developed. This study aimed to understand how gerontological social workers foresee the future of practice and intervention with older adults. A thematic analysis was conducted based on the photographs and associated narratives from 10 participants, all female, aged between 22 and 35 years, who attended a program's session. Findings Three themes were identified with the thematic analysis: (1) personal and professional growth (with renewed life perspectives and increased resilience), (2) reinvention of intervention (with improved management of emotions, teamwork, and alternative ways of intervening), and (3) hope to use the lessons learned (hope that vaccination will bring conditions to recover the older adults' well-being and opportunities to use the good lessons learned). Applications These findings are relevant to inform policymakers and governments about practices in aged care facilities and to improve the training of gerontological social workers in acute action management and intervention. We stress alternative ways of intervening that came up in the response to the pandemic such as emotional management, digital technology, communication strategies, self-care, or the families' involvement.
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Background: ACC is a heterogeneous neoplasm and there is no standard treatment for patients (pts) with recurrent/metastatic (R/M) disease. Vascular endothelial growth factor receptor inhibitors (VEGFRi) are frequently used to treat R/M ACC rendering mostly disease stabilization. ACC is resistant to PD-1/PD-L1 inhibitors (PD-L1i), consistent with its low mutational burden and uninflamed immune microenvironment. We hypothesized that the immunomodulatory role of VEGFRi (axitinib) would enhance PD-L1i (Avelumab) activity and be a more effective therapy for R/M ACC. Methods: Eligible pts had R/M ACC with radiological or clinical progression within 6 months (mos) of enrollment. Treatment consisted of axitinib 5 mg PO bid and avelumab 10 mg/Kg IV every 2 weeks. Primary endpoint was objective response rate (ORR) per RECIST 1.1;secondary endpoints included duration of response (DOR), progression-free survival (PFS), overall survival (OS), and toxicity. Simon 2-stage design was applied to test the null hypothesis of ORR ≤ 5% versus the alternative ORR ≥ 20%;≥ 4 responses out of 29 pts was required to reject the null hypothesis. Results: 41 pts enrolled from 07/24/19 to 06/29/ 21;28 were evaluable for the primary endpoint (7 screen failures, 6 evaluable for safety only due to loss of insurance/logistics issues related to COVID-19 pandemic);16 pts were treated in first-line. Mutation data was available for 23 of 28 evaluable pts;7 had NOTCH1 activating mutations. The ORR was 17.9% (5/28, 95%CI: 6.1-36.9%). One response was unconfirmed (pt progressed in non-target lesions 2 mos after achieving a PR), for a confirmed ORR of 14.3% (95%CI: 4-32.7%). The median follow-up time for the 15 alive pts was 11.6 mos (min-max: 7.7-29.2 mos). Median PFS was 7.2 mos (95%CI: 3.7-11.7 mos) with a 6-mos PFS rate of 57% (95%CI: 41-79%). Median OS was 17.4 mos (95%CI: 13-NA). 5 pts remain on therapy, 2/5 with a PR. The median DOR for the 5 responders was 5.2 mos (95% CI: 3.7-NA mos). The most common treatment-related adverse events (TRAEs) were fatigue (62%), hypertension (32%), diarrhea (29%), and stomatitis (29%). Serious TRAEs occurred in 8 (24%) pts, all grade 3 and manageable. 4 (15%) pts discontinued avelumab and 9 (32%) underwent axitinib dose reduction due to toxicity. Conclusions: The study reached its primary endpoint with ≥ 4 responses out of 28 evaluable pts (ORR of 17.8%;confirmed ORR of 14.3%). The ORR and 6- mos PFS rate of 57% with axitinib and avelumab compares favorably with single agent axitinib and warrants further study of the combination.
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Background: The COVID-19 pandemic has brought healthcare systems to the brink of collapse worldwide, imposing relevant economic challenges. Objective: To analyze the costs related to the impact of the first wave of the COVID-19 pandemic on human resource management in a Portuguese hospital. Methodology: Economic, retrospective, and single-center study. This study analyzed the costs of absenteeism, hiring new staff, and overtime work by health professionals (nurses, physicians, operational assistants, and diagnostic and therapeutic technicians) and compared data from March 1 to May 31, 2020 to the same period in 2019 to determine differences in costs. Results: Data from 6,994 health professionals were included. Compared to 2019, an additional 8,817,199.84€ were spent on staff in this trimester (absenteeism: €6,842,284.64;hiring new staff: €363,540.03;overtime work: €1,611,375.17). Conclusion: In the first trimester of the COVID-19 pandemic, the overall costs with health professionals almost tripled, representing almost €9 million more than in the same period in 2019. © 2021, Escola Superior de Enfermagem de Coimbra. All rights reserved.
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Objective: This paper aims to investigate the intersectoral activity of the Casa da Mulher Brasileira (CMB) in the State of Maranhão (CMB/MA), as well as the effectiveness of its actions in combating domestic violence in this pandemic context. Methodology: The main intellectual thesis behind this article is Pierre Bourdieu’s Reflexive Sociology. It has an exploratory nature, with a qualitative approach. To achieve its objectives, it chooses techniques such as content and speech analysis, bibliographic research, both document and data assemblage, as well as visits to the CMB/MA”. Results: It is of general understanding that domestic violence is that carried out at home, which is marked by a symbolic structure of domination, intensified by social distancing and/or isolation imposed by the pandemic. In the meantime, even if the “CMB/MA” has taken actions to reduce the distance between the victim and the services offered, there are still possibilities that influence the increase in occurrences and disfavor a more active attitude by CM”. Contributions: The research shows the need to combat domestic violence with public policies that match the dimensions of this problem in Maranhão. Thus, even with adequate normative protection, institutions such as the Casa da Mulher Brasileira are important for the formulation of concrete fighting strategies. That is why, during the pandemic, it is mandatory to provide the necessary conditions for intersectoral activities to reach women effectively and corroborate for the reduction of state indices. © 2021, Centro Universitario Curitiba - UNICURITIBA. All rights reserved.
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Purpose: The purpose of this paper is to identify the difficulties and overload/burden experienced by family caregivers of older dependent people during the COVID-19 outbreak. Design/methodology/approach: A descriptive and cross-sectional study was conducted. This work was guided according to the Guideline strengthenin the reporting of observational studies in epidemiology (EQUATOR checklist). The study included 65 family caregivers of older people with physical or mental dependence. Caregivers were selected by convenience sampling through a national association of informal caregivers. Participants responded to an online questionnaire, which aimed to assess difficulties and burdens experienced during the pandemic. Ethical principles were followed throughout the research. Findings: The participants were mostly women, with an average age of 53 years, teleworking and cohabiting with the dependent elderly. Most caregivers reported that the pandemic has led to an increase in daily difficulties and associated burden. There was a statistically significant increase in hours devoted to care during the pandemic. Also, caregivers reported less time to take care of themselves and greater fatigue during this period. Research limitations/implications: This study had some limitations. For example, the small sample size. The sample was collected through an online version, and many caregivers did not have the digital skills needed to complete the questionnaires, and most of them were busy (divided between teleworking and household responsibilities). Another limitation was related to the perceived priority of caregivers because the majority of them considered this was a time-consuming study and saw no immediate benefits. Furthermore, they considered that this study has taken their time to manage all the provision of care to the elder relative and other activities related to their children who were also in quarantine. Finally, to date, there is no sufficient evidence to compare our results with other national and international studies. Further research is needed to allow the scalability of results and to apply the best available knowledge to mitigate the known and potential effects of this pandemic. Practical implications: This study highlighted that frontline caregivers suffered a negative impact on their physical and mental health, in addition to a significant economic burden during the pandemic outbreak. More research in this field is needed to plan, train and manage large-scale public health emergencies. Social implications: The COVID-19 pandemic imposed physical distancing, which profoundly affected the physical and mental health of community-dwelling older people and their family caregivers. Because of the confinement and closure of some social support institutions, family caregivers found themselves in a complex situation, having to reconcile care and teleworking. Therefore, it is important to identify the impact of the COVID-19 pandemic on the difficulties and burden of these caregivers to implement and develop social and health support measures. Originality/value: This paper addresses an increasingly important issue – the burden and difficulties of family caregivers, in the light of a new reality – the Covid-19 pandemic, which has brought new difficulties for this population. © 2020, Emerald Publishing Limited.
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Introdução e objetivos: A incidência de Endocardite Infecciosa comunitária associada a hemoculturas negativas (EICAHN) varia de 5 a 78%. Há poucos relatos da incidência de endocardite infecciosa associada a Bartonella spp. (EIAB) no Brasil. Nesse estudo avaliaremos a incidência de endocardite (EI) por Bartonella spp. na série de 119 pacientes no Rio de Janeiro. Método: Estudo observacional, transversal, prospectivo, de 2009 a 2021, inclusos 119 pacientes com EI em hospital universitário na cidade do Rio de Janeiro. Os testes sorológicos e moleculares para Bartonella spp. foram realizados no laboratório de referência e resultados positivos de acordo com a literatura. Análise dos dados foi realizada no Stata Statistical Software. Resultados: A incidência de EIAB nesta série foi de 1,6%. Comparando os dados EICAHN (N=17) com o grupo EI comunitária com hemoculturas positivas (N = 35), 14,2% foi classificada com EICAHN. Um paciente (P1) com EIAB residia com dois cachorros e outra paciente (P2) com dois gatos. Ambos com evidência epidemiológica e laboratorial de infecção por Bartonella após visita do grupo One Health. No grupo de EIAB, o principal fator de risco foi a febre reumática (p = 0,031). A EI aórtica foi mais incidente na EICAHN (p = 0,001). Os dois casos de EIAB foram diagnosticados no ano da pandemia de COVID-19. O P1, homem branco de 47 anos, após investigação de síndrome febril e IC de evolução de três meses, foi submetido à cirurgia de troca valvar mitro-aórtica, onde foi observada vegetação valvar. Amostra de sangue submetida à imunofluorescência indireta para anticorpos anti-Bartonella, sendo reagente. A PCR sérica para Bartonella foi negativa, porém houve detecção de DNA para B. henseale na valva. Seus cachorros foram testados e em um deste houve detecção de anticorpos anti-Bartonella spp. no sangue. A P2, mulher branca, 62 anos, com prótese mitral biológica disfuncionante, internada para investigação de síndrome consumptiva há 8 meses, com insuficiência renal e anemia na ausência de febre. A pesquisa de anticorpos IgG Anti-Bartonella spp. no sangue foi positiva, assim como nos gatos que residiam com a mesma. O diagnóstico de EI se deu pelos critérios de Duke modificados. Conclusão: A incidência de EIB nesta série de 119 paciente do time de EI do Rio de Janeiro foi 1,6. Maior acometimento de EIAB foi na valva aórtica e o principal fator de risco a febre reumática. Abordagem One Health contribui em 2020 para o diagnóstico endocardite por B. henselae.
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Background: COVID-19 is responsible for a worldwide pandemic, causing more than 13 000 deaths to date in Portugal. Data already exists regarding the increased risk of adverse events in patients with cardiovascular diseases, however the impact of SARS-CoV-2 infection in patients (P) with congenital heart disease (CHD) is still under investigation. Aims: To evaluate the impact of COVID-19 in adult patients with congenital heart disease in our tertiary centre Methods: Adult patients seen at the CHD outpatient's clinic at a tertiary centre, who became infected with SARS-CoV-2 infection up to February 2021 were included. Assessment of patients' symptoms, need for hospitalization and admission in an intensive care unit was assessed based on medical records. Results: We identified 36 patients (pts) with COVID-19 infection. Symptoms were present in 31 (86%). The median age was 39 (32-49) years, 58% were females. Seven P (19%) had complex cyanotic disease;three (8%) Tetralogy of Fallot;three (8%) transposition of great arteries (one after Senning procedure and 2 after arterial switch);six (14%) right ventricle obstacle;two (8%) atrioventricular canal defect;four (11%) atrial septal defect;five (14%) ventricular septal defect;five (14%) aortic coarctation;two aortopathies (one submitted do David procedure);one subaortic stenosis;two (6%) had Eisenmenger syndrome. The majority (61%) of P had previous surgery and 58% were at New York Heart Association class of I. Mild symptoms were reported by 24 P (67%). Seven adults experienced moderate symptoms (dyspnea and hypoxia) that led to hospitalization for oxygen therapy, although none required mechanical ventilation. One death was reported. There was a significant association between the gravity of CHD and hospitalizations (p=0.012). Conclusion: Our pts had mainly mild to moderate symptoms and did not appear to have a disproportionately negative outcome;the need for hospitalization was more frequent in patients with higher CHD gravity. These findings are in line with the emerging data regarding COVID-19 in CHD P, and may be in part explained by the patient's young age and functional status.
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Introduction: Natalizumab is a highly effective treatment for multiple sclerosis (MS), with a standard interval dosing (SID) of 300 mg administered by intravenous infusion once every 4 weeks. The major adverse event associated with this drug is progressive multifocal leukoencephalopathy (PML), and extended interval dosing (EID) has been associated with reduced PML risk. Due to COVID-19 pandemic, in line with the international recommendations for MS management, we changed the natalizumab SID to EID with every six weeks infusions in all clinically stable patients on natalizumab therapy for more than one year. Objectives/Aims: The aim of this study was to evaluate the effectiveness of EID in clinical practice. Methods: Retrospective study with MS patients treated with natalizumab with EID during COVID-19 pandemic. Demographic and clinical characteristics were collected. Results: During COVID-19 pandemic 90 patients were treated with EID and were selected for this study. Of those, 74.4% (n= 67) were female, with a mean age of 41.4±12.8 years and median disease duration of 9.0±11.0 years, 96.7% (n=87) with relapsing-remitting MS. The median treatment duration with natalizumab at baseline was 3.0±4.0 years. Patients had a median EDSS of 2.0±1.5, 12.2% (n=12) with relapses in the previous 12 months. During the median 13.3±2.0 months of follow-up, 8.9% (n=8) returned to the SID. The reason for changing was occurrence of wearing-off symptoms in 13.3% of patients (n=12), with paroxysmal symptoms in 5, fatigue in 3 and constipation in 1 patient. One patient (1.1%), which already had a relapse in the previous year, experienced a relapse 2 weeks after the first EID treatment and was switched to SID. There were no cases of known SARS-CoV-2 infection. Conclusions: Our study suggests that natalizumab EID was an effective and apparently safe regimen during COVID-19 pandemic, although some patients have suffered from wearing-off symptoms with this posology.
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COVID-19 is a disease caused by the new coronavirus (SARS-CoV-2), identified in Wuhan, China, in December 2019, and declared a pandemic by the World Health Organization in March 2020. Clinical manifestations occur mainly in respiratory system, however some studies have reported extra-pulmonary changes, such as oral and maxillofacial implications. This study aims to verify the possible oral and maxillofacial implications of COVID-19. Therefore, an integrative literature review was carried out. Systematic searches were carried out in SciELO, PubMed, Web of Science, Scopus and Google Scholar from June 6 to 8, 2020. Inclusion criteria were studies that evaluated oral and / or maxillofacial manifestations of COVID-19 and portrayed clinical cases of patients with the disease. Exclusion criteria were studies that were unavailable for reading in full, literature reviews and letters to the editor. Twelve studies were selected, in which the main manifestations were changes in taste and smell, dry mouth, ulcers in the oral mucosa and increase in cervical and submandibular lymph nodes, which may present together with other respiratory symptoms or in isolation. Because of this, the identification of some of these changes can contribute to the early diagnosis of the disease, however more studies are needed to improve the scientific evidence on the subject, to clarify whether part of these changes are manifestations of the disease or a consequence of the immune status of the patient. patient who favors the development of opportunistic infections and neglect of oral hygiene.
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Objective: To identify people's outcomes and clinical characteristics of those with obesity and covid-19 in the national and international scientific literature. Method: Integrative Review, in which it aimed to answer the guiding question: What are the clinical characteristics presented by people with obesity with a confirmed diagnosis of COVID-19, and its impact on health?" indexed in the database Medical LiteratureandRetrivial System on Line, and Virtual Health Library in November 2020. Results: Out of the 13 articles analyzed in total, all were published in international journals;in the year 2020, concerning clinical outcomes, a high mortality rate was evidenced in patients admitted with covid- 19 who had obesity in comparison with those without obesity, more extended hospital stay, need for oxygen therapy, increased severity of Covid-19 disease, a risk factor for morbidity rates in younger people, being able to predispose to risk of more severe conditions and influence the progression and prognosis of the disease. Regarding the clinical characteristics, they showed that ferritin tended to remain higher in the group of obese people, being more likely to have fever, cough, and shortness of breath. Conclusion: Obesity in people with covid-19 potentiates clinical characteristics such as cough, fatigue, fever, and tiredness. Clinical outcomes include the potential risk of complications, high mortality rates, greater propensity to be intubated, longer oxygen therapy time. Thus, more attention should be paid to these patients by the health teams. © Copyright Servicio de Publicaciones - Universidad de Murcia
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Background and aims: Although rare, myelitis as neurological complications of SARS-CoV2 infection are increasingly recognized. Methods: We describe a patient with post COVID-19 myelitis presenting as Partial Brown-Sequard syndrome. Results: A 33-year-old man presented to the hospital with a one-week history of progressive weakness and diminished sensation of the lower limbs. Six weeks before, the patient was diagnosed with SARS-CoV-2 infection, with mild symptoms, from which he fully recovered (at the time negative). Neurological examination revealed right leg motor weakness (grade 4/5), left-sided hemihypoesthesia (T5-T6) and a hyperesthesic zone at T4 on the right. Spinal cord MRI revealed an intra-medullary lesion extending from T3 to T4, at the right anterolateral region, with gadolinium enhancement. Brain MRI was normal. Routine blood tests were unremarkable/negative, including serologies, autoimmune-panel and antibodies anti-MOG/ anti-aquaporin 4. Cerebrospinal fluid study was normal, oligoclonal bands were negative and SARS-CoV-2 was not detected by PCR, but serology for SARS-CoV-2 (IgG) was positive. The patient started methylprednisolone (1g/daily for five days) with improvement of the symptoms being discharged on an oral steroids tapering regimen. One month later, the patient was asymptomatic, neurological exam was normal and there was a considerably lesion reduction and no gadolinium enhancement. Conclusion: We assumed the diagnosis of post-infectious myelitis after COVID-19, considering the delayed temporal profile, no other causes were found after extensive workup and the marked improvement with steroids. A direct infection of the CNS by SARS-Cov2 seems unlikely since the myelitis occurred six weeks after the acute infection and CSF was negative for the virus.
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A series of drugs was investigated to determine structural, electronic and pharmacological properties, as well as the molecular affinity for the main protease of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The drugs were submitted to density functional theory calculations to optimize structures and predict binding preferences. The optimized geometries were used in molecular docking simulations. In the docking study, the receiver was considered rigid and the drugs flexible. The Lamarckian genetic algorithm with global search and Pseudo-Solis and Wets with local search were adopted for docking. Absorption, distribution, metabolism, excretion and toxicological properties were obtained from the Pre-ADMET online server. In this series, the antiviral atazanavir showed the potential to inhibit the main protease of SARS-CoV-2, based on the free binding energy, inhibition constant, binding interactions and its favorable pharmacological properties. Therefore, we recommend carrying out further studies with in vitro tests and subsequent clinical tests to analyze its effectiveness in the treatment of SARS-CoV-2. © 2021 Sociedade Brasileira de Química.