Outcomes and mortality in a newly implemented ECMO center in Northeast Brazil during pandemic

Objectives: To evaluate the outcomes and risk factors associated with mortality of patients cannulated on ECMO in the context of covid infection during the pandemics in a newly implemented ECMO center Methods: This was a unicentric observational retrospective study performed at Real Hospital Portugues, in Recife, state of Pernambuco, Brazil. All consecutive patients with laboratory confirmed SARS-CoV-2 infection cannulated for VV-ECMO or VA-ECMO for severe ARDS from march 2020 to december 2021 were included retrospectively. Patients recieving ECMO for isolated refratory cardiogenic shock were excluded. Descriptive statistics and association tests were used to analyze characteristics, management and patient outcomes during that period. Result(s): In our cohort of 47 ECMO for covid associated ARDS (CARDS), 39 patients (83%) were admitted by our emergency department. 8 patients (17%) had been transferred from other hospitals as soons as they had been cannulated. 32 patients (68%) were male, median age was 50 years (18-69). Mean body mass index was 31 (21,4-46,3). 37 patients (78%) had at least 1 comorbidity. Major bleeding occurred in 34 (72%) patients. Venous thromboembolism and hemolysis ocurred in 19 (40%) and 13 (23%) patients, respectively. When we compared treatments before ECMO initiation (imunoglobulin, tocilizuman, nitric oxide, neuromuscular blockade and proning), proning was associated with better survival (RR 0,67 IC 0,46-0,97 p 0,029). The mean duration in mechanical ventilation until ECMO cannulation was 9,69 days and mean time in ECMO was 23 days. The 90- day mortality was approximately 72%. Conclusion(s): The only variable associated with a better chance of survival was proning before ECMO. Our mortality (72%) is higher than reported from a recent meta-analysis of 1986 ECMO patients implanted during the first pandemic year(37,1%). However it is similar to a German populational registry of covid patients receiving VV-ECMO (73%). Althought it;s impossible to make causal inferences with such a design and sample sizes, we believe that describing the experience of smaller and newly implemented ECMO centers serves as motivation to improve quality and also to plan for future episodes of pressure on health system.

Wearable Temperature Sensor and Artificial Intelligence to Reduce Hospital Workload

Patient sensing and data analytics provide information that plays an important role in the patient care process. Patterns identified from data and Machine Learning (ML) algorithms can identify risk/abnormal patients' data. Due to automatization this process can reduce workload of medical staff, as the algorithms alert for possible problems. We developed an integrated approach to monitor patients' temperature applied to COVID-19 elderly patients and an ML process to identify abnormal behavior with alerts to physicians. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

SARS-COV-2 IN DOGS AND CATS - LITERATURE REVIEW

By the end of 2019, a new coronavirus was identified in China, in patients with severe pneumonia. Since its discovery, the SARS-CoV-2 has quickly spread thoroughout the world. This literature review was conducted to define the role of dogs and cats in the epidemiology of SARS-CoV-2. The coronavirus belongs to the Coronaviridae family, Betacoronavirus genera, is the causative agent of the human COVID-19 and shows spike glycotproteins which allow the virus to enter in the host cell through the binding the spike protein with the receptors of the angiotensin-converting enzyme type 2. There is no reports that companion animals are a source of infection for human beings, however, evidences show that infected humans can transmit viral particles to the animals in a natural way. Infected animals may show mild and self-limiting clinical signs. Thus, dogs and cats can acquire SARS-CoV-2 from their tutors and may transmit to other animals, but not to humans and that is important the understanding about the susceptibility of dogs and cats due their close contact with human beings.

COVID-19 IN CHRONIC MYELOID LEUKEMIA PATIENTS – BRAZILIAN EXPERIENCE

Aims: To collect data about COVID-19 in CML patients from Brazilian centers and their outcomes. Methods: Observational, multicentric, ongoing register study. Hematologists from private and public CML reference centers from different regions of Brazil were invited to report their cases of COVID-19 in CML patients. Those centers are responsible for the care of approximately 3030 CML patients. Results: Between March 2020 and July 2021, 16 institutions contributed to this analysis, and reported 73 COVID-19 cases in CML patients (pts). Eight-five % were from the South and Southeast regions, 11% from Northeast. The median age was 50 years (22-79), with 33% of the pts older than 60. Male patients were predominant (60%). The median time of CML diagnosis was 9 years (0-29). Most of the pts were in first line therapy (57.5%), 27% in second line and 11% in third line. Current CML treatment at COVID-19 was: imatinib (46,5%), nilotinib (22%), dasatinib (16%), post-transplant (4%), asciminib (1%), ponatinib (1%), treatment-free remission (2%), no treatment (7%). COVID-19 grade: asymptomatic (4%), mild (66%), moderate (12%), severe/critical (16%). CML status at COVID: AP/BC (3%), CP (12,4%), hematologic response (11%), complete cytogenetic response (4%), MMR (34%), MR4.0 (8%), MR4.5 (27%). Eleven patients interrupted treatment temporarily during COVID. COVID-19 was confirmed by RT-PCR of oral and nasal swab collection (68%) or rapid/serologic test (32%). Comorbidities were present in 34 pts, most common were: hypertension (33%), diabetes (14%), chronic renal failure (4%), chronic obstructive pulmonary disease/emphysema (5.5%), pulmonary hypertension (1). Hospitalization occurred in 30% of the cases, 18% in an intensive care unit, 8% with mechanical ventilation. Treatment received for COVID-19: antibiotics (31%), steroids (16%), chloroquine (5.5%), oseltamivir (4%);ivermectin (8%): heparin (3%). Sixty-nine patients recovered, 4 died from COVID-19 (5,4%): one 42 year old newly diagnosed male patient with high leukocytes counts and with a simultaneous bacterial infection, two 70-year old patients treated with imatinib, both in MR4.5, and one 31-year old male patient treated with nilotinib, after imatinib and dasatinib failure, with hematologic response. A fifth patient in the accelerated phase died 2 months after discharge, from disease progression and pulmonary infection. All cases occurred before vaccination. There was one case of re-infection, in a patient treated with imatinib. Discussion: Conclusions: the majority of COVID-19 cases in the CML population was mild, but there were 2 deaths of young patients with active disease and two deaths in elderly patients, one of them with comorbidities. The mortality in CML was lower than observed in other hematologic cancers.

Coronavirus Pandemic and Emergency Remote Teaching: perception of the impact on the well-being of university students

Young people in higher education are more vulnerable to the appearance of psychological symptoms in the context of COVID-19. Also, the adaptation to remote education and other difficulties can affect the well-being of university students. Therefore, this study sought to investigate the perception of wellbeing and mental health of university students who underwent remote education during quarantine. This is a cross-sectional, exploratory, and descriptive study. The instrument used was "Questionnaire on the perception of social isolation by university students during quarantine of COVID-19". Using the reference sampling technique, university students released the link to access the online questionnaire to their peers. 497 students participated, most of them women (74.69%), with mean age of 21.71 (SD = 2.85), enrolled in a public higher education institution (HEI) (72.89%). A positive and significant correlation was found (p<0.001) for academic performance impaired by the adhesion of Emergency Remote Education and the negative perception of mental health and well-being. In the qualitative part, participants noticed anxiety (15.35%), stress (7.3%) and altered sleep (7.67%). About 91.96% of the participants are engaged in self care and emotional management practices. Therefore, the results converge with the literature and imply that online education can impact wellbeing and generate insecurity regarding the quality and solidity of academic training. Data from this study suggest that institutions should implement preventive activities regarding students' mental health and adapt remote learning in order to reduce student's distress.

The impact of COVID-19 pandemic on acute appendicitis treatment in a Portuguese District Hospital

Background: The COVID-19 pandemic created an enormous burden on global health systems by decreasing health care access and delaying care. Acute appendicitis (AA) is one of the most common surgical emergencies worldwide. Our goal was to determine if patients treated for AA during the pandemic period had more morbidity. Methods: A retrospective study was conducted including patients with AA, from a two-months period in 2020 and a control group from a homologous period in 2019. These groups were compared regarding demographics, surgical findings, surgical and postoperative complications. Results: 68 patients were diagnosed with AA (34 - 2020 and 34 - 2019). In 2020, 2 patients were conservatively treated and 32 underwent surgical appendectomy (2 open surgery - OS and 30 laparoscopic surgery - LPS). In 2019, 1 patient had OS and 33 had LPS. No prior demographic and discharge times were observed. An increase in time until surgery and in number of complications was observed. Conclusion: There were no differences in the total number of AA, however the increased time until surgery can be attributed to the time spent waiting for SARS-CoV test results. The similar discharge time but increased number of complications could be explained by delayed presentation to the emergencies room. © 2021 Celsius Publishing House. All rights reserved.

Impact of the mandatory confinement during the first wave of the SARS-CoV-2/COVID-19 pandemic in Portuguese patients with rheumatoid arthritis: results from the COVID in RA (COVIDRA) survey

OBJECTIVE: The aim of this study was to evaluate the self-reported impact of mandatory confinement occurring in the first wave of the SARS-CoV-2 pandemic in Portuguese patients with rheumatoid arthritis (RA), as a means to improve care during this and in future pandemics. MATERIAL AND METHODS: The web-based survey COVIDRA was developed to assess 5 domains including RA symptoms, attitudes towards medication, employment status, physical exercise and mental health. The questionnaire was sent to RA patients through e-mail and social media of the Portuguese Society of Rheumatology and two patient associations;and it was filled locally at two rheumatology centers in Lisbon. Recruitment took place during June and July 2020. RESULTS: We obtained 441 valid questionnaires. Most respondents were female (88.4%), caucasian (93.6%) with a mean age of 58 years. The majority had disease lasting >10 years and were treated with csDMARDs (63.2%) and/or bDMARDs/tsDMARDS (23.7%). Over 40% experienced symptom worsening during confinement, almost half considered moderate or severe. Mobility restriction and increased stress, anxiety or depression were responsible for this worsening. Only 2.5% reduced or withheld their immunosuppressive medication due to fear of becoming infected with SARS-CoV-2. After confinement, 16.2% of those previously employed were in a lay-off regime and 3% lost their jobs. Most employed RA patients practiced telework during confinement. The majority of patients decreased or did not practice any physical exercise (80.5%). Symptoms of anxiety and depression developed or worsened in 67.3% and 51.9% respectively, approximately one third were considered moderate or severe. CONCLUSIONS: Portuguese RA patients experienced significant symptom worsening, anxiety and depression during the first wave confinement. Only a minority changed their immunosuppressive treatment for fear of SARS-CoV-2 infection. Published literature on these matters shows results very similar to ours.

Technical requirements for a safe performance of TAMIS during COVID-19 pandemic: The role of spinal anaesthesia and AirSeal®-a case report

Coronavirus disease 2019 (COVID-19) pandemic is challenging healthcare systems. Surgical care during the COVID-19 pandemic presents numerous challenges regarding not only patient and community safety, but also the safety of physicians and operating room (OR) staff. In the OR, general anaesthesia poses a risk of aerosolization during the intubation process. There is also concern about minimally invasive surgery due to aerosol formation. The SARS-CoV-2 virus was also identified in the faeces, so this is a possible pathway for transmission. This article presents the role of spinal anaesthesia (SA) and AirSeal® device in reducing the risk of COVID-19 contamination while performing transanal minimally invasive surgery (TAMIS). A 59-year-old patient, diagnosed with a T1 rectal adenocarcinoma, was submitted to TAMIS. The surgery was done during COVID-19 pandemic due to the risk of oncological progression with delayed treatment, under SA and using the AirSeal® system and adequate personnel protective equipment (PPE). Laparoscopic smoke evacuation systems with appropriate filters, like AirSeal®, minimize the aerosol formation and may reduce the risk associated with surgical smoke exposure. This case is unique because the patient was safely submitted to TAMIS using proper PPE and AirSeal® under SA, in order to minimize aerosol formation which is crucial during COVID-19 pandemic. © 2021 AME Publishing Company. All right reserved.