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Introduction: Endothelial dysfunction and coagulopathy have been reported as the basis of severe Acute Kidney Injury (AKI) associated with COVID-19. Endothelial biomarkers can detect kidney damage early and allow the adoption of efficient measures to prevent the progression of the disease and its complications. This finding could facilitate the follow-up of patients at higher risk, as well as provide early diagnosis strategies and promote the rational use of resources. The aim of this study is to assess the role of vascular biomarkers to predict the need for hemodialysis in critically ill patients with COVID-19. Method(s): This is a prospective study with 58 patients critically ill due to COVID-19 infection admitted to a tertiary hospital in Fortaleza, Northeast Brazil, from 2020 to 2021. General laboratory tests and vascular biomarkers such as VCAM-1, Syndecan-1, ACE-2, ICAM-1, Angiopoietin-1 and Angiopoietin-2 were quantified on admission to the intensive care unit (ICU). Result(s): There was a 40% mortality rate. VCAM and the Ang-2/Ang-1 ratio at ICU admission were associated with the need for hemodialysis. Vascular biomarkers (VCAM-1, Syndecan-1, angiopoietin-2/anogiopoietin-1 ratio) and thrombocytopenia were predictors of dialysis, and their cutoff values were useful to stratify patients with worse prognosis in the Kaplan-Meier analysis. In the cox multivariate regression analysis with models adjusted according to the presence or absence of platelets, VCAM-1 [O.R. 1.13 (95% CI: 1.01 - 1.27);p=0.034] was an independent predictor of dialysis in all models, and the Ang-2/Ang-1 ratio [O.R. 4.87 (95% C.I.: 1.732 - 13.719);p=0.003] was associated with the need for dialysis in the model without platelet input. Conclusion(s): Vascular biomarkers, mainly VCAM-1 and Ang-2/Ang-1 ratio, and coagulation disorders showed important predictive value for the need for hemodialysis in critically ill patients with COVID-19. No conflict of interestCopyright © 2023
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The COVID-19 pandemic has underscored the importance of awareness and preparedness on the part of medical personnel. Virtual reality (VR) may be viewed as a useful tool in enabling knowledge and ability of medical practitioners in protecting themselves during the pandemic. This research describes the details of a VR application developed to train healthcare personnel in an intensive care unit (ICU) environment on some of the critical procedures related to COVID-19 patients. We discuss design considerations of VR for healthcare training as well as a process of selecting, based on expert opinion, key ICU training modules. The process of creating a 3D model of the ICU is outlined, and the major components and the use of the VR application are discussed. We find that a practical VR training program should apply a suitable VR platform and simulation techniques, while placing emphasis on addressing emerging problems and needs of healthcare personnel during the pandemic. © 2021 The Authors.
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This article brings reflections on Electronic Contracts, covering their legal nature and the form of externalization of the business declaration in the electronic environment. This contractual methodology stems from the digital transformation in which contemporary society is inserted and was substantially boosted during the COVID-19 pandemic, given the impossibility of face-to-face interaction between the contracting parties, especially for the signatures of the instruments. There are several types of electronic contracts. This article explores some of them and the particularities related to the formation and externalization of the business declaration in some of these business models carried out in the electronic environment. © 2022, Centro Universitario Curitiba - UNICURITIBA. All rights reserved.
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Face às mudanças provocadas pela COVID-19, observam-se problemas relacionados à assimetria de informação na relação entre compradores e vendedores de produtos agroalimentares. Neste estudo, através de uma discussão bibliográfica, buscou-se compreender como as mudanças causadas pela COVID-19 na distribuição de alimentos podem impactar na relação entre compradores e vendedores de produtos agroalimentares, em especial frutas, legumes e verduras. Observou-se que as restrições na distribuição em supermercados, feiras livres e mercado online dificultam ou impedem a mensuração da qualidade dos produtos por parte dos compradores. Nesse contexto, os compradores têm a sua avaliação limitada a informações que o vendedor passa acerca dos atributos de qualidade, podendo implicar em problemas de apropriação de valor. Conclui-se que as mudanças na distribuição de produtos agroalimentares, ainda que garantam o acesso aos suprimentos, trazem riscos à relação entre compradores e vendedores quando se consideram assimetria de informação e seleção adversa.
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Hospitals and other healthcare settings use various simulation methods to improve their operations, management, and training. The COVID-19 pandemic, with the resulting necessity for rapid and remote assessment, has highlighted the critical role of modeling and simulation in healthcare, particularly distributed simulation (DS). DS enables integration of heterogeneous simulations to further increase the usability and effectiveness of individual simulations. This article presents a DS system that integrates two different simulations developed for a hospital intensive care unit (ICU) ward dedicated to COVID-19 patients. AnyLogic has been used to develop a simulation model of the ICU ward using agent-based and discrete event modeling methods. This simulation depicts and measures physical contacts between healthcare providers and patients. The Unity platform has been utilized to develop a virtual reality simulation of the ICU environment and operations. The high-level architecture, an IEEE standard for DS, has been used to build a cloud-based DS system by integrating and synchronizing the two simulation platforms. While enhancing the capabilities of both simulations, the DS system can be used for training purposes and assessment of different managerial and operational decisions to minimize contacts and disease transmission in the ICU ward by enabling data exchange between the two simulations.
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Natural products have been used in the treatment of illnesses throughout the history of humankind. Exploitation of bioactive compounds from natural sources can aid in the discovery of new drugs, provide the scaffold of new medicines. In the face of challenging diseases, such as the COVID-19 pandemic, for which there was no effective treatment, nature could offer insights as to novel therapeutic options for control measures. However, the environmental impact and supply chain of bioactive production must be carefully evaluated to ensure the detrimental effects will not outweigh the potential benefits gained. History has already proven that highly bioactive compounds can be rare and not suitable for medicinal exploitation; therefore, the sustainability must be accessed before expensive, time-demanding, and large trials can be initialized. A sustainable option to readily produce a phytotherapy with minimal environmental stress is the use of agro-industry wastes, a by-product produced in high quantities. In this review we evaluate the sustainability issues associated with the production of phytotherapy as a readily available tool for pandemic control.
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Different heterogeneous simulation components can be integrated to produce a more effective complex global system. The IEEE High-Level Architecture (HLA) is an international standard that promotes interoperability and reusability for distributed simulation (DS). This paper proposes a DS system that integrates an agent-based and discrete-event simulator with a 3D game engine to build virtual reality (VR) applications that replicate real environments. In this case study, AnyLogic is used as an agent-based and discrete event simulator to simulate the process flow and COVID-19 transmission inside the University Health Network dialysis unit, Toronto, Canada. Unity game engine delivers the 3D modelling replicating the real architecture and environment of the dialysis unit. The HLA standard plays a major role in the integration of AnyLogic and Unity to produce a more effective and powerful DS system for VR applications. © 2021 IEEE.
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Introduction: In the context of the pandemic caused by SARS-CoV-2, reports of increased incidence of Health Care-Related Infections have been published. Variability in environmental cleaning practices and differences in the microbiome composition of high-touch surfaces may be related to this trend. Objectives: To assess hospital cleaning practices and microbiome compositions of COVID and non-COVID ICUs. Methods: Prospective observational study in COVID and non-COVID intensive care units (ICU) of 3 Brazilian' hospitals. After informed consent, environmental cleaning practices were studied by mean of a qualitative instrument through Plan-Do-Study-ACT cycles that was composed by a leadership, an operation/cleaning professionals assessment, and the core component 8 of the Infection Prevention and Control Assessment Framework. 38 swabs of high-touch surfaces were collected to evaluate bacterial profile and resistance genes, using large-scale DNA sequencing and real-time PCR. Results: Environmental hygiene practices observed were different among the 3 hospitals regarding. IPCAF scores were similar. Surface microbiomes in COVID/non-COVID ICUs were similar within hospitals, but each one presented an unique diversity profile. Low impact was found of terminal cleaning processes in gram-positive bacteria (specially, Corynebacterium, Strepococcus e Staphylococcus). In 2 out 12 sanitizers samples were positive for Burkholderia Cenocepacia, Pseudomonas, Enterobacteriaceae, Stenotrophomonas. Resistance genes mec-A were found in more than 50% of the samples in 2 out 3 hospitals, reaching higher still higher rates in COVID units (71.1% and 86.7%). KPC were also found in all ICUs, indistinctly, followed by OXA23 and VanA (in much lower rate, not in all ICUs). Conclusion: Surface microbiome within hospitals in COVID and non- COVID ICUs of did not present significant differences. Conversely, each hospitals presented very distinct diversity profiles. Although presumed, clinical impact of environment-related findings, as well as differences between environmental hygiene practices and contamination of sanitizing agents deserves further investigation future studies.
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Objectives: This paper analyzes the implications of the COVID-19 pandemic in international commercial contracts and its impacts on the obligations performance within the United Nations Convention on Contracts for the International Sale of Goods (CISG). Methodology: The research was conducted through an inductive, hypothetical approach, based on an understanding of legal concepts and a bibliographic/documentary survey, with an exploratory and conclusive objective. Results: The study leads to some conclusions regarding the total or partial failure to perform contracts due to the COVID-19 pandemic and its consequences on international trades. Contributions: This is a topical matter of great relevance, given its impacts on the different countries’ economies and on the society as a whole, which falls within the field of interest of international law. © 2021, Centro Universitário Curitiba - UNICURITIBA. All rights reserved.
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The COVID-19 pandemic surprised the whole world for its high lethality rate and rapid spread, leaving international bodies, courts and governments unprepared, often without knowing how to act to reconcile the application and ensure the effectiveness of fundamental rights. In this article, some conflicts were detected between freedom of religion or belief and restrictive measures in the context of the pandemic in Brazil, for example, when the functioning of places of worship was prohibited, an issue that guided the formulation of the research problem. The hypothesis is that such measures, when they restrict or limit the right to religious freedom, can be considered legitimate, as long as they are temporary and duly justified, with the purpose of reducing illness and death. The conclusion, finally, is in line with the hypothesis raised, by pointing to the constitutionality of restrictive measures, only if they are subordinate to the duty to protect the rights to life and health.
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The present study focused on the scenario of confirmed cases of SARS-CoV-2 infection in the state of Minas Gerais (MG), Brazil, from March 2020 to March 2021. We evaluated the evolution of COVID-19 prevalence and death in one municipality from each of the 14 health macro-regions of MG state. Socio-demographic characteristics and variables related to the municipalities were analyzed. The raw dataset used in this study was freely sourced from the website Brasil.io. From the raw dataset, two time series were extracted: the cumulative confirmed cases of COVID-19 and cumulative death counts, and they were compared to the state data using a nowcasting approach. In order to make time series comparisons possible, all data was normalized per 100,000 inhabitants. When analyzing in light of colored wave code interventions initiated in August 2020 in MG, for the majority of the municipalities, there was an absence of clear influence on prevalence and deaths. The national holidays in the first semester of 2020 had a small impact on the COVID-19 prevalence of the municipalities, but the holidays in the second semester of 2020 and beginning of 2021 caused important impacts on COVID-19 prevalence. The low number of ICU beds in some municipalities contributed to the higher number of deaths. The analysis showed here is expected to contribute to the improvement of decision making of the MG government, as it opened a huge possibility to have the total macro-regions and state data analyzed.