Monitoramento das Produções

by Lis Campos Ferreira, Rívia Siqueira Amorim, Fellipe Matos Melo Campos, Rosana Cipolotti

Introduction: SARS-Cov-2 virus pandemic causes serious emotional consequences. It has occurred widespread medical courses suspension, and graduations were anticipated. Field hospitals, set up to treat patients with mild to moderate COVID-19, were the main workplaces of newly graduated doctors. Objective: To assess the impact of SARS-Cov-2/COVID-19 pandemic on mental health of medical interns and newly graduated doctors. Method: This is a cross-sectional study performed using a digital platform. Links to forms were sent in two moments: moment 1 (M1), at the beginning of the pandemic, in the first half of April/2020 and moment 2 (M2), after six months of pandemic, in the second half of September/2020. All students from the medical internship and all doctors graduated since 2018 from the three medical schools in Sergipe-NE-Brazil were invited. Results: 335 forms were answered in April and 148 in September. In M1 88.9% considered themselves exposed to excess of information about COVID-19, which was associated with anxiety symptoms (p = 0.04). Long family physical distance was also associated with these symptoms, as increased appetite (p = 0.01), feeling shortness of breath (p = 0.003) and sweating (p = 0.007). Fear of acquire COVID-19 was reported as intense by almost half of participants, and of transmitting by 85.7% in M1. In M2 41.2% reported the death of friends or relatives. Psychiatric illness was described by 38.5% and psychotropic drugs use by 30.1% in M1, especially those who lived alone (p = 0.03) and the single ones (p = 0.01). Alcohol intake was reported by 54.3%, and among doctors graduated in 2020 it increased from 50% in M1 to 85% in M2 (p = 0.04). Conclusion: The pandemic had a negative impact on the mental health of medical students and newly graduated doctors. Exposure to excessive COVID-19 information and family physical distance were associated to anxiety symptoms. Among doctors graduated in 2020, alcohol intake increased during pandemic evolution.

by Miriam Biermann, Anna Schulze, Franziska Unterseher, Konstantina Atanasova, Paulina Watermann, Annegret Krause-Utz, Dagmar Stahlberg, Martin Bohus, Stefanie Lis
Background During the Covid-19 pandemic, the negative effects of wearing a mouth-nose cover (MNC) on interpersonal functioning have been discussed in public media but empirical studies on how wearing MNCs affect social judgements are sparse. In the present study, we investigated the effects of MNCs on trustworthiness appraisals, the influence of changes due to MNCs in evaluating joy, and the relationship between a social-cognitive appraisal bias and a participant’s characteristics. Methods All participants (N = 165) judged the intensity of happiness and trustworthiness in calm facial stimuli presented with and without a surgical mask covering part of the face. We analysed the relationship of changes in judgements evoked by MNCs to participants’ evaluations of MNCs as protective tools and explored their associations with the burden experienced by wearing MNCs, compliance to behaviour recommendations, their risk associated with the pandemic, and their levels of psychological distress. Results Overall, calm facial stimuli covered with MNCs were evaluated as less trustworthy and, to an even stronger extent, less happy than uncovered facial stimuli. However, participants varied in whether they showed a negative or positive evaluation of faces with MNCs; the negative bias was stronger in those participants who attributed lower protective potential to MNCs, experienced a higher burden while wearing MNCs, wore MNCs less often, and experienced a higher level of psychological distress. Conclusions A negative bias in trustworthiness appraisals of faces with a positive emotional expression covered by MNCs is linked to a participant’s evaluation of MNCs as inefficient and burdening and their experience of high psychological distress.

by Giulia Besutti, Massimo Pellegrini, Marta Ottone, Michele Cantini, Jovana Milic, Efrem Bonelli, Giovanni Dolci, Giulia Cassone, Guido Ligabue, Lucia Spaggiari, Pierpaolo Pattacini, Tommaso Fasano, Simone Canovi, Marco Massari, Carlo Salvarani, Giovanni Guaraldi, Paolo Giorgi Rossi, on behalf of the Reggio Emilia COVID-19 Working Group

We assessed the impact of chest CT body composition parameters on outcomes and disease severity at hospital presentation of COVID-19 patients, focusing also on the possible mediation of body composition in the relationship between age and death in these patients. Chest CT scans performed at hospital presentation by consecutive COVID-19 patients (02/27/2020-03/13/2020) were retrospectively reviewed to obtain pectoralis muscle density and total, visceral, and intermuscular adipose tissue areas (TAT, VAT, IMAT) at the level of T7-T8 vertebrae. Primary outcomes were: hospitalization, mechanical ventilation (MV) and/or death, death alone. Secondary outcomes were: C-reactive protein (CRP), oxygen saturation (SO2), CT disease extension at hospital presentation. The mediation of body composition in the effect of age on death was explored. Of the 318 patients included in the study (median age 65.7 years, females 37.7%), 205 (64.5%) were hospitalized, 68 (21.4%) needed MV, and 58 (18.2%) died. Increased muscle density was a protective factor while increased TAT, VAT, and IMAT were risk factors for hospitalization and MV/death. All these parameters except TAT had borderline effects on death alone. All parameters were associated with SO2 and extension of lung parenchymal involvement at CT; VAT was associated with CRP. Approximately 3% of the effect of age on death was mediated by decreased muscle density. In conclusion, low muscle quality and ectopic fat accumulation were associated with COVID-19 outcomes, VAT was associated with baseline inflammation. Low muscle quality partly mediated the effect of age on mortality.

Title: 3. Boletim da Pesquisa "Monitoramento da saúde dos ACS em tempos de Covid-19"
Authors: Nogueira, Mariana Lima; Borges, Camila Furlanetti; Lacerda, Alda; Fonseca, Angélica Ferreira; Morel, Cristina Maria Toledo Massadar; Valsechi, Daniel Felix; Silva, Letícia Batista da; Morosini, Márcia Valéria; Barbosa, Maria Idalice Silva; Rego, Sábata Rodrigues de Moraes
Abstract: A pesquisa que subsidia a elaboração deste boletim é intitulada “Monitoramento da saúde e contribuições ao processo de trabalho e à formação profissional dos Agentes Comunitários de Saúde em tempos de Covid-19”. O estudo tem como objetivo principal analisar os impactos da Covid-19 na saúde das trabalhadoras e dos trabalhadores ACS, bem como as condições de trabalho e de formação profissional ofertada a eles no momento da pandemia em capitais do país que apresentam elevado número de casos: São Paulo (SP), Rio de Janeiro (RJ) e Fortaleza (CE), além de três cidades das regiões metropolitanas das respectivas capitais – Guarulhos (SP), São Gonçalo (RJ) e Maracanaú (CE). Esses municípios foram incluídos na pesquisa devido à alta densidade demográfica, critério relevante no que se refere ao potencial de disseminação do novo coronavírus.

by The PLOS ONE Staff

by Shruti Koulgi, Vinod Jani, Mallikarjunachari Uppuladinne V. N., Uddhavesh Sonavane, Rajendra Joshi

Drug repurposing studies targeting inhibition of RNA dependent RNA polymerase (RdRP) of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) have exhibited the potential effect of small molecules. In the present work a detailed interaction study between the phytochemicals from Indian medicinal plants and the RdRP of SARS-CoV-2 has been performed. The top four phytochemicals obtained through molecular docking were, swertiapuniside, cordifolide A, sitoindoside IX, and amarogentin belonging to Swertia chirayita, Tinospora cordifolia and Withania somnifera. These ligands bound to the RdRP were further studied using molecular dynamics simulations. The principal component analysis of these systems showed significant conformational changes in the finger and thumb subdomain of the RdRP. Hydrogen bonding, salt-bridge and water mediated interactions supported by MM-GBSA free energy of binding revealed strong binding of cordifolide A and sitoindoside IX to RdRP. The ligand-interacting residues belonged to either of the seven conserved motifs of the RdRP. These residues were polar and charged amino acids, namely, ARG 553, ARG 555, ASP 618, ASP 760, ASP 761, GLU 811, and SER 814. The glycosidic moieties of the phytochemicals were observed to form favourable interactions with these residues. Hence, these phytochemicals may hold the potential to act as RdRP inhibitors owing to their stability in binding to the druggable site.

by Tarek Bayyoud, Angelika Iftner, Thomas Iftner, Karl Ulrich Bartz-Schmidt, Focke Ziemssen, Hans Bösmüller, Falko Fend, Jens Martin Rohrbach, Marius Ueffing, Michael Schindler, Sebastian Thaler
Background/Objectives The systemic organ involvement of SARS-CoV-2 needs to be thoroughly investigated including the possibility of an ocular reservoir in humans. To examine retinal tissues and vitreous for histopathology and SARS-CoV-2 presence with regard to possible effects on the human retina and/ or vitreous. We performed histopathological analyses and quantitative (q)RT-PCR-testing for SARS-CoV-2 RNA on retinal tissues and vitreous of COVID-19 postmortem donors. Subjects/Methods Included in this study were 10 eyes of 5 deceased COVID-19 patients. The diagnosis of SARS-CoV-2 infection was confirmed via pharyngeal swabs and broncho-alveolar fluids. The highest level of personal protective equipment (PPE) and measures was employed during fluid-tissue procurement and preparation. Histopathological examinations and qRT-PCR-testing were carried out for all retinal tissues and vitreous fluids. Results The histopathological examinations revealed no signs of morphologically identifiable retinal inflammation or vessel occlusions based on hematoxylin and eosin stains. By qRT-PCRs, we detected no significant level of viral RNA in human retina and vitreous. Conclusions In this study, no significant level of SARS-CoV-2-RNA was detected in the human retinal and vitreous fluid samples of deceased COVID-19 patients. Histopathological examinations confirmed no morphological sign of damage to retinal vasculature or tissues. Further studies are needed to confirm or refute the results.

by Rebecca J. Song, Yuk-Lam Ho, Petra Schubert, Yojin Park, Daniel Posner, Emily M. Lord, Lauren Costa, Hanna Gerlovin, Katherine E. Kurgansky, Tori Anglin-Foote, Scott DuVall, Jennifer E. Huffman, Saiju Pyarajan, Jean C. Beckham, Kyong-Mi Chang, Katherine P. Liao, Luc Djousse, David R. Gagnon, Stacey B. Whitbourne, Rachel Ramoni, Sumitra Muralidhar, Philip S. Tsao, Christopher J. O’Donnell, John Michael Gaziano, Juan P. Casas, Kelly Cho, on behalf of the VA Million Veteran Program COVID-19 Science Initiative
Background The risk factors associated with the stages of Coronavirus Disease-2019 (COVID-19) disease progression are not well known. We aim to identify risk factors specific to each state of COVID-19 progression from SARS-CoV-2 infection through death. Methods and results We included 648,202 participants from the Veteran Affairs Million Veteran Program (2011-). We identified characteristics and 1,809 ICD code-based phenotypes from the electronic health record. We used logistic regression to examine the association of age, sex, body mass index (BMI), race, and prevalent phenotypes to the stages of COVID-19 disease progression: infection, hospitalization, intensive care unit (ICU) admission, and 30-day mortality (separate models for each). Models were adjusted for age, sex, race, ethnicity, number of visit months and ICD codes, state infection rate and controlled for multiple testing using false discovery rate (≤0.1). As of August 10, 2020, 5,929 individuals were SARS-CoV-2 positive and among those, 1,463 (25%) were hospitalized, 579 (10%) were in ICU, and 398 (7%) died. We observed a lower risk in women vs. men for ICU and mortality (Odds Ratio (95% CI): 0.48 (0.30–0.76) and 0.59 (0.31–1.15), respectively) and a higher risk in Black vs. Other race patients for hospitalization and ICU (OR (95%CI): 1.53 (1.32–1.77) and 1.63 (1.32–2.02), respectively). We observed an increased risk of all COVID-19 disease states with older age and BMI ≥35 vs. 20–24 kg/m2. Renal failure, respiratory failure, morbid obesity, acid-base balance disorder, white blood cell diseases, hydronephrosis and bacterial infections were associated with an increased risk of ICU admissions; sepsis, chronic skin ulcers, acid-base balance disorder and acidosis were associated with mortality. Conclusions Older age, higher BMI, males and patients with a history of respiratory, kidney, bacterial or metabolic comorbidities experienced greater COVID-19 severity. Future studies to investigate the underlying mechanisms associated with these phenotype clusters and COVID-19 are warranted.

by Sumbal Shahbaz, Muhammad Zeshan Ashraf, Rubeena Zakar, Florian Fischer, Muhammad Zakria Zakar

Limited evidence exists to help understand the experiences of university students in relation to the long-term lockdown due to the COVID-19 pandemic. For that reason, we conducted a study using a phenomenographic approach in order to understand how university students perceive COVID-19 and the associated lockdown. Data were collected from 25 students in Pakistan. They were asked to demonstrate the psychological effects of the COVID-19 pandemic and lockdown in illustrations. In addition, in-depth interviews were conducted with these students, to gain further insights into their perspectives on the psychosocial effects of the COVID-19 pandemic. The analysis revealed four interlinked directions for understanding students’ experiences. These themes were: 1) escape into peace, 2) hope for personal freedom, 3) fear of becoming a victim of COVID-19, and 4) concerns regarding education, future career, and opportunities. All four themes were analyzed and condensed into an outcome space, which further gathers the perceptions of students under one theme as “Hope for life while paradoxically living with fear”. Studying the psychological impact of the COVID-19 pandemic and lockdown on students not only highlighted their concerns, but also emphasized the importance of starting regular psychological evaluations and stress-releasing sessions, along with online education to overcome growing depression.

by Marie-Luise Buchholtz, Florian M. Arend, Peter Eichhorn, Michael Weigand, Alisa Kleinhempel, Kurt Häusler, Mathias Bruegel, Lesca M. Holdt, Daniel Teupser
Objectives During the COVID-19 pandemic, SARS-CoV-2 antibody testing has been suggested for (1) screening populations for disease prevalence, (2) diagnostics, and (3) guiding therapeutic applications. Here, we conducted a detailed clinical evaluation of four Anti-SARS-CoV-2 immunoassays in samples from acutely ill COVID-19 patients and in two negative cohorts. Methods 443 serum specimens from serial sampling of 29 COVID-19 patients were used to determine clinical sensitivities. Patients were stratified for the presence of acute respiratory distress syndrome (ARDS). Individual serum specimens from a pre-COVID-19 cohort of 238 healthy subjects and from a PCR-negative clinical cohort of 257 patients were used to determine clinical specificities. All samples were measured side-by-side with the Anti-SARS-CoV-2-ELISA (IgG), Anti-SARS-CoV-2-ELISA (IgA) and Anti-SARS-CoV-2-NCP-ELISA (IgG) (Euroimmun AG, Lübeck, Germany) and the Elecsys Anti-SARS-CoV-2 ECLIA (Roche Diagnostics International, Rotkreuz, Switzerland). Results Median seroconversion occurred earlier in ARDS patients (8–9 days) than in non-ARDS patients (11–17 days), except for EUR N-IgG. Rates of positivity and mean signal ratios in the ARDS group were significantly higher than in the non-ARDS group. Sensitivities between the four tested immunoassays were equivalent. In the set of negative samples, the specificity of the Anti-SARS-CoV-2-ELISA (IgA) was lower (93.9%) compared to all other assays (≥98.8%) and the specificity of Anti-SARS-CoV-2-NCP-ELISA (IgG) was lower (98.8%) than that of Elecsys Anti-SARS-CoV-2 (100%). Conclusions Serial sampling in COVID-19 patients revealed earlier seroconversion and higher signal ratios of SARS-CoV-2 antibodies as a potential risk marker for the development of ARDS, suggesting a utility for antibody testing in acutely diseased patients.

by Kirsi M. Manz, Ulrich Mansmann
Background It is of interest to explore the variability in how the COVID-19 pandemic evolved geographically during the first twelve months. To this end, we apply inequality indices over regions to incidences, infection related mortality, and infection fatality rates. If avoiding of inequality in health is an important political goal, a metric must be implemented to track geographical inequality over time. Methods The relative and absolute Gini index as well as the Theil index are used to quantify inequality. Data are taken from international data bases. Absolute counts are transformed to rates adjusted for population size. Results Comparing continents, the absolute Gini index shows an unfavorable development in four continents since February 2020. In contrast, the relative Gini as well as the Theil index support the interpretation of less inequality between European countries compared to other continents. Infection fatality rates within the EU as well as within the U.S. express comparable improvement towards more equality (as measured by both Gini indices). Conclusions The use of inequality indices to monitor changes in geographic inequality over time for key health indicators is a valuable tool to inform public health policies. The absolute and relative Gini index behave complementary and should be reported simultaneously in order to gain a meta-perspective on very complex dynamics.

by Kaileigh A. Byrne, Stephanie G. Six, Reza Ghaiumy Anaraky, Maggie W. Harris, Emma L. Winterlind

To reduce the spread of COVID-19 transmission, government agencies in the United States (US) recommended precautionary guidelines, including wearing masks and social distancing to encourage the prevention of the disease. However, compliance with these guidelines has been inconsistent. This correlational study examined whether individual differences in risky decision-making and motivational propensities predicted compliance with COVID-19 preventative behaviors in a sample of US adults (N = 404). Participants completed an online study from September through December 2020 that included a risky choice decision-making task, temporal discounting task, and measures of appropriate mask-wearing, social distancing, and perceived risk of engaging in public activities. Linear regression results indicated that greater temporal discounting and risky decision-making were associated with less appropriate mask-wearing behavior and social distancing. Additionally, demographic factors, including personal experience with COVID-19 and financial difficulties due to COVID-19, were also associated with differences in COVID-19 preventative behaviors. Path analysis results showed that risky decision-making behavior, temporal discounting, and risk perception collectively predicted 55% of the variance in appropriate mask-wearing behavior. Individual differences in general decision-making patterns are therefore highly predictive of who complies with COVID-19 prevention guidelines.

by Petra Rattay, Niels Michalski, Olga Maria Domanska, Anna Kaltwasser, Freia De Bock, Lothar H. Wieler, Susanne Jordan

The main strategy for combatting SARS-CoV-2 infections in 2020 consisted of behavioural regulations including contact reduction, maintaining distance, hand hygiene, and mask wearing. COVID-19-related risk perception and knowledge may influence protective behaviour, and education could be an important determinant. The current study investigated differences by education level in risk perception, knowledge and protective behaviour regarding COVID-19 in Germany, exploring the development of the pandemic over time. The COVID-19 Snapshot Monitoring study is a repeated cross-sectional online survey conducted during the pandemic in Germany from 3 March 2020 (waves 1–28: 27,957 participants aged 18–74). Differences in risk perception, knowledge and protective behaviour according to education level (high versus low) were analysed using linear and logistic regression. Time trends were accounted for by interaction terms for education level and calendar week. Regarding protective behaviour, interaction terms were tested for all risk perception and knowledge variables with education level. The strongest associations with education level were evident for perceived and factual knowledge regarding COVID-19. Moreover, associations were found between low education level and higher perceived severity, and between low education level and lower perceived probability. Highly educated men were more worried about COVID-19 than those with low levels of education. No educational differences were observed for perceived susceptibility or fear. Higher compliance with hand washing was found in highly educated women, and higher compliance with maintaining distance was found in highly educated men. Regarding maintaining distance, the impact of perceived severity differed between education groups. In men, significant moderation effects of education level on the association between factual knowledge and all three protective behaviours were found. During the pandemic, risk perception and protective behaviour varied greatly over time. Overall, differences by education level were relatively small. For risk communication, reaching all population groups irrespective of education level is critical.

by Md Saiful Islam, Abu-Hena Mostofa Kamal, Alamgir Kabir, Dorothy L. Southern, Sazzad Hossain Khan, S. M. Murshid Hasan, Tonmoy Sarkar, Shayla Sharmin, Shiuli Das, Tuhin Roy, Md Golam Dostogir Harun, Abrar Ahmad Chughtai, Nusrat Homaira, Holly Seale
Introduction Rumors and conspiracy theories, can contribute to vaccine hesitancy. Monitoring online data related to COVID-19 vaccine candidates can track vaccine misinformation in real-time and assist in negating its impact. This study aimed to examine COVID-19 vaccine rumors and conspiracy theories circulating on online platforms, understand their context, and then review interventions to manage this misinformation and increase vaccine acceptance. Method In June 2020, a multi-disciplinary team was formed to review and collect online rumors and conspiracy theories between 31 December 2019–30 November 2020. Sources included Google, Google Fact Check, Facebook, YouTube, Twitter, fact-checking agency websites, and television and newspaper websites. Quantitative data were extracted, entered in an Excel spreadsheet, and analyzed descriptively using the statistical package R version 4.0.3. We conducted a content analysis of the qualitative information from news articles, online reports and blogs and compared with findings from quantitative data. Based on the fact-checking agency ratings, information was categorized as true, false, misleading, or exaggerated. Results We identified 637 COVID-19 vaccine-related items: 91% were rumors and 9% were conspiracy theories from 52 countries. Of the 578 rumors, 36% were related to vaccine development, availability, and access, 20% related to morbidity and mortality, 8% to safety, efficacy, and acceptance, and the rest were other categories. Of the 637 items, 5% (30/) were true, 83% (528/637) were false, 10% (66/637) were misleading, and 2% (13/637) were exaggerated. Conclusions Rumors and conspiracy theories may lead to mistrust contributing to vaccine hesitancy. Tracking COVID-19 vaccine misinformation in real-time and engaging with social media to disseminate correct information could help safeguard the public against misinformation.

by Nicole Fouda Mbarga, Emilienne Epee, Marcel Mbarga, Patrick Ouamba, Herwin Nanda, Aristide Nkengni, Joseph Guekeme, Justin Eyong, Sylvie Tossoukpe, Sauvia Noumedem Sosso, Engelbert Ngono Ngono, Lazare Mbala Ntsama, Landry Bonyomo, Patrick Tchatchoua, Noel Vogue, Steve Metomb, Franck Ale, Moussa Ousman, Dorian Job, Charlotte Moussi, Modeste Tamakloe, Jessica E. Haberer, Sylvester Ndeso Atanga, Gregory Halle-Ekane, Yap Boum II
Background A year after the COVID-19 pandemic started, there are still few scientific reports on COVID-19 in Africa. This study explores the clinical profiles and factors associated with COVID-19 in Cameroon. Materials and methods In this prospective cohort study, we followed patients admitted for suspicion of COVID-19 at Djoungolo Hospital between 01st April and 31st July 2020. Patients were categorised by age groups and disease severity: mild (symptomatic without clinical signs of pneumonia), moderate (with clinical signs of pneumonia without respiratory distress) and severe cases (clinical signs of pneumonia and respiratory distress not requiring invasive ventilation). Demographic information and clinical features were summarised. Multivariable analysis was performed to predict risk. Findings A total of 313 patients were admitted during the study period; 259 were confirmed cases of COVID-19 by Polymerase Chain Reaction (PCR). Among the confirmed cases, the male group aged 40 to 49 years (13.9%) was predominant. Disease severity ranged from mild (26.2%; n = 68) to moderate (59%; n = 153) to severe (14.7%; n = 38); the case fatality rate was 1% (n = 4). Dysgusia (46%; n = 119) and hyposmia/anosmia (37.8%; n = 98) were common features of COVID-19. Nearly one-third of patients had comorbidities (29%; n = 53), of which hypertension was the most common (18.9%; n = 49). Participation in mass gatherings (Odds Ratio (OR) = 2.37; P = 0.03) and dysgusia (OR = 2.09, P = 0.02) were predictive of diagnosis of COVID-19. Age groups 60 to 69 (OR = 7.41; P = 0.0001), 50 to 59 (OR = 4.09; P = 0.03), 40 to 49 (OR = 4.54; P = 0.01), male gender (OR = 2.53; P = 0.04), diabetes (OR = 4.05; P = 0.01), HIV infection (OR = 5.57; P = 0.03), lung disease (OR = 6.29; P = 0.01), dyspnoea (OR = 3.70; P = 0.008) and fatigue (OR = 3.35; P = 0.02) significantly predicted COVID-19 severity. Conclusions Most COVID-19 cases in this study were benign with low fatality. Age (40–70), male gender, HIV infection, lung disease, dyspnoea and fatigue are associated with severe COVID-19. Such findings may guide public health decision-making.

by Zhimin Chen, Liran Chen, Huafang Chen

The objective of this study was to explore the impact of the coronavirus disease 2019 epidemic on ongoing and upcoming drug clinical trials. Qualitative semi-structured interviews were conducted with clinical trial staff and clinical trial subjects were surveyed by questionnaire in this study. The results of interviews and questionnaire showed that coronavirus disease 2019 pandemic has led to many changes in the implementation of drug clinical trials, including: a variety of meetings being held online webinars using various platforms, telemedicine and follow-up by video, A large number of deviations from protocol and losses of follow-up, delivery of clinical trial drugs by express, additional workload caused by screening for coronavirus, and anxiety of subjects. These results suggest that the coronavirus disease 2019 outbreak has hindered the progress and damaged the quality of clinical trials. The online meeting, remote follow-up, express delivery of drugs and remote monitoring in the epidemic environment can ensure the progress of clinical trials to a certain extent, but they cannot fully guarantee the quality as before.

by Jorge Calderón-Parra, Antonio Muiño-Miguez, Alejandro D. Bendala-Estrada, Antonio Ramos-Martínez, Elena Muñez-Rubio, Eduardo Fernández Carracedo, Javier Tejada Montes, Manuel Rubio-Rivas, Francisco Arnalich-Fernandez, Jose Luis Beato Pérez, Jose Miguel García Bruñén, Esther del Corral Beamonte, Paula Maria Pesqueira Fontan, Maria del Mar Carmona, Rosa Fernández-Madera Martínez, Andrés González García, Cristina Salazar Mosteiro, Carlota Tuñón de Almeida, Julio González Moraleja, Francesco Deodati, María Dolores Martín Escalante, María Luisa Asensio Tomás, Ricardo Gómez Huelgas, José Manuel Casas Rojo, Jesús Millán Núñez-Cortés, for the SEMI-COVID-19 Network
Background Most patients with COVID-19 receive antibiotics despite the fact that bacterial co-infections are rare. This can lead to increased complications, including antibacterial resistance. We aim to analyze risk factors for inappropriate antibiotic prescription in these patients and describe possible complications arising from their use. Methods The SEMI-COVID-19 Registry is a multicenter, retrospective patient cohort. Patients with antibiotic were divided into two groups according to appropriate or inappropriate prescription, depending on whether the patient fulfill any criteria for its use. Comparison was made by means of multilevel logistic regression analysis. Possible complications of antibiotic use were also identified. Results Out of 13,932 patients, 3047 (21.6%) were prescribed no antibiotics, 6116 (43.9%) were appropriately prescribed antibiotics, and 4769 (34.2%) were inappropriately prescribed antibiotics. The following were independent factors of inappropriate prescription: February-March 2020 admission (OR 1.54, 95%CI 1.18–2.00), age (OR 0.98, 95%CI 0.97–0.99), absence of comorbidity (OR 1.43, 95%CI 1.05–1.94), dry cough (OR 2.51, 95%CI 1.94–3.26), fever (OR 1.33, 95%CI 1.13–1.56), dyspnea (OR 1.31, 95%CI 1.04–1.69), flu-like symptoms (OR 2.70, 95%CI 1.75–4.17), and elevated C-reactive protein levels (OR 1.01 for each mg/L increase, 95% CI 1.00–1.01). Adverse drug reactions were more frequent in patients who received ANTIBIOTIC (4.9% vs 2.7%, p .001). Conclusion The inappropriate use of antibiotics was very frequent in COVID-19 patients and entailed an increased risk of adverse reactions. It is crucial to define criteria for their use in these patients. Knowledge of the factors associated with inappropriate prescribing can be helpful.

Title: Coronavirus 2019 y personas en situación de calle en el estado de Mato Grosso, Brasil
Authors: Terças-Trettel, Ana Cláudia Pereira; Silva, Juliana Herrero da; Oliveira, Elaine Cristina de; Hattori, Thalise Yuri; Ferreira, Dandára Thaís de Oliveira; Nascimento, Vagner Ferreira do; Lemos, Elba Regina Sampaio de

by Agata Kaczmarek, Anna Katarzyna Wrońska, Mieczysława Irena Boguś, Michalina Kazek, Aleksandra Gliniewicz, Ewa Mikulak, Marta Matławska

Aedes aegypti, the primary vector of various arthropod-borne viral (arboviral) diseases such as dengue and Zika, is a popular laboratory model in vector biology. However, its maintenance in laboratory conditions is difficult, mostly because the females require blood meals to complete oogenesis, which is often provided as sheep blood. The outermost layer of the mosquito cuticle is consists of lipids which protects against numerous entomopathogens, prevents desiccation and plays an essential role in signalling processes. The aim of this work was to determine how the replacement of human blood with sheep blood affects the cuticular and internal FFA profiles of mosquitoes reared in laboratory culture. The individual FFAs present in cuticular and internal extracts from mosquito were identified and quantified by GC–MS method. The normality of their distribution was checked using the Kolmogorov-Smirnov test and the Student’s t-test was used to compare them. GC-MS analysis revealed similar numbers of internal and cuticular FFAs in the female mosquitoes fed sheep blood by membrane (MFSB) and naturally fed human blood (NFHB), however MFSB group demonstrated 3.1 times greater FFA concentrations in the cuticular fraction and 1.4 times the internal fraction than the NFHB group. In the MFSB group, FFA concentration was 1.6 times higher in the cuticular than the internal fraction, while for NFHB, FFA concentration was 1.3 times lower in the cuticular than the internal fraction. The concentration of C18:3 acid was 223 times higher in the internal fraction than the cuticle in the MHSB group but was absent in the NFHB group. MFSB mosquito demonstrate different FFA profiles to wild mosquitoes, which might influence their fertility and the results of vital processes studied under laboratory conditions. The membrane method of feeding mosquitoes is popular, but our research indicates significant differences in the FFA profiles of MFSB and NFHB. Such changes in FFA profile might influence female fertility, as well as other vital processes studied in laboratory conditions, such as the response to pesticides. Our work indicates that sheep blood has potential shortcomings as a substitute feed for human blood, as its use in laboratory studies may yield different results to those demonstrated by free-living mosquitoes.

by Muhammed Elhadi, Ahmed Alsoufi, Abdurraouf Abusalama, Akram Alkaseek, Saedah Abdeewi, Mohammed Yahya, Alsnosy Mohammed, Mohammed Abdelkabir, Mohammed Huwaysh, Emad Amkhatirah, Kamel Alshorbaji, Samer Khel, Marwa Gamra, Abdulmueti Alhadi, Taha Abubaker, Mohamed Anaiba, Mohammed Elmugassabi, Muhannud Binnawara, Ala Khaled, Ahmed Zaid, Ahmed Msherghi
Background The coronavirus disease (COVID-19) pandemic has severely affected African countries, specifically the countries, such as Libya, that are in constant conflict. Clinical and laboratory information, including mortality and associated risk factors in relation to hospital settings and available resources, about critically ill patients with COVID-19 in Africa is not available. This study aimed to determine the mortality and morbidity of COVID-19 patients in intensive care units (ICU) following 60 days after ICU admission, and explore the factors that influence in‐ICU mortality rate. Methods This is a multicenter prospective observational study among COVID-19 critical care patients in 11 ICUs in Libya from May 29th to December 30th 2020. Basic demographic data, clinical characteristics, laboratory values, admission Sequential Organ Failure Assessment (SOFA) score, quick SOFA, and clinical management were analyzed. Result We included 465 consecutive COVID-19 critically ill patients. The majority (67.1%) of the patients were older than 60 years, with a median (IQR) age of 69 (56.5–75); 240 (51.6%) were male. At 60 days of follow-up, 184 (39.6%) were discharged alive, while 281 (60.4%) died in the intensive care unit. The median (IQR) ICU length of stay was 7 days (4–10) and non-survivors had significantly shorter stay, 6 (3–10) days. The body mass index was 27.9 (24.1–31.6) kg/m2. At admission to the intensive care unit, quick SOFA median (IQR) score was 1 (1–2), whereas total SOFA score was 6 (4–7). In univariate analysis, the following parameters were significantly associated with increased/decreased hazard of mortality: increased age, BMI, white cell count, neutrophils, procalcitonin, cardiac troponin, C-reactive protein, ferritin, fibrinogen, prothrombin, and d-dimer levels were associated with higher risk of mortality. Decreased lymphocytes, and platelet count were associated with higher risk of mortality. Quick SOFA and total SOFA scores increase, emergency intubation, inotrope use, stress myocardiopathy, acute kidney injury, arrythmia, and seizure were associated with higher mortality. Conclusion Our study reported the highest mortality rate (60.4%) among critically ill patients with COVID-19 60 days post-ICU admission. Several factors were found to be predictive of mortality, which may help to identify patients at risk of mortality during the ongoing COVID-19 pandemic.

by Birhanu Gutu, Genene Legese, Nigussie Fikadu, Birhanu Kumela, Firafan Shuma, Wakgari Mosisa, Zelalem Regassa, Yoseph Shiferaw, Lata Tesfaye, Buli Yohannes, Kogila Palanimuthu, Zewudie Birhanu, Desalegn Shiferaw
Background The world is being challenged by the COVID-19 outbreak that resulted in a universal concern and economic hardship. It is a leading public health emergency across the globe in general and developing countries in particular. Strengthening good preventive behavior is the best way to tackle such pandemics. Objective The study assessed preventive behavior and associated factors towards COVID-19 among residents of Qellam Wallaga Zone, Oromia Region, Ethiopia, 2020. Methods A community-based cross-sectional study was conducted with a multistage sampling technique. Data were collected by interview and analyzed using SPSS version 23.0. Binomial logistic regression was used to test the association between the variables. An Adjusted Prevalence with 95% CI was used to express the associations and interpret the findings. Results Among 634 participants, 417(65.8%) were from urban residences, and 347 (54.7%) belongs to a female. Age ranges 18 years through 87 years. Only 68(10.7%) participants showed good preventive behavior for COVID-19. The majority of them (84.7%) perceived that the disease is very dangerous and 450(71.0%) of them believe that they are at high risk. More than 17% of the respondents have sufficient knowledge. Respondents with sufficient knowledge about COVID-19 were about 2 times more likely to exercise good preventive behavior compare to those with insufficient knowledge, [(APR: 2.1; 95% CI: [1.2, 3.9)]. The urban residents was 3.3 more than that of rural residents to practice good preventive behavior, [(APR: 3.3; 95% CI: [1.6, 6.4)]. Respondents who use social media as a source of information were more than 2 times more likely to have good preventive behavior compared to those who did not, [(APR: 2.3; 95% CI: [1.3, 3.4)]. Conclusion Adoptions of COVID-19 preventive behavior in the study population is very low. Due emphasis should be given to rural residents. Risk communication activities should be strengthened through effective community engagement to slow down and stop the transmssion of the disease in the community.

by Roshan Acharya, Dilli Poudel, Aakash Patel, Evan Schultz, Michael Bourgeois, Rishi Paswan, Scott Stockholm, Macylen Batten, Smita Kafle, Amanda Atkinson, Hafiz Sarwar
Background The data on the COVID-19 patients who were discharged to self-quarantine is lacking. Aim The aim of the study was to investigate the percentage of COVID-19 positive patients that were hospitalized within a three-week period after discharge from ED to self-quarantine. Methods The patients who had confirmed SARS-CoV-2 on RT-PCR of the nasopharyngeal swab and were discharged from ED of a tertiary care hospital in the USA to self-quarantine from March 01- July 31, 2020, were included. Patients were divided into two groups based on serum albumin levels and were followed up for three weeks to see if low level of albumin increased the risk of hospitalization. Univariate and multivariate logistic regression analyses were performed to study the effect of albumin level and outcomes. Results A total of 112 patients were included in the study out of which 65 had low serum albumin (

Title: MASPs at the crossroad between the complement and the coagulation cascades - the case for COVID-19
Authors: Bumiller-Bini, Valéria; Oliveira-Toré, Camila de Freitas; Carvalho, Tamyres Mingorance; Kretzschmar, Gabriela Canalli; Gonçalves, Letícia Boslooper; Alencar, Nina de Moura; Gasparetto Filho, Miguel Angelo; Beltrame, Marcia Holsbach; Boldt, Angelica Beate Winter

by Lucas Lacasa, Robert Challen, Ellen Brooks-Pollock, Leon Danon

by Seyfe Asrade Atnafie, Demssie Ayalew Anteneh, Dawit Kumilachew Yimenu, Zemene Demelash Kifle
Background The burden to fight with Corona Virus Disease-19 (COVID-19) pandemic has lied to frontline health care workers that are putting themselves at a higher risk in the battle against the disease. This study aimed to assess the exposure health risks of COVID-19 among frontline healthcare workers in the Amhara region, Ethiopia. Method A web-based cross-sectional study was conducted on public health workers from May to August 2020. Data were collected using a structured questionnaire via email and telegram services. Both descriptive statistics and bivariate followed by multivariable logistic regression analyses were conducted to identify distribution patterns and factors associated with exposure risks to COVID-19. Odds ratio with 95% Confidence Interval (CI), and a P-value of 6 (AOR = 3.77), work experience of 21–30 years (AOR = 0.01), and good handwashing habit (AOR = 0.44) were the protective factors against COVID-19. On the other hand, perception of non-exposure to COVD 19 (AOR = 9.56), and poor habit of decontamination of high touch areas (AOR = 2.52) were the risk factors associated with confirmed COVID 19 cases among health care workers. Conclusion Poor adherence to personal protective equipment use and aseptic practices during and after health care interactions with patients were identified. Strategies should be implemented to institute effective and sustainable infection control measures that protect the health care workers from COVID-19 infection.

by Mutasim E. Ibrahim, Obaid S. AL-Aklobi, Mosleh M. Abomughaid, Mushabab A. Al-Ghamdi
Background Although the coronavirus disease 2019 (COVID-19) pandemic continues to rage worldwide, clinical and laboratory studies of this disease have been limited in many countries. We investigated the epidemiologic, clinical, and laboratory findings of COVID-19 infected patients to identify the effective indicators correlated with the disease. Methods A retrospective study was conducted at King Abdullah Hospital in Bisha Province, Saudi Arabia, from March 20 to June 30, 2020. Patients of different age groups were confirmed as having COVID-19 infection using a real-time polymerase chain reaction. The demographic, clinical, and laboratory data of the patients were statistically analyzed. Results Of the 132 patients, 85 were male and 47 were female, with a mean age of 50.9 years (SD±16.7). The patients were elderly (n = 29) and adults (n = 103). Of these, 54 (40.9%) had comorbidities, (25%) were admitted to the intensive care unit (ICU), and 12 (9.1%) died. On admission, the main clinical manifestations were fever (84.1%), cough (64.4%), shortness of breath (25%), chest pain (20.5%), and fatigue (18.2%). In all patients, increased neutrophils and decreased lymphocytes were observed. Patients’ lactate dehydrogenase (LDH) was elevated. C-reactive protein (CRP) was elevated in 48.5%, D-dimer in 43.2%, and the erythrocyte sedimentation rate (ESR) in 40.9% of patients. The elderly showed higher neutrophil (p = 0.011) and lower lymphocyte (p = 0.009) counts than adults. Glucose, creatine kinase-MB, LDH, bilirubin, D-dimer, and ESR were significantly higher in the elderly than in the adults. The COVID-19 death group had a higher leucocyte count (p = 0.036), and higher urea (p = 0.029) and potassium (p = 0.022) than the recovered group but had a lower hemoglobin concentration (p = 0.018). A significant association was determined between COVID-19 death and the presence of cardiovascular disease (χ2(1) = 16.297, p

Title: Developing a lab-in-a-box and low-cost paper-based sensors for ZIKV and CHIKV diagnosis in Latin America
Authors: Karlikow, Margot; Silva, Severino Jefferson Ribeiro da; Guo, Yuxiu; Cicek, Seray; Krokovsky, Larissa; Collins, Jim; Green, Alexander; Ayres, Constância; Pena, Lindomar; Pardee, Keith

Title: Development of a rapid test for detection of anti-COVID-19 IgG and IgM antibodies
Authors: Lopes, Thiciany Blener; Coelho, Fabiana Fioravante; Santos, Anna Raquel Ribeiro dos; Castro, Natália Salazar de; Bagno, Flávia Fonseca; Gazzinelli, Ricardo Tostes; Fernandes, Ana Paula Salles Moura

Title: Epidemiology and evolution of Zika virus in Minas Gerais, Southeast Brazil
Authors: Iani, Felipe C. M.; Giovanetti, Marta; Fonseca, Vagner; Souza, William M.; Adelino, Talita E. R.; Xavier, Joilson; Jesus, Jaqueline G.; Pereira, Maira A.; Silva, Marcos V. F.; Costa, Alana V. B.; Silva, Erniria C.; Mendes, Márcia C. O.; Filippis, Ana M. B.; Albuquerque, Carlos F. C.; Abreu, André L.; Oliveira, Marluce A. A.; Alcantara, Luiz J. C;.; Faria, Nuno R.

Title: Seminários Avançados em Saúde e Diplomacia "José Roberto Ferreira": Pandemia de COVID-19: Balanço 2020 e Perspectivas 2021
Authors: Buss, Paulo M.; Homma, Akira