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Silva HM. Reckoning with COVID-19 denial: Brazil's exemplary model for global response. World J Methodol 2024; 14:92512. [DOI: 10.5662/wjm.v14.i3.92512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/15/2024] [Accepted: 05/08/2024] [Indexed: 06/25/2024] Open
Abstract
In the aftermath of the coronavirus disease 2019 (COVID-19) pandemic in Brazil, accountability is crucial for those who denied the severity of the virus, spreading false information and causing harm. Some individuals have already faced legal proceedings against them, revealing economic motivations behind their actions. It is equally important to hold doctors accountable for prescribing ineffective treatments, putting the population at risk. The leaders of the denial movement and the federal government, who mishandled the pandemic, should be held accountable for the high death toll. Seeking justice from the legislative and executive branches is necessary, along with exemplary measures for those who spread misinformation about COVID-19.
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Affiliation(s)
- Heslley Machado Silva
- Department of Science and Education, University Center of Formiga and State University of Minas Gerais, Minas Gerais 35570000, Brazil
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Lazar Neto F, Hitchings MD, Amin AB, de França GV, Lind ML, Scaramuzzini Torres MS, Tsuha DH, de Oliveira RD, Cummings DA, Dean NE, Andrews JR, Ko AI, Croda J, Ranzani OT. Effectiveness of the fourth dose of COVID-19 vaccines against severe COVID-19 among adults 40 years or older in Brazil: a population-based cohort study. LANCET REGIONAL HEALTH. AMERICAS 2024; 34:100755. [PMID: 38737773 PMCID: PMC11087726 DOI: 10.1016/j.lana.2024.100755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 05/14/2024]
Abstract
Background The emergence of COVID-19 variants with immune scape and the waning of primary vaccine schemes effectiveness have prompted many countries to indicate first and second booster COVID-19 vaccine doses to prevent severe COVID-19. However, current available evidence on second booster dose effectiveness are mostly limited to high-income countries, older adults, and mRNA-based vaccination schemes scenarios. We aimed to investigate the relative vaccine effectiveness (rVE) of the fourth dose compared to three doses for severe COVID-19 outcomes in Brazil; and compare the rVE of a fourth dose with an mRNA vaccine compared to adenovirus-based product in the same settings. Methods We performed a target emulated trial using a population-based cohort of individuals aged 40 years or older who have received a homologous primary scheme of CoronaVac, ChAdOx1, or BNT162b2, and any third dose product and were eligible for the fourth dose in Brazil. The primary outcome was COVID-19 associated hospitalization or death. We built Cohort A matching individuals vaccinated with a fourth dose to individuals who received three doses to estimate the rVE of the fourth dose. We built Cohort B, a subset of Cohort A, matching mRNA-based (mRNA) to adenovirus-based fourth dose vaccinated individuals to compare their relative hazards for severe COVID-19. Findings 46,693,484 individuals were included in Cohort A and 6,763,016 in Cohort B. 45% of them were aged between 40 and 60 years old, and 48% between 60 and 79 years old. In Cohort A, the most common previous series was a ChAdOx1 two-dose followed by BNT162b2 (44%), and a CoronaVac two-dose followed by a BNT162b2 (36%). Among those fourth dose vaccinated, 36.9% received ChAdOx1, 32.7% Ad26.COV2.S, 25.8% BNT162b2, and 4.7% CoronaVac. In Cohort B, among those who received an adenovirus fourth dose, 53.7% received ChAdOx1 and 46.3% received Ad26.COV2.S. The estimated rVE for the primary outcome of four doses compared to three doses was 44.1% (95% CI 42.3-46.0), with some waning during follow-up (rVE 7-60 days 46.8% [95% CI 44.4-49.1], rVE after 120 days 33.8% [95% CI 18.0-46.6]). Among fourth dose vaccinated individuals, mRNA-based vaccinated individuals had lower hazards for hospitalization or death compared to adenovirus-vaccinated individuals (HR 0.81, 95% CI 0.75-0.87). After 120 days, no difference in hazards between groups was observed (HR 1.35, 95% CI 0.93-1.97). Similar findings were observed for hospitalization and death separately, except no evidence for differences between fourth dose brands for death in Cohort B. Interpretation In a heterogeneous scenario of primary and first booster vaccination combinations, a fourth dose provided meaningful and durable protection against severe COVID-19 outcomes. Compared to adenovirus-based booster, a fourth dose wild-type mRNA vaccine was associated with immediate lower hazards of hospitalization or death unsustained after 120 days. Funding None.
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Affiliation(s)
- Felippe Lazar Neto
- Pulmonary Division, Heart Institute, Hospital das Clínicas, Faculdade de Medicina, São Paulo, SP, Brazil
| | - Matt D.T. Hitchings
- Department of Biostatistics, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Avnika B. Amin
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory, University, Atlanta, GA, USA
| | | | - Margaret L. Lind
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | | | | | - Roberto D. de Oliveira
- State University of Mato Grosso do Sul, Dourados, MS, Brazil
- Graduate Program in Health Sciences, Federal University of Grande Dourados, Dourados, Brazil
| | - Derek A.T. Cummings
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
- Department of Biology, University of Florida, Gainesville, FL, USA
| | - Natalie E. Dean
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory, University, Atlanta, GA, USA
| | - Jason R. Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Albert I. Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil
| | - Julio Croda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Fiocruz Mato Grosso do Sul, Fundação Oswaldo Cruz, Campo Grande, MS, Brazil
- State University of Mato Grosso do Sul, Dourados, MS, Brazil
- Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Otavio T. Ranzani
- Pulmonary Division, Heart Institute, Hospital das Clínicas, Faculdade de Medicina, São Paulo, SP, Brazil
- Barcelona Institute for Global Health, ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
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Chaves LA, Andrade EIG, Santos ADFD. Configuration of Health Care Networks in the SUS: analysis based on primary and hospital care components. CIENCIA & SAUDE COLETIVA 2024; 29:e18392022. [PMID: 38896685 DOI: 10.1590/1413-81232024296.18392022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 08/08/2023] [Indexed: 06/21/2024] Open
Abstract
This study seeks to point out the different configurations of Health Care Networks in primary care (AB) and Hospital Care (AH), dimensioned based on coverage, quality, and resolvability characteristics in health macro-regions. Cross-sectional study used the cluster analysis and segmented 103 macro-regions into different profiles of coverage, quality and resolubility: group 1 (high coverage/AB and medium/AH; low quality AB-AH with high resolubility); group 2 (high coverage/AB and low/AH; low quality AB-AH with medium resolubility) and group 3 (high coverage/AB and medium/AH; high quality AB-AH with high resolubility). Coverage in AB was classified as high for 100% of the Brazilian population and in AH low to 9.70% and medium to 90.29%. Quality/AB-AH is low for 58.54% and high for 41.15%. Resolubility is high for 90.29% and medium for 9.70%. In Brazil, there is expansion of coverage with low quality/AB; shortage of hospital beds and low quality/HA with high resolution. However, in the Southeast and South, high AB-AH quality prevails. The structuring of health networks is still characterized by low resolution, demanding incentives for the governance of inter-federal arrangements.
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Affiliation(s)
- Lenir Aparecida Chaves
- Hospital das Clínicas, Universidade Federal de Minas Gerais. Av. Prof. Alfredo Balena 110, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| | - Eli Iola Gurgel Andrade
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| | - Alaneir de Fátima Dos Santos
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
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Deschamps FJ, Deschamps PSDS, da Silva LC, Blos EK, Savoldi ES, Garcia MJC, Staub GJ, da Rocha FR, Laporta GZ. Hospital cohort study on survival predictors for intubated coronavirus disease 2019 patients. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231464. [PMID: 38775534 PMCID: PMC11101181 DOI: 10.1590/1806-9282.20231464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/16/2023] [Indexed: 05/25/2024]
Abstract
OBJECTIVE The objective of this study was to assess the predictors of survival among patients with coronavirus disease 2019 who underwent tracheal intubation, as part of a hospital cohort study. METHODS This retrospective cohort study in the Rio do Sul County Hospital, Santa Catarina, Brazil, from April 2020 to May 2021, focused on patients aged 18 years or older intubated for coronavirus disease 2019. We assessed the 90-day survival of intubated patients by estimating the hazard ratio using a Cox proportional hazards regression model. RESULTS The study included 132 participants, with an average age of approximately 60 years. Tracheal intubation was successfully accomplished in 97% of cases within two attempts. The overall mortality rate was 62.9%. Notably, mortality rates were significantly higher in patients aged over 60 years (hazard ratio=2.57; 95%CI 1.54-4.29; p<0.001), those with blood oxygen saturation below 85% (hazard ratio=1.92; 95%CI 1.03-3.57; p=0.04), instances where tracheal intubation was carried out using a conventional laryngoscope (hazard ratio=2.59; 95%CI 1.22-5.48; p=0.013), and when performed by emergency physicians (hazard ratio=3.96; 95%CI 1.51-10.4; p=0.005). CONCLUSION Our analysis unveiled that the risk of death in intubated coronavirus disease 2019 patients is four times higher when an emergency physician, as opposed to an anesthesiologist, leads the tracheal intubation team.
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Affiliation(s)
- Fabiola Jahn Deschamps
- Centro Universitário Faculdade de Medicina do ABC, Graduate Program in Health Sciences – Santo Andre (SP), Brazil
- Universidade para o Desenvolvimento do Alto Vale do Rio Itajaí, School of Medicine – Rio do Sul (SC), Brazil
| | - Paulo Sergio da Silva Deschamps
- Centro Universitário Faculdade de Medicina do ABC, Graduate Program in Health Sciences – Santo Andre (SP), Brazil
- Universidade para o Desenvolvimento do Alto Vale do Rio Itajaí, School of Medicine – Rio do Sul (SC), Brazil
- Hospital of the High Itajai River Valley – Rio do Sul (SC), Brazil
| | - Laura Correa da Silva
- Universidade para o Desenvolvimento do Alto Vale do Rio Itajaí, School of Medicine – Rio do Sul (SC), Brazil
| | | | | | | | | | | | - Gabriel Zorello Laporta
- Centro Universitário Faculdade de Medicina do ABC, Graduate Program in Health Sciences – Santo Andre (SP), Brazil
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Mendes JET, Daboin BEG, Morais TC, Bezerra IMP, Cavalcanti MPE, Riera ARP, Noll M, de Abreu LC. Analyzing the COVID-19 Transmission Dynamics in Acre, Brazil: An Ecological Study. EPIDEMIOLOGIA 2024; 5:187-199. [PMID: 38804340 PMCID: PMC11130923 DOI: 10.3390/epidemiologia5020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
The north region of Brazil is characterized by significant vulnerabilities, notably surpassing national poverty indicators. These disparities exacerbated the impact of respiratory illnesses on the healthcare system during the COVID-19 pandemic, particularly in areas with limited healthcare resources, inadequate infrastructure, and barriers to healthcare access. The crisis was further influenced by multiple lineages that emerged as significant virus variants associated with increased transmissibility. Within this context, our ecological study focused on analyzing the epidemiological evolution of COVID-19 in the state of Acre. We constructed time-series trends in incidence, lethality, and mortality from March 2020 to December 2022 using the Prais-Winsten regression model. Our findings revealed that in 2020, there was an increasing trend in incidence, while mortality and lethality continued to decrease (p < 0.05). In the following year, both incidence and mortality decreased, while lethality increased at a rate of 1.02% per day. By the end of 2022, trends remained stationary across all rates. These results underscore the importance of ongoing surveillance and adaptive public health measures to bolster the resilience of healthcare systems in remote and vulnerable regions. Indeed, continuous monitoring of the most predominant SARS-CoV-2 lineages and their dynamics is imperative. Such proactive actions are essential for addressing emerging challenges and ensuring effective responses to adverse situations.
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Affiliation(s)
- Joseane Elza Tonussi Mendes
- Laboratory of Studies Design and Scientific Writing, Postgraduate Division, University Center FMABC, Santo André 09060-870, SP, Brazil; (J.E.T.M.); (B.E.G.D.); (M.P.E.C.); (A.R.P.R.)
- School of Medicine, University of Limerick, V94 T9PX Limerick, Ireland
| | - Blanca Elena Guerrero Daboin
- Laboratory of Studies Design and Scientific Writing, Postgraduate Division, University Center FMABC, Santo André 09060-870, SP, Brazil; (J.E.T.M.); (B.E.G.D.); (M.P.E.C.); (A.R.P.R.)
- School of Medicine, University of Limerick, V94 T9PX Limerick, Ireland
| | - Tassiane Cristina Morais
- School of Sciences of Santa Casa de Misericórdia de Vitória (EMESCAM), Vitoria 29045-402, ES, Brazil; (T.C.M.); (I.M.P.B.)
- Department of Integrated Health Education, Federal University of Espirito Santo, Vitoria 29075-910, ES, Brazil
| | - Italla Maria Pinheiro Bezerra
- School of Sciences of Santa Casa de Misericórdia de Vitória (EMESCAM), Vitoria 29045-402, ES, Brazil; (T.C.M.); (I.M.P.B.)
| | - Matheus Paiva Emidio Cavalcanti
- Laboratory of Studies Design and Scientific Writing, Postgraduate Division, University Center FMABC, Santo André 09060-870, SP, Brazil; (J.E.T.M.); (B.E.G.D.); (M.P.E.C.); (A.R.P.R.)
- School of Medicine, University of Limerick, V94 T9PX Limerick, Ireland
- Post-Graduate Program in Medical Sciences, Faculty of Medicine, University of São Paulo, São Paulo 01246-903, SP, Brazil
| | - Andres Ricardo Perez Riera
- Laboratory of Studies Design and Scientific Writing, Postgraduate Division, University Center FMABC, Santo André 09060-870, SP, Brazil; (J.E.T.M.); (B.E.G.D.); (M.P.E.C.); (A.R.P.R.)
| | - Matias Noll
- Department of Education, Instituto Federal Goiano, Ceres 76300-000, GO, Brazil;
| | - Luiz Carlos de Abreu
- Laboratory of Studies Design and Scientific Writing, Postgraduate Division, University Center FMABC, Santo André 09060-870, SP, Brazil; (J.E.T.M.); (B.E.G.D.); (M.P.E.C.); (A.R.P.R.)
- School of Medicine, University of Limerick, V94 T9PX Limerick, Ireland
- Department of Integrated Health Education, Federal University of Espirito Santo, Vitoria 29075-910, ES, Brazil
- Post-Graduate Program in Medical Sciences, Faculty of Medicine, University of São Paulo, São Paulo 01246-903, SP, Brazil
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Melro LMG, Trindade EM, Park M. COVID-19 underpinning the inverse equity hypothesis between public and private health care in Brazil. CRITICAL CARE SCIENCE 2024; 36:e20240294en. [PMID: 38597485 PMCID: PMC11098063 DOI: 10.62675/2965-2774.20240294-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 04/11/2024]
Affiliation(s)
- Livia Maria Garcia Melro
- Hospital Samaritano PaulistaIntensive Care UnitSão PauloSPBrazilIntensive Care Unit, Hospital Samaritano Paulista - São Paulo (SP), Brazil.
| | - Evelinda Marramon Trindade
- Universidade de São PauloHospital das ClínicasFaculdade de MedicinaSão PauloSPBrazilHealth Technology Assessment Center, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Marcelo Park
- Universidade de São PauloHospital das ClínicasFaculdade de MedicinaSão PauloSPBrazilIntensive Care Unit, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
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Bastos LSL, Hamacher S, Kurtz P, Ranzani OT, Zampieri FG, Soares M, Bozza FA, Salluh JIF. The Association Between Prepandemic ICU Performance and Mortality Variation in COVID-19: A Multicenter Cohort Study of 35,619 Critically Ill Patients. Chest 2024; 165:870-880. [PMID: 37838338 DOI: 10.1016/j.chest.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/20/2023] [Accepted: 10/05/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, ICUs remained under stress and observed elevated mortality rates and high variations of outcomes. A knowledge gap exists regarding whether an ICU performing best during nonpandemic times would still perform better when under high pressure compared with the least performing ICUs. RESEARCH QUESTION Does prepandemic ICU performance explain the risk-adjusted mortality variability for critically ill patients with COVID-19? STUDY DESIGN AND METHODS This study examined a cohort of adults with real-time polymerase chain reaction-confirmed COVID-19 admitted to 156 ICUs in 35 hospitals from February 16, 2020, through December 31, 2021, in Brazil. We evaluated crude and adjusted in-hospital mortality variability of patients with COVID-19 in the ICU during the pandemic. Association of baseline (prepandemic) ICU performance and in-hospital mortality was examined using a variable life-adjusted display (VLAD) during the pandemic and a multivariable mixed regression model adjusted by clinical characteristics, interaction of performance with the year of admission, and mechanical ventilation at admission. RESULTS Thirty-five thousand six hundred nineteen patients with confirmed COVID-19 were evaluated. The median age was 52 years, median Simplified Acute Physiology Score 3 was 42, and 18% underwent invasive mechanical ventilation. In-hospital mortality was 13% and 54% for those receiving invasive mechanical ventilation. Adjusted in-hospital mortality ranged from 3.6% to 63.2%. VLAD in the most efficient ICUs was higher than the overall median in 18% of weeks, whereas VLAD was 62% and 84% in the underachieving and least efficient groups, respectively. The least efficient baseline ICU performance group was associated independently with increased mortality (OR, 2.30; 95% CI, 1.45-3.62) after adjusting for patient characteristics, disease severity, and pandemic surge. INTERPRETATION ICUs caring for patients with COVID-19 presented substantial variation in risk-adjusted mortality. ICUs with better baseline (prepandemic) performance showed reduced mortality and less variability. Our findings suggest that achieving ICU efficiency by targeting improvement in organizational aspects of ICUs may impact outcomes, and therefore should be a part of the preparedness for future pandemics.
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Affiliation(s)
- Leonardo S L Bastos
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Silvio Hamacher
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro Kurtz
- Hospital Copa Star, Rio de Janeiro, Brazil; Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Otavio T Ranzani
- Pulmonary Division, Heart Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Barcelona Institute for Global Health, ISGlobal, Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Fernando G Zampieri
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Marcio Soares
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Fernando A Bozza
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil; National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Jorge I F Salluh
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil
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Uhlig SE, Rodrigues MK, Oliveira MF, Tanaka C. Timing to out-of-bed mobilization and mobility levels of COVID-19 patients admitted to the ICU: Experiences in Brazilian clinical practice. Physiother Theory Pract 2024; 40:865-873. [PMID: 36562697 DOI: 10.1080/09593985.2022.2160680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, there was scarce data about clinical/functional conditions during hospitalization or after hospital discharge. Little was known about COVID-19 repercussions and how to do early mobilization in intensive care unit (ICU). OBJECTIVE Identify the time to the initiation of out-of-bed mobilization and the levels of mobility (sitting over the edge of the bed, sitting in a chair, standing, and ambulating) reached by critically ill patients with COVID-19 during hospitalization and the factors that could impact early mobilization. METHODS This was a retrospective observational study of patients with COVID-19 in the ICU. RESULTS There were 157 surviving COVID-19 patients included in the study (median age: 61 years; median ICU length of stay: 12 days). The median time to initiate out-of-bed mobilization in the ICU was 6 days; between patients who received mechanical ventilation (MV) compared with those who did not, this time was 8 vs. 2.5 days (p < .001). Most patients who used MV were mobilized after extubation (79.6%). During ICU stays, 88.0% of all patients were mobilized out of bed, and 41.0% were able to ambulate either with assistance or independently. The time to initiate out-of-bed mobilization is associated with sedation time and MV time. CONCLUSION Despite the pandemic scenario, patients were quickly mobilized out of bed, and most of the patients achieved higher mobility levels in the ICU and at hospital discharge. Sedation time and MV time were associated with delays in initiating mobilization.
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Affiliation(s)
- Suélen E Uhlig
- VO2 Care Research Group, Physiotherapy Unit, Physiotherapy Hospital Company and Care, São Paulo, Brazil
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil
| | - Miguel K Rodrigues
- VO2 Care Research Group, Physiotherapy Unit, Physiotherapy Hospital Company and Care, São Paulo, Brazil
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil
| | - Mayron F Oliveira
- VO2 Care Research Group, Physiotherapy Unit, Physiotherapy Hospital Company and Care, São Paulo, Brazil
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil
- Science Division, Exercise Science, Lyon College, Batesville, AR, USA
| | - Clarice Tanaka
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil
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Boschi E, Friedman G, Moraes RB. Effects of Glycemic Variability in Critically Ill Patients with Coronavirus Disease 2019: A Retrospective Observational Study. Indian J Crit Care Med 2024; 28:381-386. [PMID: 38585321 PMCID: PMC10998520 DOI: 10.5005/jp-journals-10071-24688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Abstract
Aim and background Hyperglycemia is considered an adaptive metabolic manifestation of stress and is associated with poor outcomes. Herein, we analyzed the association between glycemic variability (GV) and hospital mortality in patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU), and the association between GV and mechanical ventilation (MV), ICU stay, length of hospital stays, renal replacement therapy (RRT), hypoglycemia, nosocomial infections, insulin use, and corticosteroid class. Materials and methods In this retrospective observational study, we collected information on blood glucose levels during the first 10 days of hospitalization in a cohort of ICU patients with COVID-19 and its association with outcomes. Results In 239 patients, an association was observed between GV and hospital mortality between the first and last quartiles among patients without diabetes [odds ratio (OR), 3.78; confidence interval, 1.24-11.5]. A higher GV was associated with a greater need for RRT (p = 0.002), regular insulin (p < 0.001), and episodes of hypoglycemia (p < 0.001). Nosocomial infections were associated with intermediate GV quartiles (p = 0.02). The corticosteroid class had no association with GV (p = 0.21). Conclusion Glycemic variability was associated with high mortality in patients with COVID-19 and observed in the subgroup of patients without diabetes. Clinical significance Glycemic control in critically ill patients remains controversial and hyperglycemia is associated with worse outcomes. Diabetes mellitus (DM) is one of the most prevalent comorbidities in patients with COVID-19. In addition, they require corticosteroids due to pulmonary involvement, representing a challenge and an opportunity to better understand how glycemic changes can influence the outcome of these patients. How to cite this article Boschi E, Friedman G, Moraes RB. Effects of Glycemic Variability in Critically Ill Patients with Coronavirus Disease 2019: A Retrospective Observational Study. Indian J Crit Care Med 2024;28(4):381-386.
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Affiliation(s)
- Emerson Boschi
- Hospital Geral de Caxias do Sul, Postgraduate Program in Pneumological Sciences of Universidade Federal do Rio Grande do Sul (UFRGS); (RS, Brazil)
| | - Gilberto Friedman
- Programa de Pos-graduacao em Ciencias Pneumologicas, Universidade Federal do Rio Grande do Sul – School of Medicine, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rafael B Moraes
- Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Moisoglou I, Katsiroumpa A, Malliarou M, Papathanasiou IV, Gallos P, Galanis P. Social Support and Resilience Are Protective Factors against COVID-19 Pandemic Burnout and Job Burnout among Nurses in the Post-COVID-19 Era. Healthcare (Basel) 2024; 12:710. [PMID: 38610133 PMCID: PMC11012117 DOI: 10.3390/healthcare12070710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/09/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
Nurses have experienced several psychological and work-related issues during the COVID-19 pandemic, including pandemic burnout and job burnout. The aim of this study was to examine the impact of social support and resilience on COVID-19 pandemic burnout and job burnout among nurses. We conducted a cross-sectional study in Greece. The study population included 963 nurses. We measured social support, resilience, COVID-19 pandemic burnout, and job burnout with the Multidimensional Scale of Perceived Social Support, Brief Resilience Scale, COVID-19 Burnout Scale, and Single-Item Burnout Measure, respectively. Nurses received high levels of social support, while their resilience was moderate. Additionally, nurses experienced moderate levels of COVID-19 burnout and job burnout. Increased social support and increased resilience were associated with reduced COVID-19 pandemic burnout. We found a negative relationship between social support and job burnout. A similar negative relationship was found between resilience and job burnout. Social support and resilience can act as protective factors against COVID-19 pandemic burnout and job burnout among nurses. Policy makers should develop and implement appropriate strategies to improve nurses' social support and resilience since they are the backbone of healthcare systems worldwide.
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Affiliation(s)
- Ioannis Moisoglou
- Faculty of Nursing, University of Thessaly, 41500 Larissa, Greece; (I.M.); (I.V.P.)
| | - Aglaia Katsiroumpa
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.K.); (P.G.); (P.G.)
| | - Maria Malliarou
- Faculty of Nursing, University of Thessaly, 41500 Larissa, Greece; (I.M.); (I.V.P.)
| | | | - Parisis Gallos
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.K.); (P.G.); (P.G.)
| | - Petros Galanis
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.K.); (P.G.); (P.G.)
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Freitas DHM, Costa ELV, Zimmermann NA, Gois LSO, Anjos MVA, Lima FG, Andrade PS, Joelsons D, Ho Y, Sales FCS, Sabino EC, Carvalho CRR, Ferreira JC. Temporal trends of severity and outcomes of critically ill patients with COVID-19 after the emergence of variants of concern: A comparison of two waves. PLoS One 2024; 19:e0299607. [PMID: 38452031 PMCID: PMC10919739 DOI: 10.1371/journal.pone.0299607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/13/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The emergence of SARS-CoV-2 variants led to subsequent waves of COVID-19 worldwide. In many countries, the second wave of COVID-19 was marked by record deaths, raising the concern that variants associated with that wave might be more deadly. Our aim was to compare outcomes of critically-ill patients of the first two waves of COVID-19. METHODS This retrospective cohort included critically-ill patients admitted between March-June 2020 and April-July 2021 in the largest academic hospital in Brazil, which has free-access universal health care system. We compared admission characteristics and hospital outcomes. The main outcome was 60-day survival and we built multivariable Cox model based on a conceptual causal diagram in the format of directed acyclic graph (DAG). RESULTS We included 1583 patients (1315 in the first and 268 in the second wave). Patients in the second wave were younger, had lower severity scores, used prone and non-invasive ventilatory support more often, and fewer patients required mechanical ventilation (70% vs 80%, p<0.001), vasopressors (60 vs 74%, p<0.001), and dialysis (22% vs 37%, p<0.001). Survival was higher in the second wave (HR 0.61, 95%CI 0.50-0.76). In the multivariable model, admission during the second wave, adjusted for age, SAPS3 and vaccination, was not associated with survival (aHR 0.85, 95%CI 0.65-1.12). CONCLUSIONS In this cohort study, patients with COVID-19 admitted to the ICU in the second wave were younger and had better prognostic scores. Adjusted survival was similar in the two waves, contrasting with record number of hospitalizations, daily deaths and health system collapse seen across the country in the second wave. Our findings suggest that the combination of the burden of severe cases and factors such as resource allocation and health disparities may have had an impact in the excess mortality found in many countries in the second wave.
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Affiliation(s)
- Daniela Helena Machado Freitas
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eduardo Leite Vieira Costa
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Natalia Alcantara Zimmermann
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Larissa Santos Oliveira Gois
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Mirella Vittig Alves Anjos
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Felipe Gallego Lima
- Divisao de Cardiologia, Faculdade de Medicina, Instituto Do Coracao (InCor), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Pâmela Santos Andrade
- Departamento de Epidemiologia, Faculdade de Saude Publica, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel Joelsons
- Divisao de Clinica de Molestias Infecciosas e Parasitarias, Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Yeh‐Li Ho
- Divisao de Clinica de Molestias Infecciosas e Parasitarias, Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Flávia Cristina Silva Sales
- Divisao de Clinica de Molestias Infecciosas e Parasitarias, Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Faculdade de Medicina, Instituto de Medicina Tropical, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ester Cerdeira Sabino
- Divisao de Clinica de Molestias Infecciosas e Parasitarias, Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Faculdade de Medicina, Instituto de Medicina Tropical, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carlos Roberto Ribeiro Carvalho
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Juliana Carvalho Ferreira
- Divisao de Pneumologia, Faculdade de Medicina, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Pazin-Filho A, do Valle Dallora MEL, Velasco TR, Cardoso Dos Santos RDO, Volpe GJ, Moroço DM, de Souza DA, Canabrava CM, Garcia LV, Joviliano EE, Maciel BC. Surgical waiting lists and queue management in a Brazilian tertiary public hospital. BMC Health Serv Res 2024; 24:290. [PMID: 38448876 PMCID: PMC10916210 DOI: 10.1186/s12913-024-10735-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 02/15/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Centralized management of queues helps to reduce the surgical waiting time in the publicly funded healthcare system, but this is not a reality in the Brazilian Unified Healthcare System (BUHS). We describe the implementation of the "Patients with Surgical Indication" (PSI) in a Brazilian public tertiary hospital, the impact on waiting time, and its use in rationing oncological surgeries during the COVID-19 Pandemic. METHODS Retrospective observational study of elective surgical requests (2016-2022) in a Brazilian general, public, tertiary university hospital. We recovered information regarding the inflows (indications), outflows and their reasons, the number of patients, and waiting time in queue. RESULTS We enrolled 82,844 indications in the PSI (2016-2022). The waiting time (median and interquartile range) in days decreased from 98(48;168) in 2016 to 14(3;152) in 2022 (p < 0.01). The same occurred with the backlog that ranged from 6,884 in 2016 to 844 in 2022 (p < 001). During the Pandemic, there was a reduction in the number of non-oncological surgeries per month (95% confidence interval) of -10.9(-18.0;-3.8) during Phase I (January 2019-March 2020), maintenance in Phase II (April 2020-August 2021) 0.1(-10.0;10.4) and increment in Phase III (September 2021-December 2022) of 23.0(15.3;30.8). In the oncological conditions, these numbers were 0.6(-2.1;3.3) for Phase I, an increase of 3.2(0.7;5.6) in Phase II and 3.9(1,4;6,4) in Phase III. CONCLUSION Implementing a centralized list of surgical indications and developing queue management principles proved feasible, with effective rationing. It unprecedentedly demonstrated the decrease in the median waiting time in Brazil.
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Affiliation(s)
- Antonio Pazin-Filho
- Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil.
| | | | - Tonicarlo Rodrigues Velasco
- Clinical Hospital - Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | | | - Gustavo Jardim Volpe
- Clinical Hospital - Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Diego Marques Moroço
- Clinical Hospital - Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Danilo Arruda de Souza
- Clinical Hospital - Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | | | - Luis Vicente Garcia
- Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | | | - Benedito Carlos Maciel
- Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
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Debaco ISS, Kluck HM, Marx R, da Rosa PRM, Teixeira C. Bacterial coinfections in COVID-19-hospitalized patients. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20230469. [PMID: 38451571 PMCID: PMC10913779 DOI: 10.1590/1806-9282.2023469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/22/2023] [Indexed: 03/08/2024]
Abstract
OBJECTIVE The aim of this study was to assess the rate of bacterial infections in COVID-19-hospitalized patients and to analyze the most prevalent germs, sources, risk factors, and its impact on in-hospital mortality. METHODS This observational retrospective study was conducted on 672 patients hospitalized between April and August 2020 in Nossa Senhora da Conceição Hospital, a public hospital located in Porto Alegre, Brazil. The inclusion criterion was adult patients hospitalized with confirmed COVID-19. Data were collected through chart review. Risk factors for bacterial infection and mortality were analyzed using both univariate and multivariate robust Poisson regression models. RESULTS Bacterial coinfection was observed in 22.2% of patients. Risk factors for bacterial infections were dementia (RR=2.06 (1.18-3.60); p=0.011), cerebrovascular disease (RR=1.75 (1.15-2.67); p=0.009), active cancer (RR=1.52 (1.082-2.15); p=0.01), need for noninvasive ventilation (RR=2.320 (1.740-3.094); p<0.01), invasive mechanical ventilation (RR=4.63 (2.24-9.56); p<0.01), and renal replacement therapy (RR=1.68 (1.26-2.25); p<0.01). In the adjusted model, bacterial infections were not associated with mortality (0.96 (0.75-1.24); p=0.79). The most common source of infection was due to respiratory, blood, and central venous catheters, with 69 (29.36%), 61 (25.96%), and 59 (25.11%) positive cultures, respectively. CONCLUSION We observed a high rate of bacterial infections in COVID-19-hospitalized patients, most commonly of respiratory source. Neurologic and oncologic morbidities and need for ventilation and renal replacement therapy was associated with risk factors for bacterial infections. Nevertheless, an association between bacterial infections and hospital mortality was not established.
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Affiliation(s)
| | - Helena Moreira Kluck
- Our Lady of Conception Hospital, Conceição Hospital Group, Internal Medicine Service – Porto Alegre (RS), Brazil
| | - Rômulo Marx
- Our Lady of Conception Hospital, Conceição Hospital Group, Internal Medicine Service – Porto Alegre (RS), Brazil
| | - Paulo Ricardo Mottin da Rosa
- Our Lady of Conception Hospital, Conceição Hospital Group, Internal Medicine Service – Porto Alegre (RS), Brazil
- Moinhos de Vento Hospital, Internal Medicine Service – Porto Alegre (RS), Brazil
| | - Cassiano Teixeira
- Universidade Federal de Ciências da Saúde de Porto Alegre, Department of Clinical Medicine and Rehabilitation Sciences – Porto Alegre (RS), Brazil
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Ranzani O, Alari A, Olmos S, Milà C, Rico A, Basagaña X, Dadvand P, Duarte-Salles T, Forastiere F, Nieuwenhuijsen M, Vivanco-Hidalgo RM, Tonne C. Who is more vulnerable to effects of long-term exposure to air pollution on COVID-19 hospitalisation? ENVIRONMENT INTERNATIONAL 2024; 185:108530. [PMID: 38422877 DOI: 10.1016/j.envint.2024.108530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/23/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Factors that shape individuals' vulnerability to the effects of air pollution on COVID-19 severity remain poorly understood. We evaluated whether the association between long-term exposure to ambient NO2, PM2.5, and PM10 and COVID-19 hospitalisation differs by age, sex, individual income, area-level socioeconomic status, arterial hypertension, diabetes mellitus, and chronic obstructive pulmonary disease. METHODS We analysed a population-based cohort of 4,639,184 adults in Catalonia, Spain, during 2020. We fitted Cox proportional hazard models adjusted for several potential confounding factors and evaluated the interaction effect between vulnerability indicators and the 2019 annual average of NO2, PM2.5, and PM10. We evaluated interaction on both additive and multiplicative scales. RESULTS Overall, the association was additive between air pollution and the vulnerable groups. Air pollution and vulnerability indicators had a synergistic (greater than additive) effect for males and individuals with low income or living in the most deprived neighbourhoods. The Relative Excess Risk due to Interaction (RERI) was 0.21, 95 % CI, 0.15 to 0.27 for NO2 and 0.16, 95 % CI, 0.11 to 0.22 for PM2.5 for males; 0.13, 95 % CI, 0.09 to 0.18 for NO2 and 0.10, 95 % CI, 0.05 to 0.14 for PM2.5 for lower individual income and 0.17, 95 % CI, 0.12 to 0.22 for NO2 and 0.09, 95 % CI, 0.05 to 0.14 for PM2.5 for lower area-level socioeconomic status. Results for PM10 were similar to PM2.5. Results on multiplicative scale were inconsistent. CONCLUSIONS Long-term exposure to air pollution had a larger synergistic effect on COVID-19 hospitalisation for males and those with lower individual- and area-level socioeconomic status.
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Affiliation(s)
- Otavio Ranzani
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Anna Alari
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Sergio Olmos
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carles Milà
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Alex Rico
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Xavier Basagaña
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Payam Dadvand
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Francesco Forastiere
- National Research Council, IFT, Palermo, Italy; Environmental Research Group, Imperial College London, London, UK
| | - Mark Nieuwenhuijsen
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Cathryn Tonne
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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Kratochvíl L, Havlíček J. The fallacy of global comparisons based on per capita measures. ROYAL SOCIETY OPEN SCIENCE 2024; 11:230832. [PMID: 38511080 PMCID: PMC10951725 DOI: 10.1098/rsos.230832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 01/19/2024] [Accepted: 02/14/2024] [Indexed: 03/22/2024]
Abstract
Media, social scientists and public health researchers often present comparisons across countries, and policy makers use such comparisons to take evidence-based action. For a meaningful comparison among countries, one often needs to normalize the measure for differences in population size. To address this issue, the first choice is usually to calculate per capita ratios. Such ratios, however, normalize the measure for differences in population size directly only under the highly restrictive assumption of a proportional increase of the measure with population size. Violation of this assumption frequently leads to misleading conclusions. We compare per capita ratios with an approach based on regression, a widely used statistical procedure that eliminates many of the problems with ratios and allows for straightforward data interpretation. It turns out that the per capita measures in three global datasets (gross domestic product, COVID-19-related mortality and CO2 production) systematically overestimate values in countries with small populations, while countries with large populations tend to have misleadingly low per capita ratios owing to the large denominators. Unfortunately, despite their biases, comparisons based on per capita ratios are still ubiquitous, and they are used for influential recommendations by various global institutions. Their continued use can cause significant damage when employed as evidence for policy actions and should therefore be replaced by a more scientifically substantiated and informative method, such as a regression-based approach.
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Affiliation(s)
- Lukáš Kratochvíl
- Department of Ecology, Faculty of Science, Charles University, Viničná 7, Prague128 00, Czech Republic
| | - Jan Havlíček
- Department of Zoology, Faculty of Science, Charles University, Viničná 7, Prague128 00, Czech Republic
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Martins Neto C, Branco MDRFC, Dos Santos AM, de Oliveira BLCA. COVID-19 death risk predictors in Brazil using survival tree analysis: a retrospective cohort from 2020 to 2022. Int J Equity Health 2024; 23:33. [PMID: 38378531 PMCID: PMC10880329 DOI: 10.1186/s12939-024-02101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/09/2024] [Indexed: 02/22/2024] Open
Abstract
PURPOSE This study analyses the survival of hospitalized patients with Severe Acute Respiratory Syndrome (SARS) due to COVID-19 and identifies the risk groups for death due to COVID-19 from the identification of potential interactions between its predictors. METHODS This was a retrospective longitudinal study with data from 1,756,917 patients reported in the Influenza Epidemiological Surveillance Information System from 26 February 2020 to 31 December 2022. In this study, all adult and older (≥ 20 years) patients were hospitalized with SARS due to COVID-19, with death as the outcome. Survival tree analysis was used to identify potential interactions between the predictors. A model was built for each year of study. RESULTS Hospital lethalitywas 33.2%. The worst survival curve was observed among those who underwent invasive mechanical ventilation and were aged 80 years or older in the three years of the pandemic. Black and brown race/color were predictors of deaths in the years 2020 and 2021 when there was greater demand from the health system due to the greater number of cases. CONCLUSION By applying survival tree analysis we identified several numbers of homogeneous subgroups with different risks for mortality from COVID-19. These findings show the effects of wide inequalities of access by the population, requiring effective policies for the reduction and adequate management of the disease.
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Affiliation(s)
- Carlos Martins Neto
- Postgraduate Program in Public Health, Department of Public Health, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil.
| | | | - Alcione Miranda Dos Santos
- Postgraduate Program in Public Health, Department of Public Health, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil
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Renck E, Zipper CB, Fabrino Junior MR, Salgado LAT, Rowe A, Helena ETDS. Vaccine effectiveness in preventing deaths in people with severe acute respiratory syndrome due to COVID-19 in Blumenau, Brazil, 2021. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2024; 33:e2023214. [PMID: 38381873 PMCID: PMC10883351 DOI: 10.1590/s2237-96222024v33e2023214.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/20/2023] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE to analyze the vaccine effectiveness in preventing deaths attributed to severe acute respiratory syndrome due to COVID-19 (SARS/COVID-19) in adults and the elderly, in Blumenau, state of Santa Catarina, Brazil, 2021. this was a population-based study conducted among individuals aged 20 years and older hospitalized with SARS/COVID-19; each death due to SARS/COVID-19 was considered a "case", and every survivor was considered a "control"; the association between vaccination status and the outcome of "death" was estimated using logistic regression, and vaccine effectiveness was estimated as (1-OR)*100. The study included 1,756 cases of SARS/COVID-19 (59.2% male, mean age of 56 years, 50.4% with elementary education, 68.4% with comorbidities and 39.1% in intensive care), of whom 398 died (cases) and 1,358 survived (controls); vaccine effectiveness was 74% and 85% (20-59 years old) and 72% and 75% (≥ 60 years old), respectively, for those who were partially vaccinated and fully vaccinated. CONCLUSION vaccines proved to be effective in reducing case fatality ratio due to SARS/COVID-19 in individuals ≥ 20 years old.
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Affiliation(s)
- Emanuelle Renck
- Universidade Regional de Blumenau, Departamento de Medicina, Blumenau, SC, Brasil
| | | | - Marcio Rodrigues Fabrino Junior
- Universidade Regional de Blumenau, Departamento de Medicina, Blumenau, SC, Brasil
- Universidade Regional de Blumenau, Programa de Pós-Graduação em Saúde Coletiva, Blumenau, SC, Brazil
| | | | - Adriel Rowe
- Prefeitura de Blumenau, Secretaria de Promoção da Saúde, Blumenau, SC, Brazil
| | - Ernani Tiaraju de Santa Helena
- Universidade Regional de Blumenau, Departamento de Medicina, Blumenau, SC, Brasil
- Universidade Regional de Blumenau, Programa de Pós-Graduação em Saúde Coletiva, Blumenau, SC, Brazil
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Wang YY, Zhang WW, Lu ZX, Sun JL, Jing MX. Optimal resource allocation model for COVID-19: a systematic review and meta-analysis. BMC Infect Dis 2024; 24:200. [PMID: 38355468 PMCID: PMC10865525 DOI: 10.1186/s12879-024-09007-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND A lack of health resources is a common problem after the outbreak of infectious diseases, and resource optimization is an important means to solve the lack of prevention and control capacity caused by resource constraints. This study systematically evaluated the similarities and differences in the application of coronavirus disease (COVID-19) resource allocation models and analyzed the effects of different optimal resource allocations on epidemic control. METHODS A systematic literature search was conducted of CNKI, WanFang, VIP, CBD, PubMed, Web of Science, Scopus and Embase for articles published from January 1, 2019, through November 23, 2023. Two reviewers independently evaluated the quality of the included studies, extracted and cross-checked the data. Moreover, publication bias and sensitivity analysis were evaluated. RESULTS A total of 22 articles were included for systematic review; in the application of optimal allocation models, 59.09% of the studies used propagation dynamics models to simulate the allocation of various resources, and some scholars also used mathematical optimization functions (36.36%) and machine learning algorithms (31.82%) to solve the problem of resource allocation; the results of the systematic review show that differential equation modeling was more considered when testing resources optimization, the optimization function or machine learning algorithm were mostly used to optimize the bed resources; the meta-analysis results showed that the epidemic trend was obviously effectively controlled through the optimal allocation of resources, and the average control efficiency was 0.38(95%CI 0.25-0.51); Subgroup analysis revealed that the average control efficiency from high to low was health specialists 0.48(95%CI 0.37-0.59), vaccines 0.47(95%CI 0.11-0.82), testing 0.38(95%CI 0.19-0.57), personal protective equipment (PPE) 0.38(95%CI 0.06-0.70), beds 0.34(95%CI 0.14-0.53), medicines and equipment for treatment 0.32(95%CI 0.12-0.51); Funnel plots and Egger's test showed no publication bias, and sensitivity analysis suggested robust results. CONCLUSION When the data are insufficient and the simulation time is short, the researchers mostly use the constructor for research; When the data are relatively sufficient and the simulation time is long, researchers choose differential equations or machine learning algorithms for research. In addition, our study showed that control efficiency is an important indicator to evaluate the effectiveness of epidemic prevention and control. Through the optimization of medical staff and vaccine allocation, greater prevention and control effects can be achieved.
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Affiliation(s)
- Yu-Yuan Wang
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, 832003, PR China
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, Urumqi, China
| | - Wei-Wen Zhang
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, 832003, PR China
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, Urumqi, China
| | - Ze-Xi Lu
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, 832003, PR China
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, Urumqi, China
| | - Jia-Lin Sun
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, 832003, PR China.
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, Urumqi, China.
- Department of Nutrition and Food Hygiene School of Public Health Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Ming-Xia Jing
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, 832003, PR China.
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, Urumqi, China.
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Beliero AM, Lázaro APP, Zaranza MDS, Lima GMC, Guimarães ÁR, Aragão NL, Meneses GC, Holanda MA, Albuquerque PLMM, da Silva GB, Fernandes PFCBC. ELMO CPAP: an innovative type of ventilatory support for COVID-19-related acute respiratory distress syndrome. J Bras Pneumol 2024; 49:e20230227. [PMID: 38232252 PMCID: PMC10769475 DOI: 10.36416/1806-3756/e20230227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/27/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE To assess whether the use of ELMO, a helmet for noninvasive ventilation created in Brazil, had a positive impact on the prognosis of patients with hypoxemic respiratory failure caused by severe COVID-19. METHODS This is a retrospective study of 50 critically ill COVID-19 patients. Epidemiological, clinical, and laboratory data were collected on ICU admission, as well as before, during, and after ELMO use. Patients were divided into two groups (success and failure) according to the outcome. RESULTS ELMO use improved oxygenation parameters such as Pao2, Fio2, and the Pao2/Fio2 ratio, and this contributed to a gradual reduction in Fio2, without an increase in CO2, as determined by arterial blood gas analysis. Patients in the success group had significantly longer survival (p < 0.001), as determined by the Kaplan-Meier analysis, less need for intubation (p < 0.001), fewer days of hospitalization, and a lower incidence of acute kidney injury in comparison with those in the failure group. CONCLUSIONS The significant improvement in oxygenation parameters, the longer survival, as reflected by the reduced need for intubation and by the mortality rate, and the absence of acute kidney injury suggest that the ELMO CPAP system is a promising tool for treating ARDS and similar clinical conditions.
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Affiliation(s)
- Andréa Mazza Beliero
- . Instituto Dr. José Frota, Prefeitura Municipal de Fortaleza, Fortaleza (CE) Brasil
- . Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade Estadual do Ceará, Fortaleza (CE) Brasil
| | - Ana Paula Pires Lázaro
- . Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
| | - Marza de Sousa Zaranza
- . Instituto Dr. José Frota, Prefeitura Municipal de Fortaleza, Fortaleza (CE) Brasil
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Giovanna Mazza Cruz Lima
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
| | - Álvaro Rolim Guimarães
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Nilcyeli Linhares Aragão
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Gdayllon Cavalcante Meneses
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Marcelo Alcantara Holanda
- . Programa de Pós-Graduação em Ciências Médicas, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
- . Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Polianna Lemos Moura Moreira Albuquerque
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
- . Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal do Ceará, Fortaleza (CE) Brasil
| | - Geraldo Bezerra da Silva
- . Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
- . Curso de Medicina, Centro de Ciências da Saúde, Universidade de Fortaleza, Fortaleza (CE) Brasil
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20
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Li Z, Fu J, Wang L, Zhou Y, Li J, He S. Transformation of proteins into reproductive DNA templates for sensitive quantification of PSA. Talanta 2024; 267:125206. [PMID: 37716239 DOI: 10.1016/j.talanta.2023.125206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023]
Abstract
A switch DNA template was designed to transform proteins into linear DNA strands of 97 nt. The linear DNA was subjected to quantitative polymerase chain reaction (qPCR) to determine the initial copy number, which correlated positively with the protein concentration. A restriction endonuclease was used to remove background amplification. Using prostate-specific antigen (PSA) as a protein model, the established method quantified PSA in the range of 10-18-10-13 mol/mL (detection limit = 0.034 pg/mL) with an R2 of 0.974. Good repeatability and specificity of the method were demonstrated. The established method was successfully applied for the quantification of serum PSA levels in women. Significant differences in PSA levels were observed between healthy participants and polycystic ovary syndrome patients.
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Affiliation(s)
- Zhao Li
- Key Laboratory of Longevity and Aging-related Diseases of Chinese Ministry of Education, Guangxi Colleges and Universities Key Laboratory of Biological Molecular Medicine Research, School of Basic Medical Sciences, Guangxi Medical University, Nanning, Guangxi, 530021, PR China
| | - Jingjing Fu
- Guangxi Medical College, Nanning, Guangxi, 530021, PR China
| | - Lijuan Wang
- The First Affiliated Hospital of Guangxi Medical College, Guangxi Medical College, Nanning, Guangxi, 530021, PR China
| | - Yingzhu Zhou
- Key Laboratory of Longevity and Aging-related Diseases of Chinese Ministry of Education, Guangxi Colleges and Universities Key Laboratory of Biological Molecular Medicine Research, School of Basic Medical Sciences, Guangxi Medical University, Nanning, Guangxi, 530021, PR China
| | - Jinyan Li
- Key Laboratory of Longevity and Aging-related Diseases of Chinese Ministry of Education, Guangxi Colleges and Universities Key Laboratory of Biological Molecular Medicine Research, School of Basic Medical Sciences, Guangxi Medical University, Nanning, Guangxi, 530021, PR China
| | - Shengbin He
- Key Laboratory of Longevity and Aging-related Diseases of Chinese Ministry of Education, Guangxi Colleges and Universities Key Laboratory of Biological Molecular Medicine Research, School of Basic Medical Sciences, Guangxi Medical University, Nanning, Guangxi, 530021, PR China.
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21
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Shirafkan H, Sadeghi F, Halaji M, Rahmani R, Yahyapour Y. Demographics, clinical characteristics, and outcomes in hospitalized patients during six waves of COVID‑19 in Northern Iran: a large cohort study. Sci Rep 2023; 13:22527. [PMID: 38110656 PMCID: PMC10728067 DOI: 10.1038/s41598-023-50139-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 12/15/2023] [Indexed: 12/20/2023] Open
Abstract
Since the first report of coronavirus disease 2019 (COVID-19) in Iran, our country has experienced several waves of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Northern Iran was one of the most affected regions of the country by COVID-19. In the current study, the demographic and clinical characteristics and outcomes of hospitalized patients were determined over a 2-year period (during six waves of SARS-CoV-2). This is a large cohort study investigating hospitalized patients with suspected and probable, and confirmed SARS-CoV-2 infection in Babol district, northern Iran, during the two years of COVID-19. The study population included patients admitted to four hospitals affiliated with Babol University of Medical Sciences between March 7, 2020 (start of the first wave) and March 20, 2022 (end of the sixth wave). Epidemiological and demographic characteristics, real-time PCR, cycle thresholds, clinical data and outcomes of COVID-19 were analyzed in 24,287 hospitalized patients. A total of 24,287 hospitalized patients were included in the study: 13,250 (46.6%) patients were suspected of having COVID-19, 11037(45.4%) were confirmed COVID-19 cases. The mean age of confirmed COVID-19 patients was 54.5 ± 18.9 years and 5961 (54%) were female. The median length of hospitalization for COVID-19 survivors and non-survivors was 5 (interquartile range [IQR] 4-8) and 7 (IQR 3-15) days, respectively. Of the patients with confirmed COVID-19, 714 (6.5%) died during hospitalization. In addition, the mortality rate from the first to the sixth wave was 22.9%, 8.1%, 9.9%, 6.8%, 2.7% and 3.5% in confirmed COVID-19 patients. The patients in the fifth wave were significantly younger than the others (mean age and SD of 51.1 ± 17.4 versus 59.2 ± 16.9, 54.7 ± 19.9, 58.4 ± 17.9, 53.5 ± 16.8 and 58.5 ± 25.1 years; p<0.001). The highest in-hospital mortality rate was 22.9% (126/551) in the first wave and the lowest in the fifth wave was 2.7% (96/3573) of cases. In conclusion, in the present study, the in-hospital mortality rate was 6.5% and more than half of the deceased patients were ≥65 years old. Male gender, advanced age and comorbidities significantly increased the mortality rate. The patients in the fifth wave were significantly younger than those in the other waves, and the lowest mortality rate and intensive care unit admission were also observed in the fifth wave.
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Affiliation(s)
- Hoda Shirafkan
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Science, Babol, Iran
| | - Farzin Sadeghi
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mehrdad Halaji
- Biomedical and Microbial Advanced Technologies Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
- Department of Medical Microbiology and Biotechnology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Rabeae Rahmani
- Cellular and Molecular Biology, Education of Amol Teacher, Amol, Iran
| | - Yousef Yahyapour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
- Biomedical and Microbial Advanced Technologies Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
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22
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Domino NR, Lapinscki BA, Zhen F, Yamaguto G, Costa ECS, Moriya VL, Pereira LA, Petterle R, Nogueira MB, Raboni SM. Assessing the impact of the Gamma variant on COVID-19 patient admissions in a southern Brazilian tertiary hospital-A comparison of dual pandemic phases. PLoS One 2023; 18:e0291701. [PMID: 38064470 PMCID: PMC10707562 DOI: 10.1371/journal.pone.0291701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
Since the first case of COVID-19, Brazil has undergone infection waves with distinct characteristics. The description of new variants has alerted the emergence of more contagious or virulent viruses. The variant of concern Gamma emerged in Brazil and caused an epidemic wave, but its spread outside the country was limited. We report the clinical-epidemiological profile of hospitalized patients with COVID-19 by comparing two periods. A retrospective cohort study was performed. The primary outcome was to assess individuals with COVID-19 admitted in wards and intensive care units at the academic hospital of the Federal University of Parana (CHC-UFPR) between March 2020 and July 2021, correlating demographic, clinical-epidemiologic, and survival data with the most prevalent viral variant found in each period. We used Kaplan-Meier analysis to estimate the probability of survival and ROC curves to evaluate laboratory tests to find a cutoff point for poor outcomes. Data from 2,887 individuals were analyzed, 1,495 and 1,392 from the first and second periods, respectively. Hospitalization predominated among males in both periods, and the median age was significantly lower in the second one. The frequency of comorbidities was similar. Various demographic factors, clinical assessments, and laboratory tests were examined in relation to greater severity. When comparing the two periods, we observed predominance of the Wild virus during the first wave and the Gamma variant during the second, with no significant difference in outcomes. The findings suggest that despite the association of many factors with increased severity, the temporal variation between the two periods did not result in a notable divergence in the measured outcomes. The COVID-19 pandemic has lasted for a long time, with periods marked by peaks of cases, often caused by the emergence of viral variants, resulting in higher infection rates and rapid dissemination but, for variant Gamma, no apparent greater virulence.
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Affiliation(s)
- Natalia R. Domino
- Infectious Diseases Division, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Bruna A. Lapinscki
- Microorganisms Research and Molecular Biology Laboratory, Universidade Federal do Paraná, Curitiba, Brazil
| | - Felipe Zhen
- Infectious Diseases Division, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Guilherme Yamaguto
- Infectious Diseases Division, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Emanueli C. S. Costa
- Infectious Diseases Division, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Vitor L. Moriya
- Infectious Diseases Division, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | | | - Ricardo Petterle
- Department of Integrative Medicine, Universidade Federal do Paraná, Curitiba, Brazil
| | - Meri B. Nogueira
- Virology Laboratory, Universidade Federal do Paraná, Curitiba, Brazil
| | - Sonia M. Raboni
- Infectious Diseases Division, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
- Department of Integrative Medicine, Universidade Federal do Paraná, Curitiba, Brazil
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23
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Portela MC, Martins M, Lima SML, de Andrade CLT, de Aguiar Pereira CC. COVID-19 inpatient mortality in Brazil from 2020 to 2022: a cross-sectional overview study based on secondary data. Int J Equity Health 2023; 22:238. [PMID: 37978531 PMCID: PMC10655483 DOI: 10.1186/s12939-023-02037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND In Brazil, the COVID-19 pandemic found the universal and public Unified Health System (SUS) with problems accumulated over time, due, among other reasons, to low investments, and disparities in resource distribution. The preparedness and response of the healthcare system, involving the SUS and a private sector, was affected by large socioeconomic and healthcare access inequities. This work was aimed at offering an overview of COVID-19 inpatient mortality during the pandemic in Brazil, exploring factors associated with its variations and, specifically, differences across public, private (for-profit) and philanthropic (private non-profit) inpatient healthcare units, providers, and non-providers of services to the SUS. METHODS This cross-sectional study used public secondary data. The main data source was the SIVEP-Gripe, which comprises data on severe acute respiratory illness records prospectively collected. We also employed the National Record of Health Establishments, the SUS' Hospitalization Information System and municipalities' data from IBGE. We considered adult COVID-19 hospitalizations registered in SIVEP-Gripe from February 2020 to December 2022 in inpatient healthcare units with a minimum of 100 cases in the period. Data analyses explored the occurrence of inpatient mortality, employing general linear mixed models to identify the effects of patients', health care processes', healthcare units' and municipalities' characteristics on it. RESULTS About 70% of the COVID-19 hospitalizations in Brazil were covered by the SUS, which attended the more vulnerable population groups and had worse inpatient mortality. In general, non-SUS private and philanthropic hospitals, mostly reimbursed by healthcare insurance plans accessible for more privileged socioeconomic classes, presented the best outcomes. Southern Brazil had the best performance among the macro-regions. Black and indigenous individuals, residents of lower HDI municipalities, and those hospitalized out of their residence city presented higher odds of inpatient mortality. Moreover, adjusted inpatient mortality rates were higher in the pandemic peak moments and were significantly reduced after COVID-19 vaccination reaching a reasonable coverage, from July 2021. CONCLUSIONS COVID-19 exposed socioeconomic and healthcare inequalities and the importance and weaknesses of SUS in Brazil. This work indicates the need to revert the disinvestment in the universal public system, a fundamental policy for reduction of inequities in the country.
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Affiliation(s)
- Margareth Crisóstomo Portela
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
| | - Mônica Martins
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Sheyla Maria Lemos Lima
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Carla Lourenço Tavares de Andrade
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Claudia Cristina de Aguiar Pereira
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
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24
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Hurtado JI, López-Radcenco A, Izquierdo-García JL, Rodríguez F, Moyna G, Greif G, Nin N. A comparative NMR-based metabolomics study of lung parenchyma of severe COVID-19 patients. Front Mol Biosci 2023; 10:1295216. [PMID: 38033387 PMCID: PMC10684917 DOI: 10.3389/fmolb.2023.1295216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
COVID-19 was the most significant infectious-agent-related cause of death in the 2020-2021 period. On average, over 60% of those admitted to ICU facilities with this disease died across the globe. In severe cases, COVID-19 leads to respiratory and systemic compromise, including pneumonia-like symptoms, acute respiratory distress syndrome, and multiorgan failure. While the upper respiratory tract and lungs are the principal sites of infection and injury, most studies on the metabolic signatures in COVID-19 patients have been carried out on serum and plasma samples. In this report we attempt to characterize the metabolome of lung parenchyma extracts from fatal COVID-19 cases and compare them with that from other respiratory diseases. Our findings indicate that the metabolomic profiles from fatal COVID-19 and non-COVID-19 cases are markedly different, with the former being the result of increased lactate and amino acid metabolism, altered energy pathways, oxidative stress, and inflammatory response. Overall, these findings provide additional insights into the pathophysiology of COVID-19 that could lead to the development of targeted therapies for the treatment of severe cases of the disease, and further highlight the potential of metabolomic approaches in COVID-19 research.
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Affiliation(s)
- Joaquín I. Hurtado
- Laboratorio de Interacción Hospedero Patógeno, Unidad de Biología Molecular, Institut Pasteur de Montevideo, Montevideo, Uruguay
| | | | - José Luis Izquierdo-García
- Grupo de Resonancia Magnética Nuclear e Imagen en Biomedicina, Instituto Pluridisciplinar, Universidad Complutense de Madrid, Madrid, Spain
- Departamento de Química en Ciencias Farmacéuticas, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Rodríguez
- Centro de Referencia COVID 1, Hospital Español, Administración de Servicios de Salud del Estado, Montevideo, Uruguay
| | - Guillermo Moyna
- Departamento de Química del Litoral, Universidad de la República, Paysandú, Uruguay
| | - Gonzalo Greif
- Laboratorio de Interacción Hospedero Patógeno, Unidad de Biología Molecular, Institut Pasteur de Montevideo, Montevideo, Uruguay
| | - Nicolás Nin
- Centro de Referencia COVID 1, Hospital Español, Administración de Servicios de Salud del Estado, Montevideo, Uruguay
- Centro de Referencia COVID 2, Instituto Nacional de Ortopedia y Traumatología, Administración de Servicios de Salud del Estado, Montevideo, Uruguay
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25
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Silva ECGE, Schmitt ACB, de Godoy CG, de Oliveira DB, Tanaka C, Toufen C, de Carvalho CRR, Carvalho CRF, Fu C, Hill KD, Pompeu JE. Risk Factors for the Impairment of Ambulation in Older People Hospitalized with COVID-19: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7057. [PMID: 37998288 PMCID: PMC10671138 DOI: 10.3390/ijerph20227057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/04/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
(1) Background: Some older people hospitalized with COVID-19 have experienced reduced ambulation capacity. However, the prevalence of the impairment of ambulation capacity still needs to be established. Objective: To estimate the prevalence of, and identify the risk factors associated with, the impairment of ambulation capacity at the point of hospital discharge for older people with COVID-19. (2) Methods: A retrospective cohort study. Included are those with an age > 60 years, of either sex, hospitalized due to COVID-19. Clinical data was collected from patients' medical records. Ambulation capacity prior to COVID-19 infection was assessed through the patients' reports from their relatives. Multiple logistic regressions were performed to identify the risk factors associated with the impairment of ambulation at hospital discharge. (3) Results: Data for 429 older people hospitalized with COVID-19 were randomly collected from the medical records. Among the 56.4% who were discharged, 57.9% had reduced ambulation capacity. Factors associated with reduced ambulation capacity at discharge were a hospital stay longer than 20 days (Odds Ratio (OR): 3.5) and dependent ambulation capacity prior to COVID-19 (Odds Ratio (OR): 11.3). (4) Conclusion: More than half of the older people who survived following hospitalization due to COVID-19 had reduced ambulation capacity at hospital discharge. Impaired ambulation prior to the infection and a longer hospital stay were risks factors for reduced ambulation capacity.
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Affiliation(s)
- Erika Christina Gouveia e Silva
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine—University of Sao Paulo, Brazil. R. Cipotanea, 51-Vila Butanta, São Paulo 05360-160, Brazil; (A.C.B.S.); (C.G.d.G.); (D.B.d.O.); (C.T.); (C.R.F.C.); (C.F.); (J.E.P.)
| | - Ana Carolina Basso Schmitt
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine—University of Sao Paulo, Brazil. R. Cipotanea, 51-Vila Butanta, São Paulo 05360-160, Brazil; (A.C.B.S.); (C.G.d.G.); (D.B.d.O.); (C.T.); (C.R.F.C.); (C.F.); (J.E.P.)
| | - Caroline Gil de Godoy
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine—University of Sao Paulo, Brazil. R. Cipotanea, 51-Vila Butanta, São Paulo 05360-160, Brazil; (A.C.B.S.); (C.G.d.G.); (D.B.d.O.); (C.T.); (C.R.F.C.); (C.F.); (J.E.P.)
| | - Danielle Brancolini de Oliveira
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine—University of Sao Paulo, Brazil. R. Cipotanea, 51-Vila Butanta, São Paulo 05360-160, Brazil; (A.C.B.S.); (C.G.d.G.); (D.B.d.O.); (C.T.); (C.R.F.C.); (C.F.); (J.E.P.)
| | - Clarice Tanaka
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine—University of Sao Paulo, Brazil. R. Cipotanea, 51-Vila Butanta, São Paulo 05360-160, Brazil; (A.C.B.S.); (C.G.d.G.); (D.B.d.O.); (C.T.); (C.R.F.C.); (C.F.); (J.E.P.)
| | - Carlos Toufen
- Division of Pulmonology, Heart Institute (InCor), School of Medicine—University of Sao Paulo, Brazil. Av. Dr. Eneas Carvalho de Aguiar, 44-Cerqueira Cesar, São Paulo 05403-900, Brazil (C.R.R.d.C.)
| | - Carlos Roberto Ribeiro de Carvalho
- Division of Pulmonology, Heart Institute (InCor), School of Medicine—University of Sao Paulo, Brazil. Av. Dr. Eneas Carvalho de Aguiar, 44-Cerqueira Cesar, São Paulo 05403-900, Brazil (C.R.R.d.C.)
| | - Celso R. F. Carvalho
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine—University of Sao Paulo, Brazil. R. Cipotanea, 51-Vila Butanta, São Paulo 05360-160, Brazil; (A.C.B.S.); (C.G.d.G.); (D.B.d.O.); (C.T.); (C.R.F.C.); (C.F.); (J.E.P.)
| | - Carolina Fu
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine—University of Sao Paulo, Brazil. R. Cipotanea, 51-Vila Butanta, São Paulo 05360-160, Brazil; (A.C.B.S.); (C.G.d.G.); (D.B.d.O.); (C.T.); (C.R.F.C.); (C.F.); (J.E.P.)
| | - Keith D. Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, VIC 3199, Australia;
| | - José Eduardo Pompeu
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine—University of Sao Paulo, Brazil. R. Cipotanea, 51-Vila Butanta, São Paulo 05360-160, Brazil; (A.C.B.S.); (C.G.d.G.); (D.B.d.O.); (C.T.); (C.R.F.C.); (C.F.); (J.E.P.)
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26
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Cerqueira-Silva T, Marcilio I, de Araújo Oliveira V, Tavares Veras Florentino P, Penna GO, Pereira Ramos PI, Boaventura VS, Barral-Netto M. Early detection of respiratory disease outbreaks through primary healthcare data. J Glob Health 2023; 13:04124. [PMID: 37917874 PMCID: PMC10623377 DOI: 10.7189/jogh.13.04124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Background The emergence of coronavirus disease 2019 (COVID-19) in 2020 highlighted the relevance of surveillance systems in detecting early signs of potential outbreaks, thus enabling public health authorities to act before the pathogen becomes widespread. Syndromic digital surveillance through web applications has played a crucial role in monitoring the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. However, this approach requires expensive infrastructure, which is not available in developing countries. Pre-existing sources of information, such as encounters in primary health care (PHC), can provide valuable data for a syndromic surveillance system. Here we evaluated the utility of PHC data to identify early warning signals of the first COVID-19 outbreak in Bahia-Brazil in 2020. Methods We compared the weekly counts of PHC encounters due to respiratory complaints and the number of COVID-19 cases in 2020 in Bahia State - Brazil. We used the data from December 2016 to December 2019 to predict the expected number of encounters in 2020. We analysed data aggregated by geographic regions (n = 34) and included those where historical PHC data was available for at least 70% of the population. Results Twenty-one out of 34 regions met the inclusion criteria. We observed that notification of COVID-19 cases was preceded by at least two weeks with an excess of encounters of respiratory complaints in 18/21 (86%) of the regions analysed and four weeks or more in 10/21 (48%) regions. Conclusions Digital syndromic surveillance systems based on already established PHC databases may add time to preparedness and response to emerging epidemics.
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Affiliation(s)
- Thiago Cerqueira-Silva
- Laboratório de Medicina e Saúde Pública de Precisão – Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
- Centro de Integração de Dados e Conhecimentos para Saúde – Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
| | - Izabel Marcilio
- Centro de Integração de Dados e Conhecimentos para Saúde – Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
| | | | | | - Gerson O Penna
- Centro de Medicina Tropical – Universidade de Brasília, Escola Fiocruz de Governo, Brasília, Brazil
| | - Pablo I Pereira Ramos
- Centro de Integração de Dados e Conhecimentos para Saúde – Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
| | - Viviane S Boaventura
- Laboratório de Medicina e Saúde Pública de Precisão – Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Manoel Barral-Netto
- Laboratório de Medicina e Saúde Pública de Precisão – Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
- Centro de Integração de Dados e Conhecimentos para Saúde – Instituto Gonçalo Moniz, Salvador, Bahia, Brazil
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Santos MMS, Pereira IJ, Cuboia N, Reis-Pardal J, Adrião D, Cardoso T, Aragão I, Santos L, Sarmento A, Rosa RG, Granja C, Teixeira C, Azevedo L. Predictors of early and long-term mortality after ICU discharge in critically ill COVID-19 patients: A prospective cohort study. PLoS One 2023; 18:e0293883. [PMID: 37917761 PMCID: PMC10621933 DOI: 10.1371/journal.pone.0293883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND To mitigate mortality among critically ill COVID-19 patients, both during their Intensive Care Unit (ICU) stay and following ICU discharge, it is crucial to measure its frequency, identify predictors and to establish an appropriate post-ICU follow-up strategy. METHODS In this multicentre, prospective cohort study, we included 586 critically ill COVID-19 patients. RESULTS We observed an overall ICU mortality of 20.1% [95%CI: 17.1% to 23.6%] (118/586) and an overall hospital mortality of 25.4% [95%CI: 22.1% to 29.1%] (149/586). For ICU survivors, 30 days (early) post-ICU mortality was 5.3% [95%CI: 3.6% to 7.8%] (25/468) and one-year (late) post-ICU mortality was 7.9% [95%CI: 5.8% to 10.8%] (37/468). Pre-existing conditions/comorbidities were identified as the main independent predictors of mortality after ICU discharge: hypertension and heart failure were independent predictors of early mortality; and hypertension, chronic kidney disease, chronic obstructive pulmonary disease and cancer were independent predictors of late mortality. CONCLUSION Early and late post-ICU mortality exhibited an initial surge (in the first 30 days post-ICU) followed by a subsequent decline over time. Close monitoring of critically ill COVID-19 post-ICU survivors, especially those with pre-existing conditions, is crucial to prevent adverse outcomes, reduce mortality and to establish an appropriate follow-up strategy.
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Affiliation(s)
- Mariana M. S. Santos
- MEDCIDS–Medicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE–Center for Health Technology and Services Research (CINTESIS) & Health Research Network Associated Laboratory (RISE), University of Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Isabel J. Pereira
- MEDCIDS–Medicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Polyvalent Intensive Care Medicine Service, Centro Hospitalar de Gaia/Espinho—Vila Nova de Gaia, Vila Nova de Gaia, Portugal
- CriticalMed–Critical Care & Emergency Medicine, CINTESIS—Center for Health, Porto, Portugal
| | - Nelson Cuboia
- MEDCIDS–Medicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE–Center for Health Technology and Services Research (CINTESIS) & Health Research Network Associated Laboratory (RISE), University of Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joana Reis-Pardal
- MEDCIDS–Medicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE–Center for Health Technology and Services Research (CINTESIS) & Health Research Network Associated Laboratory (RISE), University of Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Diana Adrião
- Polyvalent Intensive Care Medicine Service, Centro Hospitalar de Gaia/Espinho—Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Teresa Cardoso
- Intensive Care Unit (UCIP), Hospital de Santo António, Oporto Hospital Center, University of Oporto, Largo Prof. Abel Salazar, Porto, Portugal
| | - Irene Aragão
- Intensive Care Unit (UCIP), Hospital de Santo António, Oporto Hospital Center, University of Oporto, Largo Prof. Abel Salazar, Porto, Portugal
| | - Lurdes Santos
- CHUSJ-Centro Hospitalar Universitário S. João, Porto, Portugal
- Infectious Diseases Intensive Care Unit-(ID-ICU)- Centro Hospitalar Universitário S. João, Porto, Portugal
- Intensive Care Department, Centro Hospitalar Universitário de São João—Porto, Porto, Portugal
| | - António Sarmento
- CHUSJ-Centro Hospitalar Universitário S. João, Porto, Portugal
- Infectious Diseases Intensive Care Unit-(ID-ICU)- Centro Hospitalar Universitário S. João, Porto, Portugal
- Intensive Care Department, Centro Hospitalar Universitário de São João—Porto, Porto, Portugal
| | - Regis G. Rosa
- Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
- Research Unit, INOVA Medical, Porto Alegre, RS, Brazil
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil
| | - Cristina Granja
- Faculty of Medicine, University of Porto, Porto, Portugal
- CriticalMed–Critical Care & Emergency Medicine, CINTESIS—Center for Health, Porto, Portugal
- CHUSJ-Centro Hospitalar Universitário S. João, Porto, Portugal
- Intensive Care Department, Centro Hospitalar Universitário de São João—Porto, Porto, Portugal
- Anaesthesiology Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculdade de Medicina, University of Porto, Porto, Portugal
| | - Cassiano Teixeira
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil
- Intensive Care Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- UFCSPA Medical School, Porto Alegre, RS, Brazil
| | - Luís Azevedo
- MEDCIDS–Medicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE–Center for Health Technology and Services Research (CINTESIS) & Health Research Network Associated Laboratory (RISE), University of Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
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Lopes TRR, Silva Júnior JVJ, Carmo RF, Weiblen R, Flores EF. Epidemiological analysis over two years of SARS-CoV-2 circulation in southern Brazil: old and novel predictors of COVID-19 outcome. Acta Trop 2023; 247:107007. [PMID: 37659686 DOI: 10.1016/j.actatropica.2023.107007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
The overwhelming majority of SARS-CoV-2 epidemiological studies cover a narrow time period, making general knowledge about the COVID-19 pandemic difficult. To assess COVID-19-related host aspects in the overall pandemic, we analyzed COVID-19 cases during the first two years of SARS-CoV-2 circulation in southern Brazil. Herein, 390 patients admitted in 2020-2022 to a Brazilian public referral hospital were allocated into two groups according to the COVID-19 outcome: hospital discharge (n=237) or death (n=153). In the univariate analysis, several variables, including sociodemographic, clinical and laboratory aspects (primary data), were significantly different between the analyzed groups. In multivariate logistic regression, eight of these factors remained associated with the COVID-19 outcome. In particular, we report oxygen supplementation and the need for hemodialysis as predictors of hospital discharge and death from COVID-19, respectively. To the best of our knowledge, none of these findings have been previously reported in the Brazilian or world population. In conclusion, our results contribute to current knowledge by demonstrating that factors described at different times may remain associated with COVID-19 over the pandemic and by identifying novel predictors of COVID-19 outcome.
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Affiliation(s)
- T R R Lopes
- Programa de Pós-graduação em Medicina Veterinária, Universidade Federal de Santa Maria, Rio Grande do Sul, Brazil; Setor de Virologia, Departamento de Medicina Veterinária Preventiva, Universidade Federal de Santa Maria, Rio Grande do Sul, Brazil
| | - J V J Silva Júnior
- Setor de Virologia, Departamento de Medicina Veterinária Preventiva, Universidade Federal de Santa Maria, Rio Grande do Sul, Brazil; Setor de Virologia, Instituto Keizo Asami, Universidade Federal de Pernambuco, Pernambuco, Brazil; Departamento de Análises Clínicas, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Rio Grande do Sul, Brazil.
| | - R F Carmo
- Colegiado de Ciências Farmacêuticas, Universidade Federal do Vale do São Francisco, Pernambuco, Brazil
| | - R Weiblen
- Setor de Virologia, Departamento de Medicina Veterinária Preventiva, Universidade Federal de Santa Maria, Rio Grande do Sul, Brazil
| | - E F Flores
- Setor de Virologia, Departamento de Medicina Veterinária Preventiva, Universidade Federal de Santa Maria, Rio Grande do Sul, Brazil.
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de Oliveira MC, Bernardelli RS, Kozesinski-Nakatani AC, Turnes J, Reese FB, Pozzo LC, Deucher RADO, Rossi CU, Tannous LA, Réa-Neto Á. Typical phenotypes of patients with acute respiratory failure with and without COVID-19 and their relationship with outcomes: a cohort study. CRITICAL CARE SCIENCE 2023; 35:355-366. [PMID: 38265317 PMCID: PMC10802779 DOI: 10.5935/2965-2774.20230015-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/09/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To compare, within a cohort of patients with acute respiratory failure, the phenotypes of patients with and without COVID-19 in the context of the pandemic and evaluate whether COVID-19 is an independent predictor of intensive care unit mortality. METHODS This historical cohort study evaluated 1001 acute respiratory failure patients with suspected COVID-19 admitted to the intensive care unit of 8 hospitals. Patients were classified as COVID-19 cases and non-COVID-19 cases according to real-time polymerase chain reaction results. Data on clinical and demographic characteristics were collected on intensive care unit admission, as well as daily clinical and laboratory data and intensive care unit outcomes. RESULTS Although the groups did not differ in terms of APACHE II or SOFA scores at admission, the COVID-19 group had more initial symptoms of fever, myalgia and diarrhea, had a longer duration of symptoms, and had a higher prevalence of obesity. They also had a lower PaO2/FiO2 ratio, lower platelet levels than non-COVID-19 patients, and more metabolic changes, such as higher levels of blood glucose, C-reactive protein, and lactic dehydrogenase. Patients with non-COVID-19 acute respiratory failure had a higher prevalence of chronic obstructive pulmonary disease/asthma and cardiopathy. Patients with COVID-19 stayed in the hospital longer and had more complications, such as acute kidney failure, severe acute respiratory distress syndrome and severe infection. The all-cause mortality rate was also higher in this group (43.7% in the COVID-19 group versus 27.4% in the non-COVID-19 group). The diagnosis of COVID-19 was a predictor of intensive care unit mortality (odds ratio, 2.77; 95%CI, 1.89 - 4.07; p < 0.001), regardless of age or Charlson Comorbidity Index score. CONCLUSION In a prospective cohort of patients admitted with acute respiratory failure, patients with COVID-19 had a clearly different phenotype and a higher mortality than non-COVID-19 patients. This may help to outline more accurate screening and appropriate and timely treatment for these patients.
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Affiliation(s)
| | | | | | - Joelle Turnes
- Centro de Estudos e de Pesquisas em Terapia Intensiva - Curitiba
(PR), Brazil
| | | | | | | | | | | | - Álvaro Réa-Neto
- Centro de Estudos e de Pesquisas em Terapia Intensiva - Curitiba
(PR), Brazil
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Oliveira FV, Coltro PS, Nunes AA, Biaziolo CFB, Ferreira MC, Farina-Junior JA. Comparative cohort analysis of pressure ulcer/injury in intensive care unit patients before and during the COVID-19 pandemic. J Plast Reconstr Aesthet Surg 2023; 85:98-103. [PMID: 37478653 DOI: 10.1016/j.bjps.2023.06.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 06/19/2023] [Accepted: 06/29/2023] [Indexed: 07/23/2023]
Abstract
COVID-19 has emerged as a global pandemic leading to an increase in hospitalization and intensive care unit (ICU) admissions worldwide. Due to severe acute respiratory distress syndrome (ARDS), many patients require prone positioning, which is associated with increased pressure ulcer/injury (PU/PI) incidence. COVID-19 pathophysiology may favor the occurrence of PU/PI due to hypoxemia, inflammatory status, and vasculopathy. This study aimed to compare the incidence of PU/PI in ICU patients before and during the COVID-19 pandemic. A retrospective cohort study was conducted at a university hospital in Brazil. Data from the medical charts of every adult patient admitted to ICU from March to July 2019 and the same period in 2020 were collected. The group from 2019 included 408 patients admitted due to multiple causes, and the group from 2020 included 229 patients admitted due to COVID-19 infection. The incidence of PU/PI was significantly higher in patients admitted in 2020 compared to 2019 (62,5 vs. 33,8%, respectively). Also, PU/PI location and severity have been different between groups, with the patients with COVID-19 (2020 group) more exposed to stage 3, 4, and non-stageable lesions, as well as more PU/PI on face skin and other less common locations. In conclusion, the COVID-19 pandemic has highlighted a higher PU/PI incidence. ICU patients were older during the pandemic, had higher body mass index and comorbidities, and needed more invasive medical devices and pronation. The occurrence of PU/PI was also associated with prolonged hospitalization and mortality.
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Affiliation(s)
- Flávio V Oliveira
- Division of Plastic Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Pedro S Coltro
- Division of Plastic Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Brazil.
| | - Altacílio A Nunes
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Cintia F B Biaziolo
- Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Marcus C Ferreira
- Division of Plastic Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Jayme A Farina-Junior
- Division of Plastic Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Brazil
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31
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Santos BMPD, Gomes AMF, Lourenção LG, Cunha ICKO, Cavalcanti AJCDA, Silva MCND, Lopes Neto D, Freire NP. Profile and essentiality of Nursing in the context of the COVID-19 pandemic. CIENCIA & SAUDE COLETIVA 2023; 28:2785-2796. [PMID: 37878923 DOI: 10.1590/1413-812320232810.09772023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 06/01/2023] [Indexed: 10/27/2023] Open
Abstract
The present study aims to describe the sociodemographic and health profile of nursing professionals in the context of the COVID-19 pandemic and propose a reflective analysis on the essentiality of the category facing the intrinsic demands of patients and the Brazilian health system, especially in the context of the public health emergency triggered by the exponential advance of the SARS-CoV-2 virus. This study reveals the relationship between historical injustices and the different types of inequality that impacted and caused the vulnerability of the profession, with an emphasis on the presentation of potential perspectives arising from this historical process and recent events.
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Affiliation(s)
| | - Antonio Marcos Freire Gomes
- Conselho Federal de Enfermagem (COFEN). SCLN QD 304, Bloco E, Lote 09, Asa Norte. 70736-550 Brasília DF Brasil.
| | | | | | | | | | - David Lopes Neto
- Escola de Enfermagem de Manaus, Universidade Federal do Amazonas (UFAM). Manaus AM Brasil
| | - Neyson Pinheiro Freire
- Programa de Pós-Graduação em Enfermagem, Universidade Federal de São Paulo (UNIFESP). São Paulo SP Brasil
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de Almeida JC, Paiva NS, Gibson G, Bastos LS, Medronho RDA, Bloch KV. Registration with Primary Health Care and COVID-19 mortality: cohort of diabetics from five administrative health regions in the city of Rio de Janeiro, Brazil, 2020-2021. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023; 26:e230039. [PMID: 37729346 PMCID: PMC10548836 DOI: 10.1590/1980-549720230039.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/25/2023] [Accepted: 06/30/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE The present study carried out an analysis of survival according to the status of registration with Primary Health Care (PHC) and of factors associated with death from COVID-19, in cases residing in Programmatic Area 3.1 (PA3.1) with a diagnosis of diabetes (in the notification form or in the electronic medical record), of the Municipality of Rio de Janeiro (RJ), Brazil, in 2020-2021. METHODS A probabilistic linkage of databases was performed based on information on cases notified as COVID-19 and data from the electronic medical records of people living with diabetes. A survival analysis was carried out, using the Cox regression model stratified by age group and adjusted for confounding variables. RESULTS Individuals registered with the PHC of PA3.1 had almost twice the risk of death from COVID-19 (adjusted hazard ratio [HRadj]=1.91) when compared to those unregistered. This association was stronger in individuals aged 18 to 59 years registered with the PHC (HRadj=2.82) than in individuals aged 60 years or over (HRadj=1.56). CONCLUSION Surveillance strategies for identifying and adequately monitoring higher-risk groups, among individuals living with diabetes, within the scope of Primary Health Care, can contribute to reducing mortality from COVID-19.
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Affiliation(s)
- Jéssica Chagas de Almeida
- Universidade Federal do Rio de Janeiro, Instituto de Estudos em
Saúde Coletiva – Rio de Janeiro (RJ), Brasil
| | - Natalia Santana Paiva
- Universidade Federal do Rio de Janeiro, Instituto de Estudos em
Saúde Coletiva – Rio de Janeiro (RJ), Brasil
- Fundação Oswaldo Cruz – Rio de Janeiro (RJ), Brasil
| | - Gerusa Gibson
- Universidade Federal do Rio de Janeiro, Instituto de Estudos em
Saúde Coletiva – Rio de Janeiro (RJ), Brasil
| | | | - Roberto de Andrade Medronho
- Universidade Federal do Rio de Janeiro, Instituto de Estudos em
Saúde Coletiva – Rio de Janeiro (RJ), Brasil
| | - Katia Vergetti Bloch
- Universidade Federal do Rio de Janeiro, Instituto de Estudos em
Saúde Coletiva – Rio de Janeiro (RJ), Brasil
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Costa GJ, da Silva JR, da Silva CCA, de Lima TPF, Costa MM, Sousa MHO, Costa GCDS, Costa JI, Sales MJT. Risk factors for death and illness severity in vaccinated versus unvaccinated COVID-2019 inpatients: a retrospective cohort study. J Bras Pneumol 2023; 49:e20230145. [PMID: 37729337 PMCID: PMC10578947 DOI: 10.36416/1806-3756/e20230145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/05/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE To determine the clinical profile of COVID-19 inpatients who were vaccinated prior to hospitalization and to compare the risk factors for death and the 28-day survival rate of between those inpatients vaccinated with one, two, or three doses and unvaccinated COVID-19 inpatients. METHODS This was a retrospective observational cohort study involving COVID-19 patients admitted to a referral hospital in the city of Recife, Brazil, between July of 2020 and June of 2022. RESULTS The sample comprised 1,921 inpatients, 996 of whom (50.8%) were vaccinated prior to hospitalization. After adjusting the mortality risk for vaccinated patients, those undergoing invasive mechanical ventilation (IMV) had the highest mortality risk (adjusted OR [aOR] = 7.4; 95% CI, 3.8-14.1; p < 0.001), followed by patients > 80 years of age (aOR = 7.3; 95% CI, 3.4-15.4; p < 0.001), and those needing vasopressors (aOR = 5.6; 95% CI, 2.9-10.9; p < 0.001). After adjusting the mortality risk for all patients, having received three vaccine doses (aOR = 0.06; 95% CI, 0.03-0.11; p < 0.001) was the most important protective factor against death. There were progressive benefits of vaccination, reducing the frequency of ICU admissions, use for IMV, and death (respectively, from 44.9%, 39.0% and 39.9% after the first dose to 16.7%, 6.2% and 4.4% after the third dose), as well as significant improvements in survival after each subsequent dose (p < 0.001). CONCLUSIONS Vaccines were effective in reducing illness severity and death in this cohort of COVID-19 inpatients, and the administration of additional doses conferred them with accumulative vaccine protection.
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Affiliation(s)
| | - José Roberto da Silva
- . Departamento de Ensino e Pesquisa, Instituto de Medicina Integral Professor Fernando Figueira - IMIP - Recife (PE) Brasil
| | - Caio Cesar Arruda da Silva
- . Departamento de Ensino e Pesquisa, Instituto de Medicina Integral Professor Fernando Figueira - IMIP - Recife (PE) Brasil
| | | | - Mariana Menezes Costa
- . Departamento de Ensino e Pesquisa, Instituto de Medicina Integral Professor Fernando Figueira - IMIP - Recife (PE) Brasil
| | - Marcos Henrique Oliveira Sousa
- . Departamento de Ensino e Pesquisa, Instituto de Medicina Integral Professor Fernando Figueira - IMIP - Recife (PE) Brasil
| | | | - José Iran Costa
- . Departamento de Ensino e Pesquisa, Hospital Alfa, Recife (PE) Brasil
| | - Mozart Júlio Tabosa Sales
- . Departamento de Ensino e Pesquisa, Instituto de Medicina Integral Professor Fernando Figueira - IMIP - Recife (PE) Brasil
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Lemke VG, Paiva MSS, Mariano GZ, Alves TS, Ferreira E, Nunes LA, Oliveira FRA, Cantarelli R, do Nascimento EM, de Oliveira GMM. Brazilian Registry of Interventional Cardiology during the COVID-19 Pandemic (RBCI-COVID19). Arq Bras Cardiol 2023; 120:e20220840. [PMID: 37672473 PMCID: PMC10519241 DOI: 10.36660/abc.20220840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/08/2023] [Accepted: 05/17/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND At the beginning of the COVID-19 pandemic, patients with myocardial infarction (MI) took longer to present to hospitals because of fear of contamination and health care access difficulties. OBJECTIVES To assess interventional cardiology procedures performed during the COVID-19 pandemic and its implications for MI approach. METHODS Prospective registry of 24 cardiac catheterization laboratories in Brazil, with adult patients undergoing interventional cardiology procedures between May 26 and November 30, 2020. The outcomes were cardiovascular (CV) and non-CV complications, death, and MI. Concomitant COVID-19 was confirmed using RT-PCR. Machine learning techniques were used with nonparametric Classification Trees models, and Simple Correspondence Analysis, with R statistical software package. Significance level adopted of 5%. RESULTS This study included 1282 patients, 435 of whom (33.9%) had MI as follows: ST-segment elevation MI (STEMI), 239 (54.9%); and non-ST-segment elevation MI (NSTEMI), 196 (45.1%). Of the 1282 patients, 29 had CV complications, 47 had non-CV complications, and 31 died. The diagnosis of COVID-19 was confirmed in 77 patients (6%), with 15.58% mortality and non-CV complications in 6.49%. Most patients had significant coronary artery disease (63%), and an intracoronary thrombus was more often found in the presence of STEMI (3.4%) and COVID-19 (4%). A door-to-table time longer than 12 hours in NSTEMI was associated with 30.8% of complications, 25% in COVID-19 patients. CONCLUSIONS All deaths were preceded by CV or non-CV complications. The presence of COVID-19 was associated with death and non-fatal complications of patients undergoing interventional cardiology procedures during the pandemic.
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Affiliation(s)
| | - Maria Sanali Souza Paiva
- Hospital Universitário Onofre LopesNatalRNBrasilHospital Universitário Onofre Lopes – HUOL, Natal, RN – Brasil
| | | | - Thales Siqueira Alves
- Hospital Universitário Pedro ErnestoRio de JaneiroRJBrasilHospital Universitário Pedro Ernesto, Rio de Janeiro, RJ – Brasil
| | - Esmeralci Ferreira
- Universidade do Estado do Rio de JaneiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro – Doenças do Tórax, Rio de Janeiro, RJ – Brasil
| | - Leonardo Avany Nunes
- Hospital São João BatistaCriciúmaSCBrasilHospital São João Batista, Criciúma, SC – Brasil
| | | | - Rodrigo Cantarelli
- Universidade do Estado do Rio de JaneiroRio de JaneitoRJBrasilUniversidade do Estado do Rio de Janeiro, Rio de Janeito, RJ – Brasil
| | - Emilia Matos do Nascimento
- Universidade do Estado do Rio de JaneiroRio de JaneitoRJBrasilUniversidade do Estado do Rio de Janeiro, Rio de Janeito, RJ – Brasil
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da Silva NS, de Araújo NK, Dos Santos KA, de Souza KSC, de Araújo JNG, Cruz MS, Parra EJ, Silbiger VN, Luchessi AD. Post-Covid condition and clinic characteristics associated with SARS-CoV-2 infection: a 2-year follow-up to Brazilian cases. Sci Rep 2023; 13:13973. [PMID: 37633999 PMCID: PMC10460396 DOI: 10.1038/s41598-023-40586-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/13/2023] [Indexed: 08/28/2023] Open
Abstract
Until January 2023, Brazil recorded 37 million COVID-19 cases despite the decrease in mortality due to mass vaccination efforts against COVID-19. The infection continues to challenge researchers and health professionals with the persistent symptoms and onset manifestations after the acute phase of the disease, namely Post-Covid Condition (PCC). Being one of the countries with the highest infection rate, Brazil must prepare for a growing number of patients with chronic health consequences of COVID-19. Longitudinal studies that follow patients over extended periods are crucial in understanding the long-term impacts of COVID-19, including potential health consequences and the effects on quality of life. We describe the clinical profile of a cohort of COVID-19 patients infected during the first year of the pandemic in Brazil and a follow-up after two years to investigate the health impacts of SARS-CoV-2 infection. The first wave of SARS-CoV-2 infection in Brazil featured extensive drug misuse, notably the ineffective COVID kit comprised of ivermectin, antimalarials and azithromycin, and elevated in-hospital mortality. In the second phase of the study, Post-Covid Condition was reported by symptomatic COVID-19 subjects across different severity levels two years after infection. Long haulers are more likely to be women, previously hospitalized, and reported a range of symptoms from muscle pain to cognitive deficit. Our longitudinal study is essential to inform public health authorities to develop strategies and policies to control the spread of the virus and mitigate its impacts on society.
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Affiliation(s)
- Nayara Sousa da Silva
- Northeast Biotechnology Network (RENORBIO), Graduate Program in Biotechnology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Nathália Kelly de Araújo
- Graduate Program of Health and Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Biological Sciences, Federal Institute of Rondônia, Guajará-Mirim, Brazil
| | - Katiusse Alves Dos Santos
- Graduate Program of Pharmaceutical Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Jéssica Nayara Góes de Araújo
- Northeast Biotechnology Network (RENORBIO), Graduate Program in Biotechnology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Marina Sampaio Cruz
- Graduate Program of Health and Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Division of Cardiology, Department of Medicine, UC San Diego, San Diego, CA, USA
| | - Esteban J Parra
- Department of Anthropology, University of Toronto at Mississauga, Mississauga, ON, Canada
| | - Vivian Nogueira Silbiger
- Northeast Biotechnology Network (RENORBIO), Graduate Program in Biotechnology, Federal University of Rio Grande do Norte, Natal, Brazil.
- Graduate Program of Pharmaceutical Sciences, Federal University of Rio Grande do Norte, Natal, Brazil.
- Department of Clinical and Toxicology Analysis, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, 384, Natal, RN, 59012-570, Brazil.
| | - André Ducati Luchessi
- Northeast Biotechnology Network (RENORBIO), Graduate Program in Biotechnology, Federal University of Rio Grande do Norte, Natal, Brazil
- Graduate Program of Health and Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Graduate Program of Pharmaceutical Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Clinical and Toxicology Analysis, Federal University of Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, 384, Natal, RN, 59012-570, Brazil
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Sunahara AS, Pessa AAB, Perc M, Ribeiro HV. Complexity of the COVID-19 pandemic in Maringá. Sci Rep 2023; 13:12695. [PMID: 37542059 PMCID: PMC10403588 DOI: 10.1038/s41598-023-39815-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/28/2023] [Indexed: 08/06/2023] Open
Abstract
While extensive literature exists on the COVID-19 pandemic at regional and national levels, understanding its dynamics and consequences at the city level remains limited. This study investigates the pandemic in Maringá, a medium-sized city in Brazil's South Region, using data obtained by actively monitoring the disease from March 2020 to June 2022. Despite prompt and robust interventions, COVID-19 cases increased exponentially during the early spread of COVID-19, with a reproduction number lower than that observed during the initial outbreak in Wuhan. Our research demonstrates the remarkable impact of non-pharmaceutical interventions on both mobility and pandemic indicators, particularly during the onset and the most severe phases of the emergency. However, our results suggest that the city's measures were primarily reactive rather than proactive. Maringá faced six waves of cases, with the third and fourth waves being the deadliest, responsible for over two-thirds of all deaths and overwhelming the local healthcare system. Excess mortality during this period exceeded deaths attributed to COVID-19, indicating that the burdened healthcare system may have contributed to increased mortality from other causes. By the end of the fourth wave, nearly three-quarters of the city's population had received two vaccine doses, significantly decreasing deaths despite the surge caused by the Omicron variant. Finally, we compare these findings with the national context and other similarly sized cities, highlighting substantial heterogeneities in the spread and impact of the disease.
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Affiliation(s)
- Andre S Sunahara
- Departamento de Física, Universidade Estadual de Maringá, Maringá, PR, 87020-900, Brazil
| | - Arthur A B Pessa
- Departamento de Física, Universidade Estadual de Maringá, Maringá, PR, 87020-900, Brazil
| | - Matjaž Perc
- Faculty of Natural Sciences and Mathematics, University of Maribor, Koroška cesta 160, 2000, Maribor, Slovenia.
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
- Alma Mater Europaea, Slovenska ulica 17, 2000, Maribor, Slovenia.
- Department of Physics, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea.
- Complexity Science Hub Vienna, Josefstädterstraße 39, 1080, Vienna, Austria.
| | - Haroldo V Ribeiro
- Departamento de Física, Universidade Estadual de Maringá, Maringá, PR, 87020-900, Brazil.
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Rocha Tardelli N, Neves Forte D, de Oliveira Vidal EI. Advance Care Planning in Brazil. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 180:43-49. [PMID: 37380546 DOI: 10.1016/j.zefq.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/10/2023] [Accepted: 04/18/2023] [Indexed: 06/30/2023]
Abstract
Brazil is a country of continental size marked by extreme social inequalities. Its regulation of Advance Directives (AD) was not enacted by law but within the scope of the norms that govern the relationships between patients and physicians, as a resolution of the Federal Medical Council without any specific requirement for notarization. Despite this innovative starting point, most of the debate regarding Advance Care Planning (ACP) in Brazil has been dominated by a legal transactional approach focused on making decisions in advance and the creation of AD. Yet, other novel ACP models have recently emerged in the country with a focus on the creation of a specific quality of relationship between patients, families, and physicians aiming at the facilitating future decision-making. Most of the education on ACP in Brazil happens in the context of palliative care courses. As such, most ACP conversations are performed within palliative care services or by healthcare professionals with training in that area. Hence, the scarce access to palliative care services in the country means that ACP is still rare and that those conversations usually happen late in the course of disease. The authors posit that the existing paternalistic healthcare culture is one of the most important barriers to ACP in Brazil and envision with great concern the risk that its combination with extreme health inequalities and the lack of healthcare professionals' education on shared decision-making could lead to the misuse of ACP as a form of coercive practice to reduce healthcare use by vulnerable populations.
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Affiliation(s)
- Natália Rocha Tardelli
- Geriatrics division, Internal Medicine Department, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.
| | - Daniel Neves Forte
- Emergency Department, University of São Paulo (USP) Medical School, São Paulo, Brazil; Research and Teaching Institute, Sírio-Libanês Hospital, São Paulo, Brazil
| | - Edison Iglesias de Oliveira Vidal
- Geriatrics division, Internal Medicine Department, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
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Araújo MSM, Branco MDRFC, Costa SDSB, de Oliveira DC, Queiroz RCDS, de Oliveira BLCA, Pasklan ANP, dos Santos AM. [COVID-19 mortality in metropolitan areas vs. other regions of Brazil, 2020 to 2021Mortalidad por COVID-19 en las regiones metropolitanas y en el interior de Brasil, 2020-2021]. Rev Panam Salud Publica 2023; 47:e115. [PMID: 37489235 PMCID: PMC10361444 DOI: 10.26633/rpsp.2023.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/21/2023] [Indexed: 07/26/2023] Open
Abstract
Objective To compare hospital mortality rates (HMR) due to severe acute respiratory syndrome (SARS) associated with COVID-19 recorded in metropolitan areas and other regions (interior) of Brazil in 2020 and 2021. Method This ecological study used public data available on OpenDataSUS. The information was accessed in May 2022. The following variables were considered: age, sex, hospitalization, presence of a risk factor, ICU stay, use of ventilatory support, and final classification in the individual registration form of SARS cases due to COVID-19. Cases and deaths were stratified into five age groups (0-19 years, 20-39 years, 40-59 years, 60-79 years, and ≥80 years) and by place of residence (metropolitan area or interior). The HMR had as numerator the absolute number of deaths by SARS associated with covid-19; and, as a denominator, the absolute number of cases of SARS due to covid-19 according to the year of occurrence, area of residence, age bracket, sex, hospitalization, presence of a risk factor, ICU admission, and use of ventilatory support. Results There was a significant increase in HMR due to SARS associated with COVID-19 in 2021 in all age groups, except 0-19 years and ≥80 years, as well as among individuals admitted to an ICU and who used invasive ventilatory support, both in metropolitan areas as well as in the interior. Conclusions There was a worsening of the epidemiological scenario in 2021 with an increase in HMR. However, no differences were identified between the metropolitan regions and the interior of the country.
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Affiliation(s)
- Mayra Sharlenne Moraes Araújo
- Universidade Federal do Maranhão (UFMA)Programa de Pós-Graduação em Saúde ColetivaSão Luís (MA)BrasilUniversidade Federal do Maranhão (UFMA), Programa de Pós-Graduação em Saúde Coletiva, São Luís (MA), Brasil.
| | - Maria dos Remédios Freitas Carvalho Branco
- Universidade Federal do Maranhão (UFMA)Programa de Pós-Graduação em Saúde ColetivaSão Luís (MA)BrasilUniversidade Federal do Maranhão (UFMA), Programa de Pós-Graduação em Saúde Coletiva, São Luís (MA), Brasil.
| | - Silmery da Silva Brito Costa
- Universidade Federal do MaranhãoDepartamento de Saúde ColetivaSão Luís (MA)BrasilUniversidade Federal do Maranhão, Departamento de Saúde Coletiva, São Luís (MA), Brasil.
| | - Daniel Cavalcante de Oliveira
- Universidade Federal do ABC (UFABC)Departamento de Engenharia BiomédicaSanto André (SP)BrasilUniversidade Federal do ABC (UFABC), Departamento de Engenharia Biomédica, Santo André (SP), Brasil.
| | - Rejane Christine de Sousa Queiroz
- Universidade Federal do Maranhão (UFMA)Programa de Pós-Graduação em Saúde ColetivaSão Luís (MA)BrasilUniversidade Federal do Maranhão (UFMA), Programa de Pós-Graduação em Saúde Coletiva, São Luís (MA), Brasil.
| | - Bruno Luciano Carneiro Alves de Oliveira
- Universidade Federal do Maranhão (UFMA)Programa de Pós-Graduação em Saúde ColetivaSão Luís (MA)BrasilUniversidade Federal do Maranhão (UFMA), Programa de Pós-Graduação em Saúde Coletiva, São Luís (MA), Brasil.
| | - Amanda Namíbia Pereira Pasklan
- Universidade Federal do MaranhãoDepartamento de MedicinaSão Luís (MA)BrasilUniversidade Federal do Maranhão, Departamento de Medicina, São Luís (MA), Brasil.
| | - Alcione Miranda dos Santos
- Universidade Federal do Maranhão (UFMA)Programa de Pós-Graduação em Saúde ColetivaSão Luís (MA)BrasilUniversidade Federal do Maranhão (UFMA), Programa de Pós-Graduação em Saúde Coletiva, São Luís (MA), Brasil.
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Batista Filho LAC. Critical care in developing nations: what has the COVID-19 pandemic revealed? Pan Afr Med J 2023; 45:123. [PMID: 37790164 PMCID: PMC10543904 DOI: 10.11604/pamj.2023.45.123.40574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/28/2023] [Indexed: 10/05/2023] Open
Abstract
The COVID-19 pandemic has altered the lives of millions of individuals, resulting in over 600 million cases and over 6 million fatalities worldwide. In developing nations, mortality rates for intubated patients with viral pneumonia were as high as 80%, compared to 30% in developed countries. This article intends to discuss the causes of this disparity, focusing on the main problems shared by nations with limited resources.
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Faucheux L, Bassolli de Oliveira Alves L, Chevret S, Rocha V. Comparison of characteristics and laboratory tests of COVID-19 hematological patients from France and Brazil during the pre-vaccination period: identification of prognostic profiles for survival. Hematol Transfus Cell Ther 2023; 45:306-316. [PMID: 35673599 PMCID: PMC9159977 DOI: 10.1016/j.htct.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/29/2022] [Accepted: 05/04/2022] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION COVID-19 disease presentation is heterogeneous, from asymptomatic up to severe life-threatening forms. Getting further insights into patients with specific diseases is of particular interest. We aimed to identify profiles of hematology patients hospitalized with COVID-19 that would be associated with survival and to assess the differences between cohorts METHODS: A binational cohort of 263 patients with COVID-19 and hematological disease was studied in Paris, France and São Paulo, Brazil. Patient profiles were based on age, comorbidities, biological measurements, COVID-19 symptoms and hematological disease characteristics. A semi-supervised learning method with a survival endpoint was first used, following which, a classifier was identified to allow the classification of patients using only baseline information MAIN RESULTS: Two profiles of patients were identified, one being young patients with few comorbidities and low C-reactive protein (CRP), D-dimers, lactate dehydrogenase (LDH) and creatinine levels, and the other, older patients, with several comorbidities and high levels of the 4 biology markers. The profiles were strongly associated with survival (p < 0.0001), even after adjusting for age (p = 0.0002). The 30-day survival rate was 77.1% in the first profiles, versus 46.7% in the second. The Brazilian analysis emphasized the importance of age, while the French focused on the comorbidities CONCLUSION: This analysis showed the importance of CRP, LHD and creatinine in the COVID-19 presentation and prognosis, whatever the geographic origin of the patients.
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Affiliation(s)
- Lilith Faucheux
- Hôpital Saint Louis, Université de Paris, Paris, France; Université de Paris, INSERM U976, Paris, France.
| | | | | | - Vanderson Rocha
- Hospital das Clinicas, Faculty of Medicine, Universidade de São Paulo (HCFM-USP), São Paulo, SP, Brazil; Churchill Hospital, Oxford University, Oxford, UK
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Pescarini JM, Cardoso AM, Santos RV, Scaff PF, Paixao ES, Ranzani OT, Cerqueira-Silva T, Boaventura VS, Bertoldo-Junior J, de Oliveira VA, Werneck GL, Barreto ML, Barral-Netto M. Vaccine coverage and effectiveness against laboratory-confirmed symptomatic and severe Covid-19 in indigenous people in Brazil: a cohort study. BMC Public Health 2023; 23:1267. [PMID: 37386490 PMCID: PMC10311776 DOI: 10.1186/s12889-023-16196-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/27/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Indigenous people have historically suffered devastating impacts from epidemics and continue to have lower access to healthcare and be especially vulnerable to respiratory infections. We estimated the coverage and effectiveness of Covid-19 vaccines against laboratory-confirmed Covid-19 cases among indigenous people in Brazil. METHODS We linked nationwide Covid-19 vaccination data with flu-like surveillance records and studied a cohort of vaccinated indigenous people aged ≥ 5 years between 18th January 2021 and 1st March 2022. We considered individuals unexposed from the date they received the first dose of vaccine until the 13th day of vaccination, partially vaccinated from the 14th day after the first dose until the 13th day after receiving the second dose, and fully vaccinated onwards. We estimated the Covid-19 vaccination coverage and used Poisson regression to calculate the relative risks (RR) and vaccine effectiveness (VE) of CoronaVac, ChAdOx1, and BNT162b2 against Covid-19 laboratory-confirmed cases incidence, mortality, hospitalisation, and hospital-progression to Intensive Care Unit (ICU) or death. VE was estimated as (1-RR)*100, comparing unexposed to partially or fully vaccinated. RESULTS By 1st March 2022, 48.7% (35.0-62.3) of eligible indigenous people vs. 74.8% (57.9-91.8) overall Brazilians had been fully vaccinated for Covid-19. Among fully vaccinated indigenous people, we found a lower risk of symptomatic cases (RR: 0.47, 95%CI: 0.40-0.56) and mortality (RR: 0.47, 95%CI: 0.14-1.56) after the 14th day of the second dose. VE for the three Covid-19 vaccines combined was 53% (95%CI:44-60%) for symptomatic cases, 53% (95%CI:-56-86%) for mortality and 41% (95%CI:-35-75%) for hospitalisation. In our sample, we found that vaccination did not reduce Covid-19 related hospitalisation. However, among hospitalised patients, we found a lower risk of progression to ICU (RR: 0.14, 95%CI: 0.02-0.81; VE: 87%, 95%CI:27-98%) and Covid-19 death (RR: 0.04, 95%CI:0.01-0.10; VE: 96%, 95%CI: 90-99%) after the 14th day of the second dose. CONCLUSIONS Lower coverage but similar Covid-19 VE among indigenous people than overall Brazilians suggest the need to expand access, timely vaccination, and urgently offer booster doses to achieve a great level of protection among this group.
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Affiliation(s)
- Julia M Pescarini
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz, Salvador, BA, Brazil.
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Andrey M Cardoso
- Escola Nacional de Saúde Pública (ENSP), Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
| | - Ricardo Ventura Santos
- Escola Nacional de Saúde Pública (ENSP), Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
- Museu Nacional, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Priscila F Scaff
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz, Salvador, BA, Brazil
| | - Enny S Paixao
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz, Salvador, BA, Brazil
- London School of Hygiene and Tropical Medicine, London, UK
| | - Otavio T Ranzani
- Barcelona Institute for Global Health, Universitat Pompeu Fabra (UPF), CIBER Epidemiología y Salud Pública (CIBERESP), ISGlobal, Barcelona, Spain
- Pulmonary Division, Heart Institute, Faculty of Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thiago Cerqueira-Silva
- Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
- LIB and LEITV Laboratories, Instituto Gonçalo Moniz, Fiocruz, Salvador, BA, Brazil
| | - Viviane S Boaventura
- Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
- LIB and LEITV Laboratories, Instituto Gonçalo Moniz, Fiocruz, Salvador, BA, Brazil
| | - Juracy Bertoldo-Junior
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz, Salvador, BA, Brazil
- Barcelona Institute for Global Health, Universitat Pompeu Fabra (UPF), CIBER Epidemiología y Salud Pública (CIBERESP), ISGlobal, Barcelona, Spain
- Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Vinicius A de Oliveira
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz, Salvador, BA, Brazil
- Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
- LIB and LEITV Laboratories, Instituto Gonçalo Moniz, Fiocruz, Salvador, BA, Brazil
| | - Guilherme L Werneck
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Mauricio L Barreto
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz, Salvador, BA, Brazil
| | - Manoel Barral-Netto
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz, Salvador, BA, Brazil
- Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
- LIB and LEITV Laboratories, Instituto Gonçalo Moniz, Fiocruz, Salvador, BA, Brazil
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Kaul V, Chahal J, Schrarstzhaupt IN, Geduld H, Shen Y, Cecconi M, Siqueira AM, Markoski MM, Kawano-Dourado L. Lessons Learned from a Global Perspective of Coronavirus Disease-2019. Clin Chest Med 2023; 44:435-449. [PMID: 37085231 PMCID: PMC9684102 DOI: 10.1016/j.ccm.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Coronavirus disease-2019 has impacted the world globally. Countries and health care organizations across the globe responded to this unprecedented public health crisis in a varied manner in terms of public health and social measures, vaccination development and rollout, the conduct of research, developments of therapeutics, sharing of information, and in how they continue to deal with the widespread aftermath. This article reviews the various elements of the global response to the pandemic, focusing on the lessons learned and strategies to consider during future pandemics.
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Affiliation(s)
- Viren Kaul
- Department of Pulmonary and Critical Care Medicine, Crouse Health/Upstate Medical University, 736 Irving Avenue, Syracuse, NY, 13210, USA
| | - Japjot Chahal
- Department of Pulmonary and Critical Care Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - Isaac N Schrarstzhaupt
- Capixaba Institute of Health Education, Research and Innovation (ICEPi), Rua Duque de Caxias, 267 - Centro, Vitória/ES, 29010-120, Brazil
| | - Heike Geduld
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Room 5006 Clinical Building, Stellenbosch University Tygerberg Campus, Cape Town 7505, South Africa
| | - Yinzhong Shen
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care, IRCCS Instituto Clinico Humanitas, Via Manzoni 56, Rozzano (Milano), Italy
| | - Andre M Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, CEP 21040-900, Rio de Janeiro RJ Brazil
| | - Melissa M Markoski
- UFCSPA - Federal University of Health Sciences of Porto Alegre. Sarmento Leite, 245 - Centro Histórico, Porto Alegre - RS, 90050-170, Brazil
| | - Leticia Kawano-Dourado
- Hcor Research Institute, Hospital do Coracao, R. Des Eliseu Guilherme, 200, 8o andar, Sao Paulo, SP 04004-030, Brazil; Pulmonary Division, InCor, University of Sao Paulo.
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Sejópoles MD, Souza-Silva JP, Silva-Santos C, Paula-Duarte MM, Fontes CJ, Gomes LT. Prognostic value of neutrophil and lymphocyte counts and neutrophil/lymphocyte ratio for predicting death in patients hospitalized for COVID-19. Heliyon 2023; 9:e16964. [PMID: 37292322 PMCID: PMC10238120 DOI: 10.1016/j.heliyon.2023.e16964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/25/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023] Open
Abstract
COVID-19 primarily affects the respiratory system and can cause changes in other systems. Early identification of patients with a higher potential for complications is critical to provide the best possible treatment to reduce the disease's lethality. This study aimed to analyze the behavior of hematologic biomarkers in predicting mortality in patients hospitalized with COVID-19. This retrospective cohort study used data from the medical records of patients hospitalized with COVID-19 between March and August 2020 in two referral hospitals for treatment of the disease in the city of Cuiabá (in the state of Mato Grosso, Brazil). Clinical and laboratory characteristics related to cardiovascular involvement and death during hospitalization were evaluated. Neutrophils, lymphocytes, and monocytes, as well as the neutrophil-to-lymphocyte ratio (NLR) and the monocyte-to-lymphocyte ratio (MRL), were used as potential biomarkers of death. A total of 199 patients were included (male: 113; mean age: 51.4 years). Leukocyte, neutrophil, and lymphocyte counts showed a statistically significant association with death, as did NLR and MRL. Satisfactory accuracy in predicting death was observed for leukocyte, neutrophil, lymphocyte, NLR, and MLR counts. The hematologic biomarkers studied may be useful for prognosticating hospitalized patients for the possibility of death from COVID-19.
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Affiliation(s)
- Marcia D Sejópoles
- Julio Müller School Hospital, Federal University of Mato Grosso. Rua Dr Luis P Pereira Leite Sn, Cuiabá (MT), Brazil
| | - João P Souza-Silva
- Julio Müller School Hospital, Federal University of Mato Grosso. Rua Dr Luis P Pereira Leite Sn, Cuiabá (MT), Brazil
- Faculty of Medicine. Post-Graduation in Health Sciences, Federal University of Mato Grosso, Av Fernando Correa da Costa, 2367, Cuiabá (MT), Brazil
| | - Cristiane Silva-Santos
- Julio Müller School Hospital, Federal University of Mato Grosso. Rua Dr Luis P Pereira Leite Sn, Cuiabá (MT), Brazil
- Faculty of Medicine. Post-Graduation in Health Sciences, Federal University of Mato Grosso, Av Fernando Correa da Costa, 2367, Cuiabá (MT), Brazil
| | - Matheus M Paula-Duarte
- Julio Müller School Hospital, Federal University of Mato Grosso. Rua Dr Luis P Pereira Leite Sn, Cuiabá (MT), Brazil
- Faculty of Medicine. Post-Graduation in Health Sciences, Federal University of Mato Grosso, Av Fernando Correa da Costa, 2367, Cuiabá (MT), Brazil
| | - Cor Jf Fontes
- Julio Müller School Hospital, Federal University of Mato Grosso. Rua Dr Luis P Pereira Leite Sn, Cuiabá (MT), Brazil
- Faculty of Medicine. Post-Graduation in Health Sciences, Federal University of Mato Grosso, Av Fernando Correa da Costa, 2367, Cuiabá (MT), Brazil
| | - Luciano T Gomes
- Julio Müller School Hospital, Federal University of Mato Grosso. Rua Dr Luis P Pereira Leite Sn, Cuiabá (MT), Brazil
- Faculty of Medicine. Post-Graduation in Health Sciences, Federal University of Mato Grosso, Av Fernando Correa da Costa, 2367, Cuiabá (MT), Brazil
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Scudeller PG, Lamas CDA, Alvarenga AM, Garcia ML, Amaral TF, de Oliveira MR, de Macedo BR, Testa CB, Baptista FS, Francisco RPV, de Carvalho CRR. Tele-Intensive Care Unit Program in Brazil: Implementation and Expansion. TELEMEDICINE REPORTS 2023; 4:109-117. [PMID: 37283854 PMCID: PMC10240323 DOI: 10.1089/tmr.2023.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 06/08/2023]
Abstract
In this scientific report, we aimed to describe the implementation and expansion of a Tele-Intensive Care Unit (Tele-ICU) program in Brazil, highlighting the pillars of success, improvements, and perspectives. Tele-ICU program emerged during the COVID-19 pandemic at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), focusing on clinical case discussions and training of health practitioners in public hospitals of the state of São Paulo in Brazil, to support health care professionals for treating COVID-19 patients. The success of implementing this initiative endorsed the project expansion to other five hospitals from different macroregions of the country, leading to the Tele-ICU-Brazil. These projects assisted 40 hospitals, allowing more than 11,500 teleinterconsultations (exchange of medical information between health care professionals using a licensed online platform) and training more than 14,800 health care professionals, reducing mortality and length of hospitalized patients. A segment in telehealth for the obstetrics health care was implemented after detecting these were a susceptible group of patients to COVID-19 severity. As a perspective, this segment will be expanded to 27 hospitals in the country. The Tele-ICU projects reported here were the largest digital health ICU programs ever established in Brazilian National Health System until know. Their results were unprecedented and proved to be crucial for supporting health care professionals nationwide during the COVID-19 pandemic and guide future initiatives in digital health in Brazil's National Health System.
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Affiliation(s)
- Paula Gobi Scudeller
- Digital Health, Technological Innovation Hub (InovaHC); Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Pulmonary Division, Heart Institute (InCor); Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Celina de Almeida Lamas
- Digital Health, Technological Innovation Hub (InovaHC); Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Pulmonary Division, Heart Institute (InCor); Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Aline Morgan Alvarenga
- Digital Health, Technological Innovation Hub (InovaHC); Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Pulmonary Division, Heart Institute (InCor); Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Michelle Louvaes Garcia
- Digital Health, Technological Innovation Hub (InovaHC); Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Pulmonary Division, Heart Institute (InCor); Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Talita Freitas Amaral
- Digital Health, Technological Innovation Hub (InovaHC); Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Pulmonary Division, Heart Institute (InCor); Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Martina Rodrigues de Oliveira
- Digital Health, Technological Innovation Hub (InovaHC); Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Pulmonary Division, Heart Institute (InCor); Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Bruno Rocha de Macedo
- Digital Health, Technological Innovation Hub (InovaHC); Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Pulmonary Division, Heart Institute (InCor); Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Carolina Burgarelli Testa
- Department of Obstetrics and Gynecology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Fernanda Spadotto Baptista
- Department of Obstetrics and Gynecology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Department of Obstetrics and Gynecology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Carlos Roberto Ribeiro de Carvalho
- Digital Health, Technological Innovation Hub (InovaHC); Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Pulmonary Division, Heart Institute (InCor); Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Nienkotter B, Gambetta MV, Rocha FRD, Medeiros ED, Schweitzer I, Prado F, Deschamps PSDS. Analysis of possible risk predictors in patients with coronavirus disease 2019: a retrospective cohort study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20220917. [PMID: 37222314 DOI: 10.1590/1806-9282.20220917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This study aimed to analyze the clinical-epidemiological profile, possible risk predictors, and outcomes of patients with coronavirus disease 2019 admitted to the ward of a tertiary care hospital in southern Brazil. Specifically, we describe the demographic characteristics, comorbidities, baseline laboratory findings, clinical course, and survival of these patients. METHODS This is an observational, retrospective cohort study, performed from January to March 2022, on medical records of patients hospitalized between April 2020 and December 2021 in the coronavirus disease 2019 ward of a tertiary hospital in southern Brazil. RESULTS Data from 502 hospitalized patients were analyzed, of which 60.2% were male, with a median age of 56 years and 31.7% were over 65 years old. The main symptoms presented were dyspnea/respiratory discomfort (69.9%) and cough (63.1%). The most common comorbidities were obesity, systemic arterial hypertension, and diabetes mellitus. A proportion of 55.8% of 493 patients had PaO2/FiO2<300 mmHg in the first examination performed after admission and 46.0% had a neutrophil/lymphocyte ratio>6.8. Oxygen therapy by Venturi mask or mask with reservoir was used in 34.7% of the patients, and non-invasive ventilation was used in 10.0% of the patients. The majority of the patients (98.4%) used corticosteroids, and the outcome of 82.5% of the hospitalized patients was home discharge. CONCLUSION After analyzing the clinical and epidemiological profile, it can be concluded that age greater than 65 years and pulmonary involvement >50% are predictors of a worse prognosis for coronavirus disease 2019, as is the need for high-flow oxygen therapy. Corticotherapy, however, proved to be beneficial in the treatment of the disease.
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Affiliation(s)
- Beatriz Nienkotter
- Centro Universitário para o Desenvolvimento do Alto Vale do Itajaí, Núcleo de Pesquisa em Ciências Médicas: Investigações em Saúde, Faculdade de Medicina - Rio do Sul (SC), Brazil
| | - Marcelo Vier Gambetta
- Centro Universitário para o Desenvolvimento do Alto Vale do Itajaí, Núcleo de Pesquisa em Ciências Médicas: Investigações em Saúde, Faculdade de Medicina - Rio do Sul (SC), Brazil
| | - Franciani Rodrigues da Rocha
- Centro Universitário para o Desenvolvimento do Alto Vale do Itajaí, Núcleo de Pesquisa em Ciências Médicas: Investigações em Saúde, Faculdade de Medicina - Rio do Sul (SC), Brazil
| | - Erick Dieter Medeiros
- Centro Universitário para o Desenvolvimento do Alto Vale do Itajaí, Núcleo de Pesquisa em Ciências Médicas: Investigações em Saúde, Faculdade de Medicina - Rio do Sul (SC), Brazil
| | - Israel Schweitzer
- Centro Universitário para o Desenvolvimento do Alto Vale do Itajaí, Núcleo de Pesquisa em Ciências Médicas: Investigações em Saúde, Faculdade de Medicina - Rio do Sul (SC), Brazil
| | - Fernanda Prado
- Centro Universitário para o Desenvolvimento do Alto Vale do Itajaí, Núcleo de Pesquisa em Ciências Médicas: Investigações em Saúde, Faculdade de Medicina - Rio do Sul (SC), Brazil
| | - Paulo Sergio da Silva Deschamps
- Centro Universitário para o Desenvolvimento do Alto Vale do Itajaí, Núcleo de Pesquisa em Ciências Médicas: Investigações em Saúde, Faculdade de Medicina - Rio do Sul (SC), Brazil
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Lovison OA, Grigaitė R, Volpato FCZ, Iles JK, Lacey J, Barreto F, Pandiri SR, Balzan LDLR, Cantarelli VV, Barth AL, Iles RK, Martins AF. Validation of a MALDI-TOF MS Method for SARS-CoV-2 Detection on the Bruker Biotyper and Nasopharyngeal Swabs: A Brazil-UK Collaborative Study. Diagnostics (Basel) 2023; 13:diagnostics13081470. [PMID: 37189571 DOI: 10.3390/diagnostics13081470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 05/17/2023] Open
Abstract
We developed a MALDI-TOF mass spectrometry method for the detection of the SARS-CoV-2 virus in saliva-gargle samples using Shimadzu MALDI-TOF mass spectrometers in the UK. This was validated in the USA to CLIA-LDT standards for asymptomatic infection detection remotely via sharing protocols, shipping key reagents, video conferencing, and data exchange. In Brazil, more so than in the UK and USA, there is a need to develop non-PCR-dependent, rapid, and affordable SARS-CoV-2 infection screening tests that also identify variant SARS-CoV-2 and other virus infections. In addition, travel restrictions necessitated remote collaboration with validation on the available clinical MALDI-TOF-the Bruker Biotyper (microflex® LT/SH)-and on nasopharyngeal swab samples, as salivary gargle samples were not available. The Bruker Biotyper was shown to be almost log103 more sensitive at the detection of high molecular weight spike proteins. A protocol for saline swab soaks out was developed, and duplicate swab samples collected in Brazil were analyzed by MALDI-TOF MS. The swab collected sample spectra that varied from that of saliva-gargle in three additional mass peaks in the mass region expected for IgG heavy chains and human serum albumin. A subset of clinical samples with additional high mass, probably spike-related proteins, were also found. Further, spectral data comparisons and analysis, subjected to machine learning algorithms in order to resolve RT-qPCR positive from RT-qPCR negative swab samples, showed 56-62% sensitivity, 87-91% specificity, and a 78% agreement with RT-qPCR scoring for SARS-CoV-2 infection.
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Affiliation(s)
- Otávio A Lovison
- Laboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, RS, Brazil
- Núcleo de Bioinformática (Bioinformatics Core), Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, RS, Brazil
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul, Porto Alegre 90160-093, RS, Brazil
| | | | - Fabiana C Z Volpato
- Laboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, RS, Brazil
| | - Jason K Iles
- Map Sciences Ltd., The iLab, Priory Park, Bedford MK44 3RZ, UK
| | - Jon Lacey
- Map Sciences Ltd., The iLab, Priory Park, Bedford MK44 3RZ, UK
| | - Fabiano Barreto
- Laboratório Federal de Defesa Agropecuária, Porto Alegre 91780-580, RS, Brazil
| | - Sai R Pandiri
- Map Sciences Ltd., The iLab, Priory Park, Bedford MK44 3RZ, UK
| | | | - Vlademir V Cantarelli
- Departamento de Ciências Básicas da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90050-170, RS, Brazil
| | - Afonso Luis Barth
- Laboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, RS, Brazil
| | - Ray K Iles
- Map Sciences Ltd., The iLab, Priory Park, Bedford MK44 3RZ, UK
| | - Andreza F Martins
- Laboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, RS, Brazil
- Núcleo de Bioinformática (Bioinformatics Core), Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, RS, Brazil
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul, Porto Alegre 90160-093, RS, Brazil
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Passarelli-Araujo H, Passarelli-Araujo H, Pescim RR, Olak AS, Susuki AM, Tomimatsu MFAI, Volce CJ, Neves MAZ, Silva FF, Narciso SG, Paoliello MMB, Pott-Junior H, Urbano MR. Probabilistic survival modeling in health research: an assessment using cohort data from hospitalized patients with COVID-19 in a Latin American city. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2023; 86:217-229. [PMID: 36809963 DOI: 10.1080/15287394.2023.2181249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Probabilistic survival methods have been used in health research to analyze risk factors and adverse health outcomes associated with COVID-19. The aim of this study was to employ a probabilistic model selected among three distributions (exponential, Weibull, and lognormal) to investigate the time from hospitalization to death and determine the mortality risks among hospitalized patients with COVID-19. A retrospective cohort study was conducted for patients hospitalized due to COVID-19 within 30 days in Londrina, Brazil, between January 2021 and February 2022, registered in the database for severe acute respiratory infections (SIVEP-Gripe). Graphical and Akaike Information Criterion (AIC) methods were used to compare the efficiency of the three probabilistic models. The results from the final model were presented as hazard and event time ratios. Our study comprised of 7,684 individuals, with an overall case fatality rate of 32.78%. Data suggested that older age, male sex, severe comorbidity score, intensive care unit admission, and invasive ventilation significantly increased risks for in-hospital mortality. Our study highlights the conditions that confer higher risks for adverse clinical outcomes attributed to COVID-19. The step-by-step process for selecting appropriate probabilistic models may be extended to other investigations in health research to provide more reliable evidence on this topic.
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Affiliation(s)
| | - Hemanoel Passarelli-Araujo
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Rodrigo R Pescim
- Department of Statistics, State University of Londrina, Londrina, Brazil
| | - André S Olak
- Department of Architecture and Urbanism, State University of Londrina, Londrina, Brazil
| | - Aline M Susuki
- Department of Architecture and Urbanism, State University of Londrina, Londrina, Brazil
| | | | - Cilio J Volce
- Health Department of Londrina, Prefeitura de Londrina, Londrina, Brazil
| | - Maria A Z Neves
- Health Department of Londrina, Prefeitura de Londrina, Londrina, Brazil
| | - Fernanda F Silva
- Health Department of Londrina, Prefeitura de Londrina, Londrina, Brazil
| | - Simone G Narciso
- Health Department of Londrina, Prefeitura de Londrina, Londrina, Brazil
| | - Monica M B Paoliello
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, New York, USA
| | - Henrique Pott-Junior
- Department of Medicine, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Mariana R Urbano
- Department of Statistics, State University of Londrina, Londrina, Brazil
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Fernandes NF, Costa IF, Pereira KN, de Carvalho JAM, Paniz C. Hematological ratios in coronavirus disease 2019 patients with and without invasive mechanical ventilation. J Investig Med 2023; 71:321-328. [PMID: 36680362 DOI: 10.1177/10815589221149189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patients with the most severe form of coronavirus disease 2019 (COVID-19) often require invasive ventilation. Determining the best moment to intubate a COVID-19 patient is complex decision and can result in important consequences for the patient. Therefore, markers that could aid in clinical decision-making such as hematological indices are highly useful. These markers are easy to calculate, do not generate extra costs for the laboratory, and are readily implemented in routine practice. Thus, this study aimed to investigate differences in the ratios calculated from the hemogram between patients with and without the need for invasive mechanical ventilation (IMV) and a control group. This was an observational retrospective analysis of 212 patients with COVID-19 that were hospitalized between April 1, 2020 and March 31, 2021 who were stratified as IMV (n = 129) or did not require invasive mechanical ventilation (NIMV) (n = 83). A control group of 198 healthy individuals was also included. From the first hemogram of each patient performed after admission, the neutrophil-to-lymphocyte ratio (NLR), the derived NLR (d-NLR), the lymphocyte-to-monocyte ratio, the platelet-to-lymphocyte ratio, the neutrophil-to-platelet ratio (NPR), and the systemic immune-inflammation index (SII) were calculated. All hematological ratios exhibited significant differences between the control group and COVID-19 patients. NLR, d-NLR, SII, and NPR were higher in the IMV group than they were in the NIMV group. The hematological indices addressed in this study demonstrated high potential for use as auxiliaries in clinical decision-making regarding the need for IMV.
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Affiliation(s)
- Natieli Flores Fernandes
- Departamento de Análises Clínicas e Toxicológicas, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | - Isabella Ferreira Costa
- Departamento de Análises Clínicas e Toxicológicas, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | - Karla Nunes Pereira
- Departamento de Análises Clínicas e Toxicológicas, Universidade Federal de Santa Maria, Santa Maria, Brazil
- Laboratório de Análises Clínicas, Hospital Universitário, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | - José Antonio Mainardi de Carvalho
- Departamento de Análises Clínicas e Toxicológicas, Universidade Federal de Santa Maria, Santa Maria, Brazil
- Laboratório de Análises Clínicas, Hospital Universitário, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | - Clóvis Paniz
- Departamento de Análises Clínicas e Toxicológicas, Universidade Federal de Santa Maria, Santa Maria, Brazil
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Teixeira C. High mortality in Brazilian intensive care units can be a problem of laws rather than a technical one: focus on sedation practices. CRITICAL CARE SCIENCE 2023; 35:230-232. [PMID: 37712814 PMCID: PMC10406400 DOI: 10.5935/2965-2774.20230337-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/10/2022] [Indexed: 09/16/2023]
Affiliation(s)
- Cassiano Teixeira
- Department of Internal Medicine and Rehabilitation, Universidade
Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS),
Brazil
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50
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Oliveira MCL, Simões E Silva AC, Colosimo EA, Campos MK, Martelli-Júnior H, Silva LR, Pinhati CC, Mak RH, Oliveira EA. Clinical Impact and Risk Factors of Mortality in Hospitalized Children and Adolescents With Hematologic Diseases and COVID-19: An Observational Retrospective Cohort Study. J Pediatr Hematol Oncol 2023; 45:e315-e322. [PMID: 36044328 DOI: 10.1097/mph.0000000000002532] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022]
Abstract
This study aimed to evaluate the risk factors for COVID-19-related death in a large cohort of hospitalized children with hematological disorders. We performed an analysis of all pediatric patients with COVID-19 registered in a Brazilian nationwide surveillance database between February 2020 and May 2021. The primary outcome was time to death, which was evaluated considering discharge as a competitive risk by using the cumulative incidence function. Among 21,591 hospitalized pediatric patients with COVID-19, 596 cases (2.8%) had hematological diseases. Sixty-one children (27.4%) with malignant hematological diseases had a fatal outcome as compared with 4.2% and 7.4% of nonmalignant hematological and nonhematological cohorts, respectively ( P <0.0001). Children with hematological diseases had a significant increased hazard of death compared with those without these conditions (hazard ratio [HR],=2.40, 95% confidence interval, 1.98 - 2.91). In multivariable analysis, the factors associated with death were the presence of malignant hematological disease (HR, 2.22, 95% CI 1.47 - 3.36), age >10 years (HR 2.19, 95% CI 1.46 - 3.19), male (HR 1.52, 95% CI 1.02 - 2.27), oxygen saturation <95% (HR 2.02, 95% CI 1.38 - 2.96), and abdominal pain at admission (HR 2.75, 95% CI 1.76 - 4.27). Children with malignant hematological diseases had a higher risk of death compared with those without these disorders.
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Affiliation(s)
| | | | | | | | - Hercílio Martelli-Júnior
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros (Unimontes), Montes Claros
| | - Ludmila R Silva
- Health Science/Postgraduate Program in Nursing. School of Nursing, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Clara C Pinhati
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
| | - Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital, University of California, San Diego, La Jolla, CA
| | - Eduardo A Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine
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