Monitoramento das Produções

by Tamara Carvalho, Marcela Guimarães Landim, Maria Letícia Duarte Lima, Cíntia Bittar, Beatriz Carvalho de Araújo Oliveira Faria, Paula Rahal, Milena Campelo Freitas de Lima, Valdir Florêncio da Veiga Junior, Graziella Anselmo Joanitti, Marilia Freitas Calmon

Zika virus (ZIKV) has spread all over the world since its major outbreak in 2015. This infection has been recognized as a major global health issue due to the neurological complications related to ZIKV infection, such as Guillain–Barré Syndrome and Zika virus Congenital Syndrome. Currently, there are no vaccines or specific treatments for ZIKV infection, which makes the development of specific therapies for its treatment very important. Several studies have been developed to analyze the potential of compounds against ZIKV, with the aim of finding new promising treatments. Herein, we evaluate the ability of a copaiba (Copaifera officinalis) oil nanoemulsion (CNE) to inhibit ZIKV. First, the highest non-cytotoxic concentration of 180 μg/mL was chosen since this concentration maintains 80% cell viability up to 96h after treatment with CNE in VERO cells resulted from MTT assay. The intracellular uptake assay was performed, and confirmed the internalization of the nanoemulsion in cells at all times analyzed. VERO cells were infected with ZIKV and simultaneously treated with CNE and the nanoformulation without oil (ENE) at the highest non-toxic concentration. The results evaluated by plaque assay revealed a viral inhibition of 80% for CNE and 70% for ENE. A dose-dependence assay revealed that the CNE treatment demonstrated a dose-dependent response in the viral RNA levels, whereas all ENE tested concentrations exhibited a similar degree of reduction. Taken together, our results suggest CNE as a promising nano-sized platform to be further studied for antiviral treatments.

by Jesús Salvador Sánchez Díaz, Karla Gabriela Peniche Moguel, José Manuel Reyes-Ruiz, Orlando Rubén Pérez Nieto, Diego Escarramán Martínez, Eder Iván Zamarrón López, María Verónica Calyeca Sánchez
Objective To evaluate the central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference (∆Pv-aCO2/∆Ca-vO2 ratio) as a predictor of mortality in patients with COVID-19-related severe acute respiratory distress syndrome (ARDS). Methods Patients admitted to the intensive care unit with severe ARDS secondary to SARS-CoV-2, and invasive mechanical ventilation were included in this single-center and retrospective cohort study performed between April 18, 2020, and January 18, 2022. The tissue perfusion indexes (lactate, central venous oxygen saturation [ScvO2], and venous-to-arterial carbon dioxide pressure difference [∆Pv-aCO2]), anaerobic metabolism index (∆Pv-aCO2/∆Ca-vO2 ratio), and severity index (Simplified Acute Physiology Score II [SAPSII]) were evaluated to determine its association with the mortality through Cox regression analysis, Kaplan-Meier curve and receiver operating characteristic (ROC) curve. Results One hundred fifteen patients were included in the study and classified into two groups, the survivor group (n = 54) and the non-survivor group (n = 61). The lactate, ScvO2, ∆Pv-aCO2, and ∆Pv-aCO2/∆Ca-vO2 ratio medians were 1.6 mEq/L, 75%, 5 mmHg, and 1.56 mmHg/mL, respectively. The ∆Pv-aCO2/∆Ca-vO2 ratio (Hazard Ratio (HR) = 1.17, 95% confidence interval (CI) = 1.06–1.29, p = 0.001) was identified as a mortality biomarker for patients with COVID-19-related severe ARDS. The area under the curve for ∆Pv-aCO2/∆Ca-vO2 ratio was 0.691 (95% CI 0.598–0.774, p = 0.0001). The best cut-off point for ∆Pv-aCO2/∆Ca-vO2 ratio was >2.14 mmHg/mL, with a sensitivity of 49.18%, specificity of 85.19%, a positive likelihood of 3.32, and a negative likelihood of 0.6. The Kaplan-Meier curve showed that survival rates were significantly worse in patients with values greater than this cut-off point. Conclusions The ∆Pv-aCO2/∆Ca-vO2 ratio could be used as a predictor of mortality in patients with severe ARDS secondary to SARS-CoV-2.

by Sashi Silwal, Kristina Parajuli, Astha Acharya, Ajnish Ghimire, Savita Pandey, Ashok Pandey, Anil Poudyal, Bihungum Bista, Pradip Gyanwali, Meghnath Dhimal
Background Nepal has been devastated by an unprecedented COVID-19 outbreak, affecting people emotionally, physically, and socially, resulting in significant morbidity and mortality. Approximately 10% of COVID-19 affected people have symptoms that last more than 3–4 weeks and experience numerous symptoms causing an impact on everyday functioning, social, and cognitive function. Thus, it is vital to know about the recovered patient’s health status and undertake rigorous examinations to detect and treat infections. Hence, this study aims to assess the health status of COVID-19 post-recovery patients in Nepal. Method A descriptive cross-sectional mixed-method study was conducted in all seven provinces of Nepal. A total of 552 interviews were conducted for the quantitative study, and 25 in-depth interviews were conducted for the qualitative study among above 18 years COVID-19-recovered patients. The data was gathered over the phone through the purposive sampling method The results of a descriptive and thematic analysis were interpreted. Finding The majority (more than 80%) of the recovered patients could routinely perform household duties, activities outside the home, and financial job accounting. However, a few of them required assistance in carrying out all of those tasks. Prior and then after COVID-19 infection, smoking habits reduced by about one-tenth and alcohol intake decreased by a twelve percent. A qualitative finding revealed that the majority of COVID-19 symptomatic patients experienced a variety of physical symptoms such as fever, headache, body pain, fatigue, tiredness, sore throat, cough, loss of taste, loss of smell, sneezing, loss of appetite, and difficulty breathing, while others felt completely fine after being recovered. Furthermore, there was no variation in the daily functional activities of the majority of the recovered patients, while a few were found conducting fewer activities than usual because they were concerned about their health. For social health, quantitative data indicated that more than half of the participants’ social health was severely impacted. According to the IDI, the majority of the interviewees perceived society’s ignorance and misbehavior. Family members were the most often solicited sources of support. Some participants got care and assistance, but the majority did not get affection or love from their relatives. Moreover, regarding mental health, 15 percent of participants had repeated disturbing and unwanted thoughts about COVID-19 after being recovered, 16 percent tried to avoid information on COVID-19 and 7 .7 percent of people had unfavorable ideas or sentiments about themselves. More than 16 percent of participants reported feeling some level of stress related to the workplace and home. While in-depth interviews participants revealed that COVID-infected patients who were asymptomatic didn’t experience any emotional change in them but recovered patients who are symptomatic symptoms had anxiety and still being conscious of COVID-19 in fear of getting infected again Additionally, it was discovered that participants’ mental health is influenced by ignorance of society, as well as by fake news posted to social media. Conclusion COVID-19 infection has had an impact on physical, mental, and social well-being. Hence, to aid in the early recovery of COVID-19 patients, provision of evaluating and reporting the clinical features, early detection and management of long COVID case is needed from the local and provincial and central government of Nepal.

by Adam Rose, Eliana Ein Mor, Michal Krieger, Arie Ben-Yehuda, Shoshana Revel-Vilk, Arnon D. Cohen, Eran Matz, Edna Bar-Ratson, Ronen Bareket, Ora Paltiel, Ronit Calderon-Margalit

Reports from many settings suggest that pediatric overweight and obesity increased in 2020 and 2021, presumably due to lifestyle changes associated with the COVID-19 pandemic. Many of these previous reports have relied on convenience samples or subsets of the population. Here, we present results of a longitudinal study of the entire population of Israel, a nation of approximately 9 million people, with the proportion with underweight, normal weight, overweight, and obesity at age 7 and at age 14–15, across the years 2017–2021. Our results show that the prevalence of overweight and obesity, which had been steady or improving through 2019, increased relatively quickly in 2020 and 2021. For example, among 7-year-olds, the percentage of children with obesity in 2019 was 6.8% (99% CI: 6.69–7.05), and by 2021, it had increased to 7.7% (99% CI: 7.53–7.93). There were important disparities in overweight and obesity based on SES; for example, the rate ratio for obesity comparing the poorest with the wealthiest 14–15-year-olds in 2019 was 1.63 (99% CI: 1.55–1.72). However, these disparities did not change meaningfully in 2020 and 2021, implying that while obesity did become more prevalent, this increase in prevalence was not differential across socioeconomic status. Like many other nations, Israel too experienced considerable increases in pediatric overweight and obesity in 2020–2021, erasing the improvements of the previous years among younger children.

by Eleni Zavrakli, Andrew Parnell, David Malone, Ken Duffy, Subhrakanti Dey

The outbreak of a novel coronavirus causing severe acute respiratory syndrome in December 2019 has escalated into a worldwide pandemic. In this work, we propose a compartmental model to describe the dynamics of transmission of infection and use it to obtain the optimal vaccination control. The model accounts for the various stages of the vaccination, and the optimisation is focused on minimising the infections to protect the population and relieve the healthcare system. As a case study, we selected the Republic of Ireland. We use data provided by Ireland’s COVID-19 Data-Hub and simulate the evolution of the pandemic with and without the vaccination in place for two different scenarios, one representative of a national lockdown situation and the other indicating looser restrictions in place. One of the main findings of our work is that the optimal approach would involve a vaccination programme where the older population is vaccinated in larger numbers earlier while simultaneously part of the younger population also gets vaccinated to lower the risk of transmission between groups. We compare our simulated results with those of the vaccination policy taken by the Irish government to explore the advantages of our optimisation method. Our comparison suggests that a similar reduction in cases may have been possible even with a reduced set of vaccinations available for use.

by Mohit D. Gupta, Shekhar Kunal, Girish M. P., Dixit Goyal, Rajeev Kumar Malhotra, Prashant Mishra, Mansavi Shukla, Aarti Gupta, Vanshika Kohli, Nitya Bundela, Vishal Batra, Ankit Bansal, Rakesh Yadav, Jamal Yusuf, Saibal Mukhopadhyay
Background COVID-19 vaccines are highly immunogenic but cardiovascular effects of these vaccines have not been properly elucidated. Objectives To determine impact of COVID-19 vaccination on mortality following acute myocardial infarction (AMI). Methods This was a single center retrospective observation study among patients with AMI enrolled in the the North India ST-Elevation Myocardial Infarction (NORIN-STEMI) registry. In all the enrolled patients, data regarding patient’s vaccination status including details on type of vaccine, date of vaccination and adverse effects were obtained. All enrolled subjects were followed up for a period of six months. The primary outcome of the study was all-cause mortality both at one month and at six months of follow-up. Propensity-weighted score logistic regression model using inverse probability of treatment weighting was used to determine the impact of vaccination status on all-cause mortality. Results A total of 1578 subjects were enrolled in the study of whom 1086(68.8%) were vaccinated against COVID-19 while 492(31.2%) were unvaccinated. Analysis of the temporal trends of occurrence of AMI post vaccination did not show a specific clustering of AMI at any particular time. On 30-day follow-up, all-cause mortality occurred in 201(12.7%) patients with adjusted odds of mortality being significantly lower in vaccinated group (adjusted odds ratio[aOR]: 0.58, 95% CI: 0.47–0.71). Similarly, at six months of follow-up, vaccinated AMI group had lower odds of mortality(aOR: 0.54, 95% CI: 0.44 to 0.65) as compared to non-vaccinated group. Conclusions COVID-19 vaccines have shown to decrease all-cause mortality at 30 days and six months following AMI.

by Weiguang Liu, Rafael Delalibera Rodrigues, Jianglong Yan, Yu-tao Zhu, Everson José de Freitas Pereira, Gen Li, Qiusheng Zheng, Liang Zhao

In this work, we present a network-based technique for chest X-ray image classification to help the diagnosis and prognosis of patients with COVID-19. From visual inspection, we perceive that healthy and COVID-19 chest radiographic images present different levels of geometric complexity. Therefore, we apply fractal dimension and quadtree as feature extractors to characterize such differences. Moreover, real-world datasets often present complex patterns, which are hardly handled by only the physical features of the data (such as similarity, distance, or distribution). This issue is addressed by complex networks, which are suitable tools for characterizing data patterns and capturing spatial, topological, and functional relationships in data. Specifically, we propose a new approach combining complexity measures and complex networks to provide a modified high-level classification technique to be applied to COVID-19 chest radiographic image classification. The computational results on the Kaggle COVID-19 Radiography Database show that the proposed method can obtain high classification accuracy on X-ray images, being competitive with state-of-the-art classification techniques. Lastly, a set of network measures is evaluated according to their potential in distinguishing the network classes, which resulted in the choice of communicability measure. We expect that the present work will make significant contributions to machine learning at the semantic level and to combat COVID-19.

by Nosayba Al-Azzam, Sayer Al-Azzam, Basheer Khassawneh, Mohammad Araydah, Reema A. Karasneh, Mamoon A. Aldeyab

Diabetes Mellitus (DM) is a frequent comorbidity in patients infected with the SARS-CoV-2 virus. The risk of developing severe or critical COVID-19 and higher mortality was observed to be increased in diabetic patients hospitalized due to COVID-19. In this study we aimed to find out the impact of clinical characteristics, comorbidities, laboratory results, and complications on the outcomes of diabetic patients hospitalized due to COVID-19. This article is a retrospective cohort study that include diabetic patients hospitalized with COVID-19 infection. A definition of diabetes was based on the past history of diabetes or if the HbA1c was 6.5% or higher. Demographics, clinical characteristics, comorbidities, laboratory results, and complications were extracted from the electronic medical records. The mortality rate increased with increasing age (from 5.56% in younger patients to 46% in the elderly) and with severity (from 25.71% in moderate cases to 43.77% in critical cases). We found that a critical severity on admission (OR: 5.26, 95% CI: 1.28–21.66, p = 0.0214), a history of stroke (OR: 8.37, 95% CI: 2.2–31.88, p = 0.0018), and low calcium levels on admission (OR: 2.23, 95% CI: 1.01–4.91, p = 0.0475) were significant risk factors predicting higher COVID-19 mortality in diabetic patients. The findings of this study suggest that reduced calcium levels could potentially indicate higher mortality due to COVID-19 in patients with DM. Furthermore, careful monitoring of diabetic patients hospitalized due to COVID-19 infection, especially those with critical disease severity or those with a history of stroke, may improve their outcome and lessen mortality.

by Marina Lleal, Celia Corral-Vazquez, Montserrat Baré, Ricard Comet, Susana Herranz, Francisco Baigorri, Antonio Gimeno-Miguel, Maria Raurich, Cristina Fortià, Marta Navarro, Beatriz Poblador-Plou, Marisa Baré
Background Several chronic conditions have been identified as risk factors for severe COVID-19 infection, yet the implications of multimorbidity need to be explored. The objective of this study was to establish multimorbidity clusters from a cohort of COVID-19 patients and assess their relationship with infection severity/mortality. Methods The MRisk-COVID Big Data study included 14 286 COVID-19 patients of the first wave in a Spanish region. The cohort was stratified by age and sex. Multimorbid individuals were subjected to a fuzzy c-means cluster analysis in order to identify multimorbidity clusters within each stratum. Bivariate analyses were performed to assess the relationship between severity/mortality and age, sex, and multimorbidity clusters. Results Severe infection was reported in 9.5% (95% CI: 9.0–9.9) of the patients, and death occurred in 3.9% (95% CI: 3.6–4.2). We identified multimorbidity clusters related to severity/mortality in most age groups from 21 to 65 years. In males, the cluster with highest percentage of severity/mortality was Heart-liver-gastrointestinal (81–90 years, 34.1% severity, 29.5% mortality). In females, the clusters with the highest percentage of severity/mortality were Diabetes-cardiovascular (81–95 years, 22.5% severity) and Psychogeriatric (81–95 years, 16.0% mortality). Conclusion This study characterized several multimorbidity clusters in COVID-19 patients based on sex and age, some of which were found to be associated with higher rates of infection severity/mortality, particularly in younger individuals. Further research is encouraged to ascertain the role of specific multimorbidity patterns on infection prognosis and identify the most vulnerable morbidity profiles in the community. Trial registration NCT04981249. Registered 4 August 2021 (retrospectively registered).

by Yuri Jang, Jieun Jung, Nan Sook Park, Miyong T. Kim, Soondool Chung

Considering that individuals’ health information can enable their adoption of health behaviors, we examined the use of health information sources related to COVID-19 and its association with preventive behaviors in a sample of older residents in Seoul, South Korea (N = 400, M age = 76.1 years). Latent profile analysis of 12 sources of health information representing conventional media, online sources, interpersonal networks, and health professionals or authorities yielded a 4-group typology: limited, moderate/traditional, moderate/digital, and diverse. In a multivariate model with the diverse group as a reference, the limited group (B = −4.48, SE = 1.14, p .001) and the moderate/digital group (B = −2.73, SE = 0.76, p .001) were associated with lower adherence to COVID-19 preventive behaviors. Our findings support the heterogeneity in the use of health information sources and the hypothesis that groups with restricted sources of health information would report less desirable behaviors. The findings also underscored the importance of proper use of digital health information. Efforts should be made not only to help older adults with low education access diverse sources of health information, including digital sources, but also to empower them to build digital and health literacy.

by Lisa Sattenspiel, Carolyn Orbann, Aaron Bogan, Hailey Ramirez, Sean Pirrone, Sushma Dahal, Jane A. McElroy, Christopher K. Wikle

This study compares pandemic experiences of Missouri’s 115 counties based on rurality and sociodemographic characteristics during the 1918–20 influenza and 2020–21 COVID-19 pandemics. The state’s counties and overall population distribution have remained relatively stable over the last century, which enables identification of long-lasting pandemic attributes. Sociodemographic data available at the county level for both time periods were taken from U.S. census data and used to create clusters of similar counties. Counties were also grouped by rural status (RSU), including fully (100%) rural, semirural (1–49% living in urban areas), and urban (>50% of the population living in urban areas). Deaths from 1918 through 1920 were collated from the Missouri Digital Heritage database and COVID-19 cases and deaths were downloaded from the Missouri COVID-19 dashboard. Results from sociodemographic analyses indicate that, during both time periods, average farm value, proportion White, and literacy were the most important determinants of sociodemographic clusters. Furthermore, the Urban/Central and Southeastern regions experienced higher mortality during both pandemics than did the North and South. Analyses comparing county groups by rurality indicated that throughout the 1918–20 influenza pandemic, urban counties had the highest and rural had the lowest mortality rates. Early in the 2020–21 COVID-19 pandemic, urban counties saw the most extensive epidemic spread and highest mortality, but as the epidemic progressed, cumulative mortality became highest in semirural counties. Additional results highlight the greater effects both pandemics had on county groups with lower rates of education and a lower proportion of Whites in the population. This was especially true for the far southeastern counties of Missouri (“the Bootheel”) during the COVID-19 pandemic. These results indicate that rural-urban and socioeconomic differences in health outcomes are long-standing problems that continue to be of significant importance, even though the overall quality of health care is substantially better in the 21st century.

by Rachel L. Snyder, Laura E. A. Barnes, Katelyn A. White, Ronda L. Cochran
Introduction Healthcare worker burnout is a growing problem in the United States which affects healthcare workers themselves, as well as the healthcare system as a whole. The goal of this qualitative assessment was to understand factors that may lead to healthcare worker burnout and turnover through focus groups with Certified Nursing Assistants who worked in acute care hospitals during the COVID-19 pandemic. Methods Eight focus group discussions lasting approximately 30 minutes each were held remotely from October 2022–January 2023 with current and former Certified Nursing Assistants who worked during the COVID-19 pandemic in acute care hospitals. Participants were recruited through various sources such as social media and outreach through professional organizations. The focus groups utilized open-ended prompts including topics such as challenges experienced during the pandemic, what could have improved their experiences working during the pandemic, and motivations for continuing or leaving their career in healthcare. The focus groups were coded using an immersion-crystallization technique and summarized using NVivo and Microsoft Excel. Participant demographic information was summarized overall and by current work status. Results The focus groups included 58 Certified Nursing Assistants; 33 (57%) were current Certified Nursing Assistants and 25 (43%) were Certified Nursing Assistants who no longer work in healthcare. Throughout the focus groups, five convergent themes emerged, including staffing challenges, respect and recognition for Certified Nursing Assistants, the physical and mental toll of the job, facility leadership support, and pay and incentives. Conclusions Focus group discussions with Certified Nursing Assistants identified factors at individual and organizational levels that might contribute to burnout and staff turnover in healthcare settings. Suggestions from participants on improving their experiences included ensuring staff know they are valued, being included in conversations with leadership, and improving access to mental health resources.

by Luke Okafor, Usman Khalid

The COVID-19 outbreak has had a catastrophic effect on the tourism sector and poverty alleviation efforts. This is especially the case, given the crucial role the tourism sector plays in poverty alleviation and the generation of foreign exchange earnings. This study investigates the moderating influence of extreme poverty on the underlying link between the size of the tourism industry and COVID-19 Economic Stimulus Packages (ESPs) while accounting for the influence of external debt. The results show that tourism-dependent economies with a larger share of individuals living in extreme poverty introduced larger ESPs to cushion the impacts of the COVID-19 outbreak. In addition, economies with larger external debt have less fiscal and monetary leeway to alleviate the negative effects of the COVID-19 outbreak.

by James X. Zhang, David O. Meltzer
Objective To study cost-related medication non-adherence (CRN) for a 30-month period before and during the COVID-19 pandemic using a sample of Medicare patients at high risk of hospitalization. Design A novel data set of quarterly surveys of CRN was used to evaluate CRN before and during the COVID-19 pandemic. Generalized Estimating Equation (GEE) analyses were conducted to evaluate the adjusted coefficients of change in CRN behaviors controlling for socio-demographic and health characteristics. Participants Six hundred seventy-seven Medicare beneficiaries at high risk of hospitalization who were alive on January 1, 2020 and followed up through quarterly surveys on CRN for 30 months before and during the COVID-19 pandemic. Main outcomes and measures Two metrics of prevalence and persistence of CRN and their adjusted coefficients in GEE with binomial family distribution and log link function controlling for socio-demographic and health characteristics. Results A total of 5,990 quarterly surveys were completed by the 677 patients during the 30-month study period. Among the 677 patients, 250 (37%) were men, 591 (87%) were African American, and 288 (42%) were Medicare-Medicaid dual eligible. The unadjusted prevalence of CRN before and during the COVID-19 pandemic was 31.1% and 25.7% respectively (p = 0.02 by Chi-squared test), and persistent CRN rates were 12.1% and 9.7% respectively (p = 0.17 by Chi-squared test). The adjusted odds ratio of CRN prevalence during the pandemic compared to the pre-pandemic level was 0.75 (p

by Brian M. Hicks, Catherine Vitro, Elizabeth Johnson, Carter Sherman, Mary M. Heitzeg, C. Emily Durbin, Edelyn Verona

There was a large spike in gun purchases and gun violence during the first year of the COVID-19 pandemic in the United States. We used an online U.S. national survey (N = 1036) to examine the characteristics of people who purchased a gun between March 2020 and October 2021 (n = 103) and compared them to non-gun owners (n = 763) and people who own a gun but did not purchase a gun during the COVID-19 pandemic (n = 170). Compared to non-gun owners, pandemic gun buyers were younger and more likely to be male, White race, and to affiliate with the Republican party. Compared to non-gun owners and pre-pandemic gun owners, pandemic gun buyers exhibited extreme elevations on a constellation of political (QAnon beliefs, pro-gun attitudes, Christian Nationalism, approval of former President Donald Trump, anti-vax beliefs, COVID-19 skepticism; mean Cohen’s d = 1.15), behavioral (intimate partner violence, antisocial behavior; mean d = 1.38), mental health (suicidality, depression, anxiety, substance use; mean d = 1.21), and personality (desire for power, belief in a dangerous world, low agreeableness, low conscientiousness; mean d = 0.95) characteristics. In contrast, pre-pandemic gun owners only endorsed more pro-gun attitudes (d = 0.67), lower approval of President Joe Biden (d = -0.41) and were more likely to be male and affiliate with the Republican party relative to non-gun owners. Pandemic gun buyers represent an extreme group in terms of political and psychological characteristics including several risk-factors for violence and self-harm.

by Ruth Helena de Souza Britto Ferreira de Carvalho, Maria Teresa Seabra Soares de Britto e Alves, Aluísio Gomes da Silva-Junior, Gisele Caldas Alexandre, Tatiana Raquel Selbmann Coimbra, Maurício Moraes, Letícia Oliveira de Menezes, Sandro Schreiber de Oliveira, Erika Barbara Abreu Fonseca Thomaz, Zeni Carvalho Lamy, Lely Stella Guzman Barreira
Objective To analyze the experiences of maternal health workers in three Brazilian cities, located in the Northeast (São Luís), Southeast (Niterói), and South (Pelotas) regions during the first year of the COVID-19 pandemic. Methods Qualitative research carried out between December 2020 and February 2021. Interviews were conducted, in person or remotely, with 30 health workers, doctors and nurses, working in maternity hospitals of different degrees of complexity. Results Sociodemographic characteristics, employment relationships and professional qualification of the interviewees were described. Two thematic axes were identified: 1) changes in hospital organization and dynamics in the pandemic; 2) Illness and suffering of health workers. The majority of respondents were women. Most physicians had work relationships in the public and private sectors. In Niterói, health workers had better professional qualifications and more precarious work relationships (as temporary hires), compared to São Luís and Pelotas. In the context of the uncertainties resulting from the pandemic, this situation generated even more insecurity for those workers. The statements at the beginning of the pandemic covered topics such as changes in the organizational dynamics of services, healthcare, telemedicine, and interaction between health workers and users. In the health workers’ perception, the initial period of the health emergency, which resulted in intense changes in the provision of services, was marked by an increase in preterm births, perinatal mortality, and fetal losses. Work overload, fear of contamination, concern for family members and uncertainties regarding the new disease caused intense suffering in health workers who had little institutional support in the cities studied. The suffering experienced by health workers went beyond the work dimension, reaching their private life. Conclusion Changes caused by the pandemic required immediate adjustments in professional practices, generating insecurities in healthcare regardless of the location studied. The method of hiring health workers remained the same as the previously practiced one in each city. Due to the risk of disease transmission, measures contrary to humanization practices, and more restrictive in São Luís, were reported as harmful to obstetric care. The Covid-19 pandemic was a huge challenge for the Brazilian health system, aggravating the working conditions experienced by health workers. In addition to the work environment, it was possible to briefly glimpse its effects on private life.

by Tharwat El Zahran, Nour Kalot, Rola Cheaito, Malak Khalifeh, Natalie Estelly, Imad El Majzoub
Background Adult cancer patients with COVID-19 were shown to be at higher risk of Intensive Care Unit (ICU) admission. Previously published prediction models showed controversy and enforced the importance of heterogeneity among different populations studied. Therefore, this study aimed to identify predictors of ICU admission (demographic, clinical, and COVID-19 targeted medications) in cancer patients with active COVID-19 infection presenting to the Emergency Department (ED). Methods This is a retrospective cohort study. It was conducted on adult cancer patients older than 18 years who presented to the American University of Beirut Medical Center ED from February 21, 2020, till February 21, 2021, and were found to have COVID-19 infection. Relevant data were extracted from electronic medical records. The association between different variables and ICU admission was tested. Logistic regression was done to adjust for confounding variables. A p-value less than 0.05 was considered significant. Results Eighty-nine distinct patients were included. About 37% were admitted to the ICU (n = 33). Higher ICU admission was seen in patients who had received chemotherapy within one month, had a respiratory rate at triage above 22 breaths per minute, oxygen saturation less than 95%, and a higher c-reactive protein upon presentation to the ED. After adjusting for confounding variables, only recent chemotherapy and higher respiratory rate at triage were significantly associated with ICU admission. Conclusion Physicians need to be vigilant when taking care of COVID-19 infected cancer patients. Patients who are tachypneic at presentation and those who have had chemotherapy within one month are at high risk for ICU admission.

by Amanda Formosa, Erica Acton, Amy Lee, Paul Turgeon, Shehla Izhar, Pamela Plant, Jim N. Tsoporis, Sabri Soussi, Uriel Trahtemberg, Andrew Baker, Claudia C. dos Santos

The COVID-19 pandemic has created an urgency to study the host gene response that leads to variable clinical presentations of the disease, particularly the critical illness response. miRNAs have been implicated in the mechanism of host immune dysregulation and thus hold potential as biomarkers and/or therapeutic agents with clinical application. Hence, further analyses of their altered expression in COVID-19 is warranted. An important basis for this is identifying appropriate reference genes for high quality expression analysis studies. In the current report, NanoString technology was used to study the expression of 798 miRNAs in the peripheral blood of 24 critically ill patients, 12 had COVID-19 and 12 were COVID-19 negative. A list of potentially stable candidate reference genes was generated that included ten miRNAs. The top six were analyzed using reverse transcription quantitative polymerase chain reaction (RT-qPCR) in a total of 41 patients so as to apply standard computational algorithms for validating reference genes, namely geNorm, NormFinder, BestKeeper and RefFinder. There was general agreement among all four algorithms in the ranking of four stable miRNAs: miR-186-5p, miR-148b-3p, miR-194-5p and miR-448. A detailed analysis of their output rankings led to the conclusion that miR-186-5p and miR-148b-3p are appropriate reference genes for miRNA expression studies using PaxGene tubes in the peripheral blood of patients critically ill with COVID-19 disease.

by Thandi Davies, Ingrid Daniels, Marinda Roelofse, Carol Dean, John Parker, Charlotte Hanlon, Graham Thornicroft, Katherine Sorsdahl

In the context of an already large treatment gap in South Africa, this study aimed to examine how Covid-19 and the related lockdown measures affected the availability, accessibility, quality, and continuity of mental health services in the Western Cape province in South Africa. A mixed-methods design was employed, using narrative surveys, quantitative surveys, and qualitative semi-structured interviews, with 17 public mental health providers, and secondary data from the District Health Information System. We analysed and combined the data using descriptive statistics, template analysis and methodological triangulation. Results showed that Covid-19 and the lockdowns had negative impacts on mental health service provision at all levels of care, such as reduced access to services, increased stigma and discrimination, disrupted medication supply, increased workload and stress for providers, and the closure of psychosocial and therapeutic services. Innovations used by providers to mitigate these impacts included telehealth, online training, peer support groups, and community outreach. The study concludes that Covid-19 and the lockdowns exposed and exacerbated the existing gaps and challenges in mental health service provision in South Africa. Key recommendations for policy formation and response to future pandemics in the public mental health sector include: classifying psychological treatments as essential services, establishing an intersectoral mental health emergency response plan, involving mental health care users in the development of pandemic responses, creating policies for managing health emergencies in psychiatric facilities, and increasing resources for the mental health sector in South Africa. These recommendations are relevant for South Africa and other LMICs in ensuring adequate mental health care during public health emergencies.

by Víctor Pérez-Segura, Raquel Caro-Carretero, Antonio Rua

There are numerous academic studies on the relationship between population wealth and the incidence of COVID-19. However, research developed shows contradictory results on their relationship. In accordance with this question, this work pursues two objectives: on the one hand, to check whether wealth and disease incidence have a unidirectional and stable relationship. And on the other hand, to find out if the country’s statistical production capacity is masking the real incidence of the COVID-19 pandemic. In order to achieve this objective, an ecological study has been designed at international level with the countries established as study units. The analytical strategy utilized involves the consecutive application of cross-sectional analysis, specifically employing multivariate linear regression daily throughout the first two years of the pandemic (from 03/14/2020 to 03/28/2022). The application of multiple cross-sectional analysis has shown that country wealth has a dynamic relationship with the incidence of COVID-19. Initially, it appears as a risk factor and, in the long term, as a protective element. In turn, statistical capacity appears as an explanatory variable for the number of published COVID-19 cases and deaths. Therefore, the inadequate statistical production capacity of low income countries may be masking the real incidence of the disease.

Caracterização e avaliação da formação e sensibilidade do biofilme de stenotrophomonas maltophilia isoladas de pacientes durante a pandemia da covid-19
Souza, Paula Araujo de; Santos, Milena Cristina Silva dos; Brandão, Marcelo Luiz Lima; Miranda, Rebeca Vitória da Silva Lage de; Villas Boas, Maria Helena Simões; Costa, Luciana Veloso da
Stenotrophomonas maltophilia foi amplamente associada a coinfecções em pacientes com COVID-19, visto que esta espécie possui capacidade de formar biofilme em dispositivos médicos utilizados na intubação. O presente estudo teve como objetivo caracterizar cepas de S. maltophilia isoladas durante pandemia da COVID-19 oriundas de um hospital localizado no Rio de Janeiro, coletadas entre 2021 e 2022. Nove cepas foram isoladas de sítios clínicos de sete pacientes diferentes, sendo que dois apresentavam com co-infecção por COVID-19. As cepas foram caracterizadas pelo sistema semi automatizado VITEK®2, ionização por dessorção a laser assistida por matriz - espectrometria de massa com tempo de vôo (MALDI-TOF MS) e reação em cadeia da polimerase (PCR) espécie-específico para o gene 23S rRNA. Foi avaliada a formação de biofilme em matriz de poliestireno nas temperaturas 22,5ºC e 37ºC. As cepas classificadas como moderadamente e fortemente aderentes foram avaliadas quanto a sensibilidade do biofilme frente aos desinfetantes: álcool 70%/15 min, hipoclorito de sódio 0,1; 0,5 e 1,0%/15 min, quaternário de amônio de 5ª geração e biguanida polimérica estabilizada/10 min, ácido peracético 0,5%/10 min. Todas as cepas foram identificadas como S. maltophilia pelo VITEK®2, VITEK®MS e MALDI Biotyper® com 99% de confiança, ≥80,1% de confiança e score ≥2,02, respectivamente e todas as cepas foram positivas na PCR para o 23S rRNA. Na análise de formação de biofilme, seis (66,7%) cepas foram classificadas como fortemente aderentes e três como fracamente aderentes a 37ºC. A 22,5ºC, sete (77,8%) foram classificadas como fortemente ou moderadamente aderentes. Sete cepas foram selecionadas para o teste de sensibilidade a desinfetantes. A exposição ao álcool 70%, quaternário de amônio de 5ª geração/biguanida polimérica estabilizada e ácido peracético 0,5% não apresentaram eficácia contra a formação de biofilme (P≥0,16). Já o hipoclorito de sódio nas concentrações 0,5 % e 1% foi capaz de reduzir o biofilme (P=0,0015). Conclui-se que todas as técnicas foram satisfatórias para identificar as cepas de S. maltophilia, e que a maiorias das cepas apresentaram formação de biofilme, sendo o hipoclorito de sódio o desinfetante mais adequado para sua eliminação. Estes resultados podem auxiliar na escolha de protocolos de limpeza para eliminação do biofilme, reduzindo o risco de infeções.

by Hua Liu, Xiaotao Han, Xiaofen Lin, Xinjie Zhu, Yumei Wei

In many nations, efforts to prevent and control COVID-19 have been significantly impeded by the SARS-CoV-2 virus ongoing mutation. The Omicron strain, a more recent and prevalent strain, has had more significant detrimental effects in countries worldwide. To investigate the impact of the Omicron BA.2 strain on vaccine efficacy, we proposed a model with vaccination and immunological decline in this research. Then, we fitted our model based on the number of daily new instances reported by the government in Jilin and Shanghai, China. We estimated the effective reproduction number Re = 4.71 for the Jilin and Re = 3.32 for Shanghai. Additionally, we do sensitivity analysis to identify the critical factors affecting the effective reproduction number Re. It was found that vaccination rate, effectiveness rate, and declining rate had a significant effect on Re. Further, we investigate the relevant parameter thresholds that make Re lower than unity. Finally, rich numerical experiments were then carried out. We observed that even when vaccine efficiency was not high, increasing vaccination rates had a significant effect on early disease transmission, that limiting social distance was the most economical and rational measure to control the spread of disease, and that for a short period, reducing immune decline was not significant in curbing disease transmission.

by Ieva Kubiliute, Monika Vitkauskaite, Jurgita Urboniene, Linas Svetikas, Birute Zablockiene, Ligita Jancoriene
Background The COVID-19 infection had spread worldwide causing many deaths. Mortality rates and patients’ characteristics varied within and between countries, making it important to understand the peculiarities of different populations. The aim of this study was to identify the main predictors associated with in-hospital mortality due to COVID-19 in Vilnius, Lithuania. Materials and methods This was a retrospective observational cohort study conducted at Vilnius University Hospital Santaros Clinics, Lithuania. The study included SARS-CoV-2 positive patients aged over 18 years and hospitalized between March 2020 and May 2021. Depersonalized data were retrieved from electronic medical records. The predictive values of laboratory parameters were evaluated using ROC analysis. Multivariable binary logistic regression was performed to reveal predictors of in-hospital mortality due to COVID-19. Results Among 2794 patients, 54.4% were male, the age median was 59 years (IQR 48–70), 47.4% had at least one comorbidity. The most common comorbidities were arterial hypertension (36.9%) and diabetes mellitus (13.7%). Overall, 12.7% of patients died. Multivariable regression revealed that age (OR 1.04, 95%CI 1.02–1.06), congestive heart failure (OR 3.06, 95%CI 1.96–4.77), obesity (OR 3.90, 95%CI 2.12–7.16), COPD (OR 2.92, 95%CI 1.12–7.60), previous stroke (OR 5.80, 95%CI 2.07–16.21), urea >7.01 mmol/l (OR 2.32, 95%CI 1.47–3.67), AST/ALT >1.49 (OR 1.54, 95%CI 1.08–2.21), LDH >452.5 U/l (OR 2.60, 95%CI 1.74–3.88), CRP >92.68 mg/l (OR 1.58, 95%CI 1.06–2.35), IL-6 >69.55 ng/l (OR 1.62, 95%CI 1.10–2.40), and troponin I >18.95 ng/l (OR 2.04, 95%CI 1.38–3.02), were associated with increased risk for in-hospital mortality in COVID-19 patients. Conclusions Age, congestive heart failure, obesity, COPD, prior stroke, and increased concentration of urea, LDH, CRP, IL-6, troponin I, ALT to AST ratio were identified to be the predictors for in-hospital mortality of COVID-19 patients.

by Beata Dobrowolska, Aleksandra Gutysz-Wojnicka, Magdalena Dziurka, Patrycja Ozdoba, Dorota Ozga, Beata Penar-Zadarko, Renata Markiewicz, Agnieszka Markiewicz-Gospodarek, Alvisa Palese
Background Nurse managers play an important role in coordinating the multidisciplinary teamwork, which is specifically important in emergency and crises situations like the COVID-19 pandemic. The aim of this qualitative study is twofold: (1) to explore the experiences of the Intensive care units (ICU) nurse managers regarding their work during the first wave of the COVID-19 pandemic, and (2) to analyse what implications might be provided based on experiences of nurse managers for future possible epidemiological crises. Methods In-depth phone interviews were conducted to explore the experiences of ward managers–nurses (n = 15) working in different hospitals across Poland. Interviews were taped and transcribed verbatim, and then qualitatively analysed. Results Three main categories were identified: (1) Challenge of working with the unknown, (2) Nurse managers’ expectations, and (3) Methods of coping and received support. The COVID-19 pandemic strongly affected the work of ICU nurse managers and uncovered the malfunctioning of the healthcare system. Conclusion It is important to improve the knowledge and competence of hospital management personnel through exercises and in-service training on how to handle emergencies in order to improve the management of healthcare facilities, increase the safety of patients and employees, and the quality of healthcare.

by Nicole Wolter, Stefano Tempia, Anne von Gottberg, Jinal N. Bhiman, Sibongile Walaza, Jackie Kleynhans, Jocelyn Moyes, Sue Aitken, Sarah Magni, Jessica Yun, Tamika Fellows, Tetelo Makamadi, Renay Weiner, Cherie Cawood, Neil Martinson, Limakatso Lebina, Cheryl Cohen

Healthcare utilization surveys contextualize facility-based surveillance data for burden estimates. We describe healthcare utilization in the catchment areas for sentinel site healthcare facilities during the first year of the COVID-19 pandemic. We conducted a cross-sectional healthcare utilization survey in households in three communities from three provinces (KwaZulu-Natal, Western Cape and North West). Field workers administered structured questionnaires electronically with the household members reporting influenza-like illness (ILI) in the past 30 days or severe respiratory illness (SRI) since March 2020. Multivariable logistic regression was used to identify factors associated with healthcare utilization among individuals that reported illness. From November 2020 through April 2021, we enrolled 5804 households and 23,003 individuals. Any respiratory illness was reported by 1.6% of individuals; 0.7% reported ILI only, 0.8% reported SRI only, and 0.1% reported both ILI and SRI. Any form of medical care was sought by 40.8% (95% CI 32.9% - 49.6%) and 71.3% (95% CI 63.2% - 78.6%) of individuals with ILI and SRI, respectively. On multivariable analysis, respiratory illness was more likely to be medically attended for individuals at the Pietermaritzburg site (aOR 3.2, 95% CI 1.1–9.5, compared to Klerksdorp), that were underweight (aOR 11.5, 95% CI 1.5–90.2, compared to normal weight), with underlying illness (aOR 3.2, 95%CI 1.2–8.5), that experienced severe illness (aOR 4.8, 95% CI 1.6–14.3) and those with symptom duration of ≥10 days (aOR 7.9, 95% CI 2.1–30.2, compared to

by Indraneel Salukhe, Ryan Choi, Wesley Van Voorhis, Lynn Barrett, Jennifer Hyde

SARS-CoV-2, the etiologic agent of the COVID-19 pandemic, has had an enduring impact on global public health. However, SARS-CoV-2 is only one of multiple pathogenic human coronaviruses (CoVs) to have emerged since the turn of the century. CoVs encode for several nonstructural proteins (nsps) that are essential for viral replication and pathogenesis. Among them is nsp15, a uridine-specific viral endonuclease that is important in evading the host immune response and promoting viral replication. Despite the established endonuclease function of nsp15, little is known about other determinants of its cleavage specificity. In this study we investigate the role of RNA secondary structure in SARS-CoV-2 nsp15 endonuclease activity. Using a series of in vitro endonuclease assays, we observed that thermodynamically stable RNA structures were protected from nsp15 cleavage relative to RNAs lacking stable structure. We leveraged the s2m RNA from the SARS-CoV-1 3’UTR as a model for our structural studies as it adopts a well-defined structure with several uridines, two of which are unpaired and thus highly probable targets for nsp15 cleavage. We found that SARS-CoV-2 nsp15 specifically cleaves s2m at the unpaired uridine within the GNRNA pentaloop of the RNA. Further investigation revealed that the position of uridine within the pentaloop also impacted nsp15 cleavage efficiency suggesting that positioning within the pentaloop is necessary for optimal presentation of the scissile uridine and alignment within the nsp15 catalytic pocket. Our findings indicate that RNA secondary structure is an important determinant of nsp15 cleavage and provides insight into the molecular mechanisms of RNA recognition by nsp15.

by Pier Francesco Roggero, Arianna Calistri, Giorgio Palù

Here we propose that viruses emerging in the human population undergo an evolution that is conditioned by the rules of chaos. Our data support the notion that the initial growth rate “r” affects the chances of the virus to establish a long-lasting relationship with the new host. Indeed, an emerging virus is able to spread and adapt only when it displays an initial r falling in a range frankly associated with chaotic growth.

by Craig Hogg, Sian Boots, Daniel Howorth, Christopher Williams, Margaret Heginbothom, Jane Salmon, Robin Howe
Background Lateral flow tests (LFTs) have been used to screen for SARS-CoV2 in Wales since January 2021. Between May and August 2021, adult care home staff policy was for biweekly Innova LFT and weekly Polymerase Chain Reaction (PCR) testing while asymptomatic. We estimated test performance of LFTs conducted in adult care home staff using PCR tests as a reference standard. Methods Test results from surveillance data were matched by individual where both LFT and PCR were taken on the same day. We calculated sensitivity, specificity, positive and negative predictive values, and agreement using Matthew’s correlation coefficient. Ct values of positive PCR results were compared by matched LFT result. Analysis was conducted using R v4.1.3. Results We analysed 115,593 test pairs, 499 (0.43%) of which were PCR positive. Median age was 48 (IQR: 22) and 85.00% of the study population were female. Test result agreement was 99.59% (95%CI 99.55–99.63; MCC: 0.38, p

by Renee Veldkamp, Karin Hek, Rinske van den Hoek, Laura Schackmann, Eugène van Puijenbroek, Liset van Dijk
Aim A population-based COVID-19 cohort was set up in the Netherlands to gain comprehensive insight in the short- and long-term effects of COVID-19 in the general population. The present study aims to describe the methodology and infrastructure used to recruit individuals with COVID-19, and the representativeness of the population-based cohort. The second aim was to characterize the population by description of their symptoms and health care usage during the acute COVID-19 phase. Method The starting point of the set-up of the cohort was to recruit participants in routinely recorded, general practice electronic health records (EHR) data, which are sent to the Netherlands Institute for Health Services Research Primary Care Database (Nivel-PCD) on a weekly basis. Patients registered with COVID-19 were flagged in the Nivel-PCD based on their COVID-19 diagnoses. Flagged patients were invited for participation by their general practitioner via a trusted third party. Participating patients received a series of four questionnaires over the duration of one year allowing for a combination of data from patient reported outcomes and EHRs. Results In this study, results from the first questionnaire are used. The Nivel Corona Cohort consists of 442 participants and is population-based, containing a complete image of severity of symptoms from patients with none or hardly any symptoms to those who were hospitalized due to the COVID-19. The five most prevalent symptoms during the acute COVID-19 phase were fatigue (90.5%), reduced condition (88.2%), coughing/sneezing/stuffy nose (79.3%), headache (75.4%), and myalgia (66.7%). Conclusion The population-based Nivel Corona Cohort provides ample opportunities for future studies to gain comprehensive insight in the short- and long-term effects of COVID-19 by combining patients’ perspectives and clinical parameters via the EHRs within a long-term follow-up of the cohort.

by Arezoo Yari, Homa Yousefi Khoshsabegheh, Yadolah Zarezadeh, Majid Amraei, Mohsen Soufi Boubakran, Mohamad Esmaeil Motlagh

The present study aimed to evaluate the effects of the healthcare incident command system (HICS) on the district health networks (DHNs) covered by provincial Medical Universities (PMU) in terms of the management and commanding of the COVID-19 pandemic in Iran. This study was a cross-sectional survey. The study was performed in Iran in June 2020 in 60 DHNs, 41 of which had an active HICS. Data were collected on eight HCIS dimensions from all 60 DHNs by trained crisis management experts to evaluate the effects of HICS use on management of the COVID-19 pandemic. For all the 60 DHNs, the mean score of the COVID-19 incident command and management was 78.79 ± 11.90 (range 20–100); with mean scores highest for organizational support and coordination and lowest for logistic and planning. Significant differences were observed between the DHNs with active HICS and DHNs with inactive or no HICS in terms of the mean scores of incident management and command and their associated dimensions. According to the results, the HICS use had a positive impact on the improvement of incident management and command and all the related dimensions. Therefore, the HICS could be conducted and implemented in primary healthcare for the systematic and proper management of crises caused by infectious diseases and increasing primary healthcare system efficiency in response to these crises.