Evaluation of oxidative stress level: reactive oxygen species, reduced glutathione, and D-dimer in patients hospitalized due to COVID-19

Elevated D-dimer levels at hospital admission may also indicate a higher likelihood of progressing to a severe or critical state. This study aimed to assess reactive oxygen species (ROS), non-enzymatic antioxidant reduced glutathione (GSH), and D-dimer levels in COVID-19 patients upon admission, examining their association with mortality outcomes. Data was collected from the medical records of 170 patients hospitalized in a referral hospital unit between March 2020 and December 2021. Patients were divided into two groups: the ward bed group (n = 87), comprising 51% with moderate clinical conditions, and the intensive care unit (ICU) group (n = 83), comprising 49% with severe conditions. The mean age was 59.4 years, with a male predominance of 52.4%. The overall death rate was 43%, with 30.6% in the moderate group and 69.4% in the severe group. The average time from symptom onset to hospitalization was 6.42 days. Results showed that non-survivors had high D-dimer and ROS counts, longer ICU stays, and worse saturation levels at admission. In conclusion, elevated ROS and D-dimer levels may contribute to worse outcomes in critically ill patients, potentially serving as specific and sensitive predictors of poor outcomes upon admission.

Latent Tuberculosis Infection Diagnosis Using QuantiFERON-TB Gold Plus Kit Among Correctional Workers: A Cross-Sectional Study in Francisco Beltrão-PR, Brazil

Correctional workers form a high-priority group for tuberculosis control measures because of their high exposure and risk. This cross-sectional study conducted in April and May 2022 included 71 criminal police officers from the State Penitentiary of Francisco Beltrão-PR, Brazil. Their sociodemographic and laboratory data were collected. Latent tuberculosis infection (LTBI) was assessed using a QuantiFERON-TB Gold Plus in-tube test kit. Binary logistic regression was applied to calculate the odds ratios (ORs) and 95% confidence intervals (CI) of the LTBI predictors. The prevalence of LTBI was 22.6% (95% CI, 12.8-32.2%). Factors associated with LTBI were age > 43 years (OR, 0.18; 95% CI, 0.04-0.70; p < 0.014) and the use of medications (OR, 5.13; 95% CI, 1.40-18.87; p < 0.014). The prevalence was close to that estimated worldwide for LTBI in correctional workers, reinforcing the need for occupational health control measures consisting of regular screening and treatment of positive cases of latent infection among correctional workers to reduce the risk of illness and spread of infection in the penitentiary system and community.

Sociodemographic, behavioral, obstetric, and healthcare factors associated with low weight at birth: a case-control study

BACKGROUND

Understanding social determinants is crucial for implementing preventive strategies, especially for low birth weight (LBW)-a public health issue that severely increases the risk of morbimortality in children.

OBJECTIVE

This study aimed to identify the factors associated with LBW among newborns, assisted by the Brazilian Unified Health System.

DESIGN AND SETTING

It analyzed data from newborns and their mothers. The sample was selected by convenience from users of the public health system in Francisco Beltrão (Paraná, Brazil).

METHODS

Cases (n = 26) were babies weighing ≤ 2,500 g and controls (n = 52) > 2,500 g. All babies were assessed and paired by sex and date of birth in a 1:2 proportion. Statistical power was computed a posteriori, revealing a power of 87% (α = 0.05).

RESULTS

Strong and significant differences were found in the bivariate analysis, in which the number of current smokers or those who quit during pregnancy was higher among mothers of babies with LBW. Moreover, the gestational weeks were lower among these cases. Logistic regression models indicated that the gestational week (odds ratio [OR] = 0.17, 95% confidence interval [CI]:0.05-0.54) and fathers' educational level (high school or above; OR = 0.22, 95% CI:0.06-0.99) were related to lower chances of low birth weight.

CONCLUSIONS

Our findings confirm previous investigations on LBW's multi-causality, showing that the gestational week could reduce up to 82% chances of a baby being born with ≤ 2,500 g. Its association with paternal education underlines the importance of comprehensive policies to protect newborns.

Prevalence of HPV and associated factors in a population of women living in southern Brazil

OBJECTIVE

To determine the prevalence of HPV and investigate factors associated with the infection in women in the city of Francisco Beltrão, southwest Paraná, attending the public health system.

METHODS

This cross-sectional study included 324 women, aged between 18 and 65 years, who were attending public health services for routine gynecological consultation. Interviews were conducted to obtain information about socioeconomic, sexual, gynecological, and life habits. After performing the Papanicolaou test, endocervical brush was employed to detect HPV by polymerase chain reaction with the primers MY09-MY11.

RESULTS

The prevalence of HPV was 6.8%, out of which 58.3% presented with cytopathologic alterations. And the presence of current cervical alterations can increase the chances of having HPV by almost 33 times (ORadj: 32.688; p < 0.001), recent vaginal infection increased the chances of HPV infection by 2.7 times (ORadj: 2.773; p = 0.04). The non-white ethnicity increased HPV infection chances threefold (ORadj: 3.058; p = 0.039).

CONCLUSION

The main finding was low prevalence of HPV infection. Factors that may be linked to HPV infection were cervical alterations, recent vaginal infection, and women's ethnicity.

Fatores associados a pior prognóstico da COVID-19 em Francisco Beltrão - PR

A pandemia causada pelo vírus SARS-CoV-2 impactou de diversas formas a população mundial, sendo importante conhecer a ação da doença em seus diferentes contextos. Este trabalho objetivou analisar os fatores associados a pior prognóstico da doença em Francisco Beltrão, Paraná. Realizou-se um estudo do tipo caso-controle com pacientes acometidos pela COVID-19 no município entre março de 2020 e novembro de 2021. Dentre os resultados, verificou-se que a presença de um maior número de comorbidades favorece o óbito como desfecho, havendo 3,981 (IC95%: 2,312 – 6,853) mais chances de um indivíduo ir a óbito. Notou-se que os pacientes que tiveram o pior desfecho possuíam uma média de IMC mais elevada (31,86). Os pacientes com histórico de tabagismo apresentaram 1,787 (IC95%: 1,068 – 2,990) mais chances de ir a óbito. Em suma, em Francisco Beltrão, a presença de comorbidades, obesidade e histórico de tabagismo foram fatores de pior prognostico.

Working Conditions and Health of Prison Officers in Paraná (Brazil)

OBJECTIVES

This cross-sectional study was carried out to identify the associations between working and health conditions among prison officers at a state prison in Paraná, Brazil.

MATERIAL AND METHOD

A proportional and stratified random sample of 125 individuals was used. The participants, who were not identified, completed a self-administered questionnaire.

RESULTS

The results showed a prevalence of minor psychiatric disorders (MPD) of 30.4% (95%CI: 22.4-39.2). A total of 17.9% of the respondents had persistent stress (95%CI: 12.2-25.2), 66.4 had up to five health-related complaints (95%CI: 58.4-75.2) and 9.6% had scores that indicated higher risk for alcohol abuse and/or dependance (95%CI:4.8-16.0). Multivariate analyses showed that with an MPD outcome, health problems (p<0.01), physical environment (p=0.013) and organizational risks (p<0.01) were significant predictors. Persistent stress was predicted by age (p=0.031), health problems (p<0.01) and organizational risks (p=0.023), while health complaints were associated with health problems (p<0.01) and physical environment (p<0.01). There were no significant predictors for higher risk for alcohol abuse and/or dependance.

DISCUSSION

In general, the results demonstrate the precarious nature of the work of prison officers, and reveal the importance of further studies to evaluate whether this is a specific reality of the unit that was investigated, or whether these results are common in other prison environments.

University Students' Knowledge about the Relation between Human Papillomavirus (HPV) and Head and Neck and Oral Cancers

INTRODUCTION

Human papillomavirus (HPV) causes the most common sexually transmitted infection (STI) in the world. It affects people regardless of gender and age, causing genital warts and cancer.

OBJECTIVE

To evaluate university students' knowledge of HPV and its relationship with head and neck and oral cancers.

METHODS

This is a cross-sectional study using an online questionnaire administered to undergraduate students at a public university (n=335).

RESULTS

In total, 69.3% of the participants were unaware of the relationship between HPV and head and neck cancers and 34.6% claimed that HPV may not cause oral cancer.  The chances of knowing about the relationship of HPV with head and neck cancers were significant for participants who knew that HPV could be asymptomatic (OR = 9.9; p = 0.029), that might cause genital warts in men (OR = 4.0; p = 0.015), and those aged 24 years or older (OR = 1.9; p = 0.021). However, undergraduate students in the field of health and medicine (OR = 0.419; p = 0.002), who had sex at least twice a week (OR = 0.471; p = 0.017), and were unaware of the target public for the HPV vaccine (OR: 0.222, p<0.001) were less likely to know about the relationship. Students who knew of the relationship between HPV and female (OR = 3.6; p = 0.010) and male genital warts (OR = 3.0; p = 0.005) or were immunized (OR = 1.8; p = 0.020) were more likely to understand the viral interaction with oral cancer. Those who were unaware of the population eligible for HPV vaccine (OR = 0.493; p = 0.017) also showed gaps in their knowledge of this relationship.

CONCLUSION

Our findings showed that there were limitations in the knowledge about HPV, its vaccine, and its relationship with head and neck and oral cancers.

COVID-19: The question of genetic diversity and therapeutic intervention approaches

Coronavirus disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus type 2 (SARS-CoV-2), is the largest pandemic in modern history with very high infection rates and considerable mortality. The disease, which emerged in China's Wuhan province, had its first reported case on December 29, 2019, and spread rapidly worldwide. On March 11, 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic and global health emergency. Since the outbreak, efforts to develop COVID-19 vaccines, engineer new drugs, and evaluate existing ones for drug repurposing have been intensively undertaken to find ways to control this pandemic. COVID-19 therapeutic strategies aim to impair molecular pathways involved in the virus entrance and replication or interfere in the patients' overreaction and immunopathology. Moreover, nanotechnology could be an approach to boost the activity of new drugs. Several COVID-19 vaccine candidates have received emergency-use or full authorization in one or more countries, and others are being developed and tested. This review assesses the different strategies currently proposed to control COVID-19 and the issues or limitations imposed on some approaches by the human and viral genetic variability.

Frequência e fatores associados em casos confirmados e descartados e óbitos da COVID-19 em um hospital secundário

Diante dessa emergência de caráter pandêmico e grande impacto na Saúde Pública ocasionado pela Covid – 19, a pesquisa buscou descrever a frequência e fatores associados aos casos confirmados, descartados e óbitos da doença na abrangência da 8ª Regional de Saúde do Estado do Paraná. Trata-se de um estudo quantitativo e transversal, que avaliou dados de 471 pacientes. A maior frequência do sexo masculino (56,7%). Entre os casos confirmados para COVID-19, 87,5% (n=112) faziam uso de suporte ventilatório não invasivo. A taxa de mortalidade calculada foi de 10,7% (IC95%: 7,8 – 13,4%). A letalidade geral foi de 10,6% (IC95%:8,64 – 9,20) (50/471), não apresentando diferença estatisticamente significativa entre casos confirmados 10,9% (IC95%:8,95 – 9,25) versus 10,5% (IC95%:8,91 – 9,37) os descartados. Em suma, os dados corroboram a estudos prévios ao indicar uma maior ocorrência de hospitalizações em homens idosos e de elevada alteração em exames tomográficos dentre os casos confirmados da COVID-19 na instituição analisada.

Prevalence and factors associated to cervical changes in units from the Single Health System

OBJECTIVE

To estimate the prevalence and risk factors associated with cytopathological changes in the uterine cervix of women treated by the Unified Health System.

METHOD

This is a cross-sectional study carried out with 350 women, between 14 and 79 years old who underwent pap smear tests in heath units in Francisco Beltrão, Paraná. Cervical cytopathological analyses and a questionnaire were applied to obtain socioeconomic information, as well as data on sexual behavior, gynecological aspects, and life habits. Chi-square test and logistic regression with p <0.05 were applied for statistical analysis.

RESULTS

The prevalence of cervical changes was 3.4% and the main categories found were low-grade cervical intraepithelial lesion, high-grade cervical intraepithelial lesion, and atypical cells of undetermined significance. From these, the first were present in 16.6% of women under 25 years old. The multivariate analysis pointed at associations between previous results of the cytopathology test (OR = 25.693), smoking (OR = 7.576), and oral contraceptives (OR = 5.265) and the outcome.

CONCLUSION

Women with a history of previous cervical cytopathological abnormality, use of oral contraceptives, and smokers were more likely to have an abnormal result in the pap smear test.

Sleep quality and common mental disorder in the hospital Nursing team

Objective:

to determine the prevalence of sleep quality and common mental disorder in Nursing professionals and factors associated with sleep change.

Method:

a cross-sectional, analytical and quantitative study developed with 196 Nursing professionals of a public hospital and a mixed one. Data was collected by means of an instrument of sociodemographic characterization, by the Self-Report Questionnaire 20 and Pittsburgh Sleep Quality Index and were analyzed by descriptive and inferential statistics to identify possible factors associated with sleep changes.

Results:

sleep changes were identified among the Nursing professionals with a frequency of 76.5% (70.4-82.1). Sleep quality was classified as poor in 41.8% (41.8-55.6) and sleep disorder in 27.6%. (21.4-34.2). The prevalence of common mental disorder was identified in 36.7% (30.1-43.9). The main factor for poor sleep quality was the presence of common mental disorder (Odds Ratio: 5.15; p<0.001).

Conclusion:

sleep changes were prevalent and the characteristics of the work environment and the presence of mental disorder showed relevance in the changes.

Fatores de risco associados ao acometimento pela COVID-19 em pacientes oncológicos: uma revisão sistemática

Introdução: A pandemia da COVID-19 afetou inúmeros aspectos da vida cotidiana mundialmente. Nesse cenário, encontram-se os pacientes oncológicos, cuja sensibilidade imunológica cria impasses às necessidades de comparecer a ambientes hospitalares e da manutenção de tratamentos, com risco de exposição ao vírus. Objetivos: Identificar fatores de risco relacionados à COVID-19 em pacientes com câncer. Metodologia: Revisão sistemática da literatura, cuja seleção ocorreu após pesquisa por publicações que abordassem aspectos da COVID-19 em pacientes com neoplasias, nas bases de dados BVS/Lilacs e MEDLINE/PubMed, com uso dos termos “COVID-19” and “cancer” or “câncer” and “Brazil” (DeCs e MeSH terms). Resultados: A evidência indica maior suscetibilidade a contrair COVID-19 e maior chance de internamento para pacientes com câncer, assim como, maior proporção de óbitos nessa população. Conclusão: Consonante com estudos em outros continentes, no Brasil, a imunossupressão e a submissão a tratamentos anticâncer indicaram maiores riscos para evolução mais grave da COVID-19.

Sociodemographic, behavioral, and geriatric characteristics in older adults with and without HIV: A case-control study

Older adults with human immunodeficiency virus (HIV) have higher risks for early manifestations of age-related disabilities. The objective of this study was to compare HIV-positive and HIV-negative adults aged ≥50 years in relation to sociodemographic, behavioral, and geriatric characteristics. A case-control study was conducted with a >90% estimated statistical power. A total of 52 individuals living with HIV were matched by age, sex, and neighborhood of residence with 104 community controls. Age-related disabilities were assessed throughout a comprehensive geriatric assessment. Review of medical records and interviews were used to obtain behavioral and clinical covariates. No statistical differences on clinically significant age-related disabilities were found. However, multivariate regression analyses, controlling for education and income, revealed that behavioral (use of condom [odds ratio {OR}: 7.03; 95% confidence intervals {CI}: 2.80-7.65] and number of medical visits [OR: 1.25; 95%CI: 1.09-1.43]), along with faster gait speed (OR: 17.68; 95%CI: 2.55-122.85) and lower body and muscle mass indexes were independently associated with HIV (OR: .88; 95%CI: .79-.98 and OR: .72; 95%CI: .54-.97, respectively). In summary, results on age-related disabilities between groups could mean that public policies on HIV might be contributing to patients' positive outcomes regardless of the effects of aging, albeit gait speed, body and muscle mass indexes were independently associated with HIV. Screenings for age-related disabilities in specialized HIV services are recommended.

Associated factors of Acinetobacter baumannii complex in hospitalized patients: A case-control study

INTRODUCTION

Acinetobacter baumannii complex are microorganisms of critical priority of resistance, being associated with higher costs and negative outcomes for hospitalized patients. Thus, the study aimed to analyse the factors associated with A. baumannii complex infection in various hospital sectors.

METHODOLOGY

This is a case-control study that included patients hospitalized from January 2017 to June 2019. Demographic, microbiological and clinical variables were collected from each patient. All cases had positive culture results for A. baumannii complex resistant to more than three classes of antimicrobials. Carbapenem-resistance was examined by the disk diffusion test, while the broth microdilution method was used to determine the susceptibility to colistin.

RESULTS

A. baumannii complex infection was mostly present in ICU (74.2%) than in other hospital areas. The bacteria was also linked with the length of hospitalization until the results for the culture (OR = 1.13; 95% CI: 1.06 - 1.21; p < 0.001) and with pneumonia associated with mechanical ventilation (OR = 4.48; 95% CI: 1.55 - 13.00; p = 0.006). Moreover, patients exposed to infection with multidrug-resistant A. baumannii complex had higher risks of death (OR = 3.25; 95% CI: 1.06 - 9.91; p = 0.039).

CONCLUSIONS

This study provides evidence that A. baumannii complex infection is associated with the number of days of hospitalization up to culture positivity, pneumonia associated with the use of mechanical ventilation and death. Infections appear to be more critical in ICU when compared to other areas. Taken together, these findings could support hospital infection surveillance programs, as well as prevention measures to reduce mortality rates and other complications.

Burnout Syndrome in Brazilian Medical Doctors: A Cross-Sectional Examination of Risk and Protective Factors

Objectives: This investigation sought to identify the prevalence of Burnout Syndrome (BS) among Brazilian medical doctors (BS) and the associations with risk factors and protective factors. Methods: Out of 206 registered MD from a medium-sized municipality, 121 were enrolled in this cross-sectional study. Convenience sampling was used. Based on Cohen's f ², a power of 98% and a 0.05 alpha was achieved. MD responded to sociodemographic questions and to the Portuguese-version of the Maslach Burnout Inventory-Human Services Survey (MBI). Risk and protective factors linked with BS were examined with regression analyses. Results: The age of the participants ranged from 25 to 69 years (M = 40.89; SD = 10.13) and 73.6% were male. The prevalence of BS was 7.5%. Differential aspects were related to BS. For instance, while not reporting satisfaction with the institution (β = 16.16, p < 0.001) and not practicing physical exercise (β = 7.39, p = 0.014) were associated with higher scores in the BS composite score, those who did not intend to change their careers (β = -17.15, p < 0.001) and participants who saw mental health specialists (β = -8.99, p = 0.007) scored lower, accounting for nearly a half of the BS composite score (R ² = 46%). Conclusion: The prevalence of BS in this study falls within the range previously reported among healthcare professionals (i.e., 2.6-11.8%). Moreover, data suggested that commitment with the occupation and with the participant's own mental health could boost reactions against the deleterious effects of the BS. In this sense, organizations can develop strategies for preventing BS, a process that is known to be chronic and, to some extent, preventable.

Dexamethasone for treating SARS-CoV-2 infection: a systematic review and meta-analysis

BACKGROUND

Considering the disruptions imposed by lockdowns and social distancing recommendations, coupled with overwhelmed healthcare systems, researchers worldwide have been exploring drug repositioning strategies for treating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

OBJECTIVE

To compile results from randomized clinical trials on the effect of dexamethasone, compared with standard treatment for management of SARS-CoV-2.

DESIGN AND SETTING

We conducted a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in a Brazilian public university.

METHODS

We sought to compile data from 6724 hospitalized patients with confirmed or suspected SARS-CoV-2 infection.

RESULTS

Treatment with dexamethasone significantly reduced mortality within 28 days (risk ratio, RR: 0.89; 95% confidence interval, CI: 0.82-0.97). Dexamethasone use was linked with being discharged alive within 28 days (odds ratio, OR: 1.20; 95% CI: 1.07-1.33).

CONCLUSIONS

This study suggests that dexamethasone may significantly improve the outcome among hospitalized patients with SARS-CoV-2 infection and associated severe respiratory complications. -Further studies need to consider both dose-dependent administration and outcomes in early and later stages of the disease.

PROSPERO PLATFORM

CRD42021229825.

Caracterização epidemiológica da hepatite B em idosos

Resumo Objetivo Caracterizar o perfil e identificar os fatores associados à Hepatite B na população com 60 anos ou mais de idade da região Sudoeste do Paraná, Brasil. Método Trata-se de um estudo epidemiológico descritivo e inferencial que analisou quantitativamente dados secundários obtidos através do Sistema Nacional de Agravos de Notificação (SINAN), entre 2007 a 2017. Resultados A Hepatite B foi mais frequente em homens, com baixa escolaridade e em indivíduos que exerciam atividade ligada à agricultura. A maioria dos casos foi notificada entre 2013 a 2017 e em sujeitos que reportaram exposição a material biológico. No modelo multivariado de regressão logística, as infecções pelos vírus da hepatite B foram associadas à raça/cor não branca (OR: 2,89; IC95% 1,07 – 7,87), ao histórico de realização de transfusão sanguínea (OR: 14,51; IC95% 5,44 – 38,74), em residentes de municípios de 10 a 20 mil habitantes (OR: 4,57; IC95% 1,59 – 13,12) e de municípios entre 20 a 50 mil habitantes (OR: 4,33; IC95% 1,61 – 11,56). Conclusão A caracterização dos possíveis fatores de risco para hepatite B nessa população podem subsidiar ações mais eficazes de prevenção e promoção de saúde, bem como fomentar estudos específicos que possam guiar políticas de atenção integral ao idoso.

Characteristics associated with anti-HCV serological markers in prisoners in the state of Paraná, Brazil: a case-control study

Background

The prison system in Paraná, Brazil, is experiencing serious problems related to the increasing number of prisoners. Control of hepatitis C virus (HCV) has become more intense because the incarcerated population is considered a high-risk group for contagious diseases due to the favorable conditions found in prisons for the spread of these morbidities. The objective of this study was to identify features associated with hepatitis C infection among male prisoners in correctional institutions of Paraná state, Brazil.

Methods

This was a case-control study (27 cases and 54 controls) of men incarcerated in 11 penitentiaries in Paraná, Brazil. Information was obtained through a questionnaire in a cross-sectional epidemiological survey on HCV infection during the period from May 2015 to December 2016. Eligible men were recruited after testing positive for anti-HCV antibodies. Cases and controls were selected based on serological results of enzyme-linked immunosorbent assays and were matched by age, location of the penitentiary, and time in prison. Logistic regression analysis was used to identify risk factors for HCV seropositivity.

Results

The main significant independent risk factor for the acquisition of HCV infection was the use of injectable drugs (OR = 4.00; 95%CI:1.41–11.35; p < 0.001).

Conclusions

This study provides evidence that HCV infection is associated with drug use by this population. This information is pivotal for tailoring prevention programs and guiding specific socioeducational measures that aim to reduce or prevent HCV transmission within the prison setting.