VIRTUAL JURY, CORONAVIRUS AND HUMAN RIGHTS: A STUDY BY THE NUCLEUS OF THE JURY TRIBUNAL OF THE STATE PUBLIC DEFENDER'S OFFICE OF TOCANTINS

The article approaches the Jury Court in the virtual modality in Brazil, as well as the legality and constitutionality of its instrumentalization in the penal rite in the days of COVID-19. It seeks to elucidate the existence of human and fundamental rights of the defendant in criminal proceedings, analyzing possible violations of due process in the face of the use of this technological instrumentation of videoconference in the Jury's judgment sessions. The objective is to diagnose practical difficulties in the Jury's performance in times of pandemic. Finally, it is understood that the virtual jury is illegal in Brazil, for violating the Federal Constitution and the International Human Rights Treaties, violating the due legal process and the criminal procedural guarantees listed throughout this article.

Lung ultrasound score predicts outcomes in COVID-19 patients admitted to the emergency department

RATIONALE During the COVID-19 pandemic, creating tools to assess disease severity is one of the most important aspects of reducing the burden on emergency departments. Lung ultrasound has a high accuracy for the diagnosis of pulmonary diseases;however, there are few prospective studies demonstrating that lung ultrasound can predict outcomes in COVID-19 patients. We hypothesized that lung ultrasound score (LUS) at hospital admission could predict outcomes of COVID-19 patients. METHODS This is a prospective cohort study conducted from 14 March through 6 May 2020 in the emergency department (ED) of an urban, academic, level I trauma center. Patients aged 18 years and older and admitted to the ED with confirmed COVID-19 were considered eligible. Emergency physicians performed lung ultrasounds and calculated LUS, which was tested for correlation with outcomes. This protocol was approved by the local Ethics Committee number 3.990.817 (CAAE: 30417520.0.0000.0068). RESULTS The primary endpoint was death from any cause. The secondary endpoints were ICU admission and endotracheal intubation for respiratory failure. Among 180 patients with confirmed COVID-19 who were enrolled (mean age, 60 years;105 male), the average LUS was 18.7 ± 6.8. LUS correlated with findings from chest CT and could predict the estimated extent of parenchymal involvement (mean LUS with < 50% involvement on chest CT, 15±6.7 vs. 21±6.0 with >50% involvement, p<0.001), death (AUC 0.72, OR 1.13, 95% CI 1.07 to 1.21;p < 0.001), endotracheal intubation (AUC 0.76, OR 1.17, 95% CI 1.09 to 1.26;p < 0.001), and ICU admission (AUC: 0.71, OR 1.14, 95% CI 1.07 to 1.21;p < 0.001). CONCLUSION In this study, LUS was a good predictor of death, ICU admission, and endotracheal intubation in patients with COVID-19 admitted in ED. The study provides support for further research, ideally combining clinical, laboratory, and imaging parameters, to estimate the risk of poor outcomes from COVID-19 infection.

Community-acquired Pneumonia Severity Assessment Tools in Patients Hospitalized with COVID-19: a Validation and Clinical Applicability Study

OBJECTIVE: To externally validate community acquired pneumonia (CAP) tools on patients hospitalized with COVID-19 pneumonia from two distinct countries, and compare its performance to recently developed COVID-19 mortality risk stratification tools. METHODS: We evaluated 11 risk stratification scores in a binational retrospective cohort of patients hospitalized with COVID-19 pneumonia in Sao Paulo and Barcelona: Pneumonia Severity Index (PSI), CURB, CURB-65, qSOFA, Infectious Disease Society of America and American Thoracic Society Minor Criteria, REA-ICU, SCAP, SMART-COP, CALL, COVID GRAM and 4C. The primary and secondary outcomes were 30-day in-hospital mortality and seven-day intensive-care unit (ICU) admission respectively. We compared their predictive performance using the area under the ROC curve (AUROC), sensitivity, specificity, likelihood ratios, calibration plots and decision curve analysis. RESULTS: Of 1363 patients, the mean (SD) age was 61 (16) years. The 30-day in-hospital mortality rate was 24.6% (228/925) in Sao Paulo and 21.0% (92/438) in Barcelona. For in-hospital mortality, we found higher AUROCs for PSI (0.79, 95%CI 0.77-0.82), 4C (0.78, 95%CI 0.75-0.81), COVID GRAM (0.77, 95%CI 0.75-0.80), and CURB-65 (0.74 95%CI 0.72-0.77). Results were similar for both countries. For most 1-20% threshold range in decision curve analysis, PSI would avoid a higher number of unnecessary interventions, followed by the 4C score. All scores had poor performance (AUROC<0.65) for seven-day ICU admission. CONCLUSIONS: Recent clinical COVID-19 assessment scores had comparable performance to standard pneumonia assessment tools. Because it is expected that new scores outperform older ones during development, external validation studies are needed before recommending their use.