Evolution of Clusters Transmission Patterns in France during the Last Decade

Background: The recent transmission clusters (RTCs) identified through phylogenetic approaches allow to describe the main transmission networks. This render possible to describe potential shifts among HIV transmission routes and populations and, in some cases, to specifically target prevention measures. Here we describe the evolution of RTCs over the last decade in a specialized laboratory serving centers from the entire French territory. Method(s): We extracted all the HIV reverse transcriptase sequences available between 01/01/2013 and 31/08/2022. The sequences dataset was studied overall and divided into three equal time periods: 2013-15, 2016-18, 2019-2021. The first sequences available for each patient were aligned and the trees were reconstructed by maximum likelihood using IQtree software. Clusters, defined by a maximum genetic distance < 4.5% and a branch support >90%, were extracted using ClusterPicker. Result(s): Overall, 8591 sequences were included. Among them, 950 RTCs were identified including 2492 sequences (29%) and 68 large RTCs ( >4 sequences) with 475 (5.6%) sequences. The mean duration of large RTCs (from the first to the last sequences) was 5.1 years [IQR: 4.1-7.1] and 34 were still active (including at least one sequence during the last year of the study period). 3640, 2897 and 2157 sequences were included for the 2013-15, 2016-18 and 2019-2021 periods, respectively. We identified 298 RTCs (19.5% of sequences), 249 (20.4%) and 226 (27.5%) among those periods, respectively. While the number of sequence pairs decreased from 2013-15 to 2019-21, the number of large RTCs increased steadily (see Table 1). During the period 2019-21, including the largest clusters, patients belonging to a RTC were more often male (68 vs 58%, p< 0.001) and younger (average age: 39 vs 44 years, p< 0.001) than non-RTC patients. This observation was even more marked for very large RTCs (see Table 2). It should be noted that the largest cluster (14 patients) was mainly composed of women and located in French overseas territories. Conclusion(s): This study shows an evolution of the structure of HIV sequence clusters over time with a decreasing number of small RTCs but an increasing number of large RTCs. These trends can be explained by a better global control of transmission, due in part to TasP, but not preventing some super-transmitters networks, despite PrEP use and not only including MSM is some settings. The COVID period does not seem to have strongly prevented such large transmission networks.

Sedation in the ICU: association between dexmedetomidine and 28-day mortality in patients with COVID-19

Introduction: The aim of our study is to evaluate the relationship between dexmedetomidine (DEX) use as a sedative agent in mechanical ventilated ICU patients and 28-day mortality. DEX, a selective alfa-2 adrenergic receptor agonist, widely used for its sedative and analgesic properties, has been linked to increasing parasympathetic tone, reducing the inflammatory response and oxidative stress [1]. Since severe COVID-19 is associated with an hyperinflammatory state, it is hypothesized that DEX might improve outcomes in these patients. Method(s): This is a retrospective observational study of mechanically ventilated patients admitted with COVID-19 pneumonia in the ICU of a tertiary center in Portugal, between March 2020 and December 2021. Logistic regression analysis was performed to evaluate the association of DEX use and 28-day mortality from time of intubation. Result(s): A total of 277 patients were analyzed, 151 in the DEX group and 126 in the no DEX group. Patients in the DEX group were younger (53.3 vs. 63.3 years, p < 0.001), had less comorbidities (2.8 vs. 3.5, p = 0.01), lower SOFA at admission (6.2 vs. 7.1, p = 0.01) but had a prolonged ICU stay (21.4 vs. 15.9, p < 0.001). Male gender (65.6 vs. 69.0, p = 0.54), incidence of obesity (56.3 vs. 46.8, p = 0.12), coronary artery disease (4.0 vs. 7.9, p = 0.16) and atrial fibrillation (4.0 vs. 7.1, p = 0.25) were similar between groups. PaO2/ FiO2 ratio at admission (111.1 vs. 108.1, p = 0.61), days spent in RASS < 3 (13.7 vs. 12.4, p = 0.31) and opioid use (14.8 vs. 13.1, p = 0.16) were also similar. From time of intubation, 28-day mortality in the cohort receiving DEX was 14.7% compared to 59.5% in the no DEX group (OR 0.12;95% CI 0.07-0.21;p = 0.01). Conclusion(s): Use of DEX was associated with lower 28-day mortality in COVID-19 critically ill patients requiring invasive mechanical ventilation in our study analysis. Considering the limitations of a retrospective observational study, RCTs are needed to confirm the results.

Risk factors for nosocomial infections in COVID-19 ICU population

Introduction: The aim of this study is to identify the factors associated with an increased risk of developing nosocomial infections (NI) in COVID-19 patients admitted with pulmonary involvement in the ICU. NI in COVID-19 ICU population are an important cause of morbidity and mortality worldwide and its prompt identification might lead to its prevention and better outcomes. Method(s): This is a retrospective observational study of patients admitted with COVID-19 pneumonia in the ICU of a tertiary center in Portugal, between March 2020 and December 2021. We considered NI as any infection acquired > 48 h post ICU admission. Clinical, analytical and baseline patient data were evaluated. Logistic regression analysis was performed to correlate patient related variables with the development of NI. Result(s): A total of 338 patients were enrolled, from which 167 (47.9%) presented with NI. Baseline characteristics are described in Table 1. In the logistic regression analysis, older age (OR 1.13;95% CI 1.03-1.25;p = 0.013), coronary artery disease (CAD) (OR 28.7;95% CI 1.92-429;p = 0.02), obesity (OR 3.14;95% CI 0.86-11.42;p = 0.008), chronic liver disease (CLD) (OR 104.33;95% CI 1,.04-1008.49;p = 0.04), use of dexamethasone (OR 21.89;95% CI 3.04-157.85;p = 0.002) and days in RASS < 3 (OR 1.4;95% CI 1.05-1.86;p = 0.02) were associated with an increased risk of developing NI in the ICU. Surprisingly, SOFA at admission, days of invasive mechanical ventilation, days of sedation and PaO2/ FiO2 ratio at admission, although statistically significantly different between groups, did not correlate with the risk of infection. Conclusion(s): We identified prolonged deep sedation, corticosteroid use, and patient characteristics (CAD, obesity, CLD, older age) as independent risk factors for NI development in COVID-19 critically ill patients. It is also noteworthy to point out for the presence of confounding variables, including the excessive workload in the ICU during this period, leading to an increase in NI numbers.

Outcomes of renal replacement therapy in critically ill COVID-19 patients

Introduction: Our goal is to describe outcomes of critically ill COVID-19 patients submitted to renal replacement therapy (RRT), in particular the association of RRT with mortality. Multi-system organ failure or direct kidney injury caused by SARS-CoV-2 is associated with the development of acute kidney injury (AKI) which subsequently increases the need for RRT and may affect the outcomes. Method(s): This is a retrospective observational study of 338 critically ill patients admitted with COVID-19 pneumonia in the ICU of a tertiary center in Portugal, between March 2020 and December 2021. Clinical, analytical and baseline patient characteristics were evaluated. Logistic regression analysis was performed to correlate patient data with the need for RRT and ICU mortality. Result(s): From a total of 338 patients, 5% required RRT (n = 16), 25% of which received intermittent hemodialysis (n = 4) and 87,5% continuous veno-venous hemofiltration (n = 14). Baseline characteristics are described in Table 1. In our sample, 61 patients (18%) presented with acute AKI, from whom 14 (23%) were submitted to RRT. From all the patients receiving RRT, 10 (62.5%) did not have pre-existing chronic kidney disease. In the logistic regression analysis, AKI (OR 45.4;95% CI 7.7-269.5;p < 0.001), higher SOFA (OR 1.24;95% CI 103-1.51;p = 0,03), creatinine (OR 2.01;95% CI 1.4-3.0;p < 0.001) and C-reactive protein (OR 1.09;95% CI 1.02-1.16;p = 0,01) on admission were associated with the need for RRT. Additionally, ICU mortality associated with RRT was 75% compared to 28.3% in the group not submitted to RRT (OR 7.6;2.4-24.2;p = 0.001). Conclusion(s): The need for RRT in critically ill COVID-19 patients is associated with an increased mortality rate in our study. We were also able to identify AKI, higher SOFA, creatinine and C-reactive protein at admission as risk factors for RRT. However, due to the retrospective nature of our analysis and our small sample size, more studies on this topic are needed to confirm these results.

Aumento Do Numero De Testes Reagentes Confirmados Para Hiv No Hemocentro De Sao Jose Do Rio Preto Em 2021

Introducao: O virus da Imunodeficiencia Humana (HIV) e um lentivirus que causa a Sindrome da Imunodeficiencia Adquirida, caracterizada por uma deterioracao progressiva do sistema imune, facilitando o aparecimento de doencas oportunistas. Segundo o relatorio anual UNAIDS (Programa Conjunto das Nacoes Unidas sobre HIV/AIDS), no Brasil ao menos 5 pessoas/hora foram infectadas pelo virus HIV em 2021, totalizando 1,5 milhoes de casos neste periodo. Objetivo: Analisar o perfil sorologico dos doadores de sangue em relacao aos testes de HIV nos anos de 2019 a 2021. Material e metodos: Foi realizada triagem sorologica em doadores de sangue pela metodologia de quimioluminescencia e teste de acido nucleico para HIV (NAT HIV), nos anos de 2019 a 2021 e os testes reagentes foram confirmados com metodologia complementar de eletroquimioluminescencia. Para estes doadores, foram solicitadas coleta de nova amostra para repeticao dos testes para confirmacao dos resultados encontrados. Resultados: Das 35.720 doacoes de sangue realizadas em 2019, 06 (0,016%) apresentaram resultados reagentes na triagem sorologica, testes NAT HIV detectaveis e confirmados pela metodologia de eletroquimioluminescencia. Em relacao ao genero, foi observado, 5 masculinos (83,4%) e 1 feminino (16,6%). Quanto a faixa etaria, foi identificada mediana de 31 anos (min. 24 e max. 44) e referente ao estado civil, 4 solteiros e 2 casados. Das 34.723 doacoes de sangue realizadas em 2020, 02 (0,005%) apresentaram resultados reagentes na triagem sorologica, testes NAT HIV detectaveis e confirmados pela metodologia de eletroquimioluminescencia. Foram identificados 2 doadores do genero masculino (100%) e quanto a faixa etaria, foi encontrada mediana de 35,5 anos (min. 22 e max. 49) e o estado civil de ambos solteiros. Em relacao a 2021, das 35.871 doacoes de sangue realizadas, foram observados que 11 (0,030%) doadores apresentaram resultados reagentes na triagem sorologica, testes NAT HIV detectaveis e confirmados pela metodologia de eletroquimioluminescencia. Foi observado que todos os doadores (100%) reagentes eram do genero masculinos, com mediana de 28 anos (min. 20 e max. 40) e quanto ao estado civil foram encontrados 9 solteiros, 1 casado e 1 uniao estavel. Discussao: No periodo de 2019 a 2021 as campanhas de doacao de sangue se intensificaram com o objetivo de reposicao do estoque de hemocomponentes em nosso servico, devido a escassez de doadores de sangue, incluindo o periodo da pandemia COVID-19. Analisando os dados dos perfis dos doadores confirmados reagentes, nao foi possivel estabelecer relacao com o tipo de doacao e o aumento do numero de casos de HIV no ano de 2021. Embora, os testes confirmados reagentes sejam predominantes entre os doadores de primeira doacao, foi observado estabilidade no numero de doadores desta categoria em relacao ao numero de doadores por ano ao longo deste periodo. Com isso, nao e possivel estabelecer correlacao com o aumento do numero de casos de testes reagentes confirmados para HIV, com as doacoes de primeira vez. Conclusao: Embora os dados nacionais mostrem o aumento de infectados por HIV em 2021 e o mesmo foi evidenciado em nosso servico, nao foi possivel justificar este aumento atraves dos dados epidemiologicos dos nossos doadores de sangue. Este fato pode ser reflexo das caracteristicas do aumento do numero de casos de infectados pelo virus HIV na populacao geral. Copyright © 2022

(Im) Possibilities of Subjective Formation: Educational Weightings in Pandemic Times

The present article investigates the question of the emergent condition of education in pandemic times, especially regarding the meaning of the (im)possibilities of subjective formation. Meanwhile, we outline some elements of the educational implications of the pandemic scenario of the new coronavirus. In this way, we outline a diagnosis of the social and educational transformations in the current context and discuss how this indicates something about the processes of subjective formation. The research is bibliographic, with aspects of integrative review. Thus, we bring to the text authors that we have already been studying, for an interlocution with new commentators, who bring elements of contextualization to form a panorama of the current educational scenario. In this way, we understand that the recrudescence of the educational situation is a sign of the advance of a more serious and severe situation globally established. A social and civilizing condition, greatly aggravated, by the social, ethical and economic-political model, which permeates all dimensions in our contemporary world (which, consequently, has strong impacts on the possibilities of subjective formation).

Web Information in Face of COVID-19 Crisis: Evidence from Tourism Sector

Due to COVID-19, the global health crisis has had an unprecedented effect on the tourism industry. Academics and politicians are asked to point out solutions that will help people and the economy mitigate such a bad impact. This paper aims to answer the following research questions: (i) How the pandemic caused by COVID-19 was treated by tourism e/m-commerce companies, (ii) What kind of information is available on social media about COVID-19, (iii) What economic and financial information can be access on the web regarding these companies. This is an exploratory study based on multiple case-study approaches that combine different methodologies and techniques. The content analysis focuses on two main pillars: COVID-19 related information available in websites and social networks;the economic and financial information available and freely accessible on the web. The results indicate that, in general, companies have strengthened their presence in the digital world. Services that were previously provided face-to-face or in a mixed format, are now exclusively remote. Communication with customers about pandemic awareness, public health care and, especially, procedures to be carried out, were also distributed through digital channels. Financial data of companies with a diversified business portfolio evidence systematic risk, while companies that deal exclusively with tourism business already show expected losses due to their exposure to specific risk, expected for the tourism sector.

I9MASKS: FROM A MULTIDISCIPLINARY SUMMER PROJECT TO A NON-ACCREDITED SHORT COURSE

This study presents a research experience with engineering students at undergraduate and graduate levels, during the summer of 2020 at the School of Engineering, University of Minho, Portugal. Following the first pandemic event in Portugal, from March to May 2020, the Foundation for promoting Science and Technology (FCT) has opened a call for research projects among students and researchers at different Universities. The main aim of these projects was to motivate students to return physically to the campus during a summer course, and to promote a research environment among them. i9Masks was one of the projects approved by the University of Minho and its main objective was the development of innovative masks in a silicone elastomer for the protection of COVID-19 with the use of state-of-the-art technologies. The development of masks was at the time a very hot topic as well as a fashionable subject for research. Considering the results obtained, from the final works presented by students, a very positive balance of the experience was achieved. The i9Masks project was a useful learning experience for engineering education, particularly in Portugal, where the opportunity to participate in this type of "learning by doing" experience is very small. Copyright © 2021 by ASME

Stress and resilience in nurses: a comparative study of portugal/germany in the COVID-19 pandemic

Introduction: Stress was recognized by the WHO as an epidemic of the 21st century. Studies show that nurses work in a stressful work environment, which impairs their mental health. During the COVID-19 pandemic, research revealed that frontline professionals have great vulnerability to stress, anxiety and depression. However, resilience can be a protective factor and promote psychological well-being. Objectives: This study aim to identify and compare stress and resilience levels in Portuguese and German nurses working in hospitals during the COVID-19 pandemic, as well as to analyze their interrelationship and verify if they vary according to sociodemographic and professional characteristics. Methodology: This is a quantitative, cross-sectional, comparative and correlational study, using Portuguese and German versions of the Nursing Stress Scale and Resilience Scale. The data were collected online using the snowball method, with voluntary participation, between June and December 2020. The convenience sample consisted of 588 nurses with definitive labor bond, being 49.5% Portuguese and 50.5% German, 75% women, 72% with bachelor, 80% working by shifts, with an average age of 35.12 years old and an average of 12.01 years of job experience. Results: We found that, compared to German nurses, Portuguese nurses present greater stress, especially related to dealing with death, work overload and physical environment, and lower resilience, especially in the acceptance of themselves and life. Discussion: There is a different influence of sociodemographic/professional variables in each country. Globally, it can be concluded that stress has been increasing, and the COVID-19 pandemic has aggravated the situation worldwide, especially in health care. However, in each country nurses may have specific vulnerability factors due to different demand and different work organization. Conclusion: The results are useful to develop strategies for an adequate stress management in which individual resilience is a protective factor and helps promotion of mental health during and after the pandemic.

Energy, Thermal Comfort and Pathologies—A Current Concern

Objective: In view of the flow rate established by law of 10 renewals per hour to protect spilled particles, conclude if these are removed from the domain and the thermal comfort is maintained in the room. Background: Currently, any building or project needs to meet standards of comfort and energy efficiency for certification. It is important to study comfort, but also to study the extraction of particles expelled during a sneeze phenomenon. Particles are studied with particular importance due to the panorama that we experience today with the pandemic situation. The Sars-Cov-2 virus is still a subject of study in several areas, especially due to its easy form of contagion. The study of the behavior of water particles expelled through the mouth facilitates the perception of risk, as well as preventive measures to be adopted. Method: For the study, numerical simulation was used, namely the Ansys ® program. For this, a mannequin was modeled inside a 15 m 2 room, whose HVAC system incorporates an insufflation grid and an extraction grid. The mannequin has an associated respiratory cycle and during the same period it suffers a sneeze period expelling water particles. Results: Due to the obtained PMV, the thermal comfort of the occupant cannot be ensured, having to adopt a greater diffusion of the inflated air. The behavior of the particles expelled during a sneeze is predicted. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Learning science during summer vacations and its effects on attitude and anxiety towards research

The outbreak of COVID-19 had a great impact on education with the sudden shift from traditional to online learning. As a result, the difficulties experienced by students increased, professors had to adapt the teaching method of the contents and experimental activities were all transmitted from a screen, making this a difficult task for everyone. In this context, the resumption of in-person activities is of great importance to surpass the difficulties that this pandemic crisis has brought to students learning. Motivated by this necessity, the Foundation for Science and Technology (FCT), proposed a program called “Summer with Science”. This program aimed to develop presential activities with the participation of students, professors, and researchers in the summer of 2020, that involved innovative solutions related to the COVID-19 pandemic. i9Masks was one of the interesting projects that emerged from this initiative and it consisted of developing transparent facial masks for preventing the virus’ dissemination. This project joined students of different engineering and biological sciences at any level in a Higher Education Institution to learn science. In order to understand the impact of this course on student’s motivation to conduct research, in the present study, a questionnaire was used to collect the data from the students who participated in the i9Masks summer project. The same questionnaire was applied to non-participants as a control group. After the data are gathered, the results were evaluated, and it was observed that effectively this course had a great and positive impact on student’s perspective on research activities. Significant differences were observed regarding the attitudes towards research between participants and non-participants. © 2021 University of Minho. All rights reserved.

A Content Analysis of Social Media in Tourism During the Covid-19 Pandemic

The tourism sector is one of the most important drivers of the Portuguese economy. Indeed, any impacts on tourism organizations’ performance have a huge influence on the economic, social and cultural dynamic of the Portuguese society. As such, considering the challenges and pressure that the recent pandemic of COVID-19 has put on tourism organizations, much attention has been devoted to the problem. This paper focuses on web communication strategy followed by key organization in the tourism sector during COVID-19. It is an exploratory study based on a multiple case-study approach that combines different methodologies and techniques. The cases under study were selected through an analytic tool - SimilarWeb - and the preliminary findings, obtained through content analysis of websites and social media profiles of the organizations, indicate that Portuguese tourism organizations have entered in a new age of communication with their clients, characterized by more flexible, complex, and unbureaucratic communication strategies. © 2021, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Mobile applications for assessing human posture: A systematic literature review

Smartphones are increasingly incorporated with features such as sensors and high resolution cameras that empower their capabilities, enabling their use for varied activities including human posture assessments. Previous reviews have discussed methods used in postural assessment but none of them focused exclusively on mobile applications. This paper systematically reviews mobile applications proposed for analyzing human posture based on alignment of the body in the sagittal and coronal plane. The main digital libraries were searched, 26 articles published between 2010 and 2020 were selected, and 13 mobile applications were identified, classified and discussed. Results showed that the use of mobile applications to assist with posture assessment have been demonstrated to be reliable, and this can contribute to clinical practice of health professionals, especially the assessment and reassessment phases of treatments, despite some variations when compared to traditional methods. Moreover, in the case of image-based applications, we highlight the advantage that measurements can be taken with the assessor at a certain distance with respect to the patient’s position, which is an important function for assessments performed in pandemic times such as the outbreak of COVID-19. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.

Covid-19 and Digestive Endoscopy: Emergency Endoscopic Procedures and Risk Factors for Upper Gastrointestinal Bleeding

BACKGROUND: The COVID-19 pandemic has changed digestive endoscopy services around the world. OBJECTIVE: This study aimed to measure the number of urgent/emergency endoscopic procedures performed in a Brazilian hospital, comparing it to the same period in the previous year, and to identify risk factors in COVID-19 patients undergoing endoscopic procedures for upper gastrointestinal bleeding (UGIB). METHODS: This was a retrospective, cross-sectional, observational, single-center study. The study evaluated urgent/emergency endoscopic procedures performed on adult patients from March to August in 2019 and 2020. The COVID-19 patients included were diagnosed using RT-PCR, aged over 18 years with complete medical record information. The variables evaluated were age, sex, comorbidities, length of stay, D-dimer, need for intensive care unit (ICU) and mechanical ventilation. Student's t-test for independent samples or the non-parametric Mann-Whitney test was used to compare quantitative variables. Categorical variables were analyzed using Fisher's exact test. A P-value <0.05 indicated statistical significance. RESULTS: A total of 130 urgent/emergency endoscopic procedures were performed in 2020 and 97 in 2019. During the study period, 631 patients were hospitalized due to COVID-19, of whom 16 underwent urgent/emergency endoscopic procedures, 10 (1.6%) due to UGIB. Of the variables analyzed, the need for ICU and/or mechanical ventilation during hospitalization was statistically significant as a risk factor for UGIB. CONCLUSION: This study showed increased urgent/emergency endoscopic procedures during the pandemic at the study site. Among the patients hospitalized with the novel coronavirus, there is a higher risk for UGIB in those needing ICU and/or mechanical ventilation.

Detection of SARS-CoV-2 through pool testing for COVID-19: an integrative review

INTRODUCTION: The pool testing technique optimizes the number of tests performed and reduces the delivery time of results, which is an interesting strategy for the health crisis caused by the COVID-19 pandemic. This integrative review investigated studies in which pool testing was carried out for epidemiological or screening purposes to analyze its clinical or cost effectiveness and assessed the applicability of this method in high-, middle-, and low-income countries. METHODS: This integrative review used primary studies published in the MEDLINE, EMBASE, Literatura Latino-Americana e do Caribe em Ciencias da Saude (LILACS), and Cochrane Library databases. RESULTS: A total of 435 studies were identified: 35.3% were carried out in Asia, 29.4% in Europe, 29.4% in North America, and 5.9% in Oceania. CONCLUSIONS: This review suggests that pool testing in the general population may be a useful surveillance strategy to detect new variants of SARS-CoV-2 and to evaluate the period of immunogenicity and global immunity from vaccines.