ABSTRACT
Introduction: Orosomucoid also named Alpha-1 Acid Glycoprotein(AGP) is a major acute-phase protein and is increased in response to systemic injury and inflammation. AGP has been described as an inhibitor of neutrophil migration on sepsis, particularly its immunomodulation effects. The AGP biological functions are not understood in Coronavirus disease 2019 (COVID-19). Hypothesis: We hypothesize that plasmatic AGP is upregulated in severe Covid-19 patients and is involved in the regulation of netosis. Therefore, we sought to investigate the role of AGP in plasmatic from COVID-19 severe infection patients and neutrophils infected with Severe Acute Respiratory Syndrome Coronavirus-2 (SarsCov-2). Method(s): Epidemiological data and AGP, interleukin-6 (IL-6), C-reactive protein (PCR), lactate, and other laboratorial parameters were measured in blood samples from 52 subjects hospitalized in the ICU with clinically SarsCov-2 infection confirmed by RT-PCR. To evaluate the role of AGP in netosis in neutrophils, blood samples from health patients (n=13) were collected, and neutrophils were separated and infected with Sars-Cov-2 (Moi=1). Those neutrophils were treated with AGP (10mug/ml) or vehicle for 18 hours and netosis was analyzed by flow cytometry (n=10) and immunofluorescence (IF;n=10). Early and late netosis, respectively, were characterized by negative or positive FVS and positive Sytox. The neutrophil extracellular traps (NETs) were investigated by myeloperoxidase (MPO), neutrophil elastase (NE), and DAPI by IF and quantified Netquant/Matlab software. This study was approved by Ethics Committee -CAAE: 30816620.0.0000.5440. Result(s): AGP increased in severe Covid-19 patients (p<0.05). A positive correlation between AGP with IL-6 and C-reactive protein (respectively, p=0.005, p=0.002) and a negative correlation between AGP and lactate (p=0.004) were found it. Together, AGP treatment downregulated early (35,7%) and late (43,5%) netosis in neutrophils infected with SarsCov-2. Confocal analysis by MPO, NE e DAPI showed NETs released by neutrophils infected with Sar-Cov-2 decreased when neutrophils were treated with AGP (p<0.05). Conclusion(s): Our data showed increased AGP in COVID-19 infection and contributed to netosis regulation.
ABSTRACT
The massive and urgent adoption of telework during the Covid-19 pandemic, supported by information and communication technologies, implied an increasing number of risks in the security of the digital infrastructure of the institutions, due to potential vulnerabilities in personal devices used by teleworkers. In this paper, this problem is raised in the context of a public healthcare institution, whose IT team was unable to monitor in real time and in an automated way the security status of these devices, nor security incidents that had been targeted. Several endpoint detection and response (EDR) solutions to mitigate this problem were researched, analyzed and tested. A validation experiment was conducted with teleworkers that allowed the selection of an effective and affordable centralized solution to solve the problem raised in this research. © 2022 IEEE Computer Society. All rights reserved.
ABSTRACT
Background: A lot of attention has been drawn to the identification of predictors of VTE in COVID-19 patients, and an accurate clinical prediction model is still lacking in this context. Aims: To develop a clinical prediction model using artificial intelligence techniques, to predict VTE in COVID-19 patients, using variables easily available upon hospital admission. Methods: This multicenter cohort included consecutive adult patients (≥ 18 years-old) with laboratory-confirmed COVID-19 from 37 Brazilian hospitals from 17 cities, between March and September 2020. Study data were collected from medical records using Research Electronic Data Capture (REDCap) tools. We trained multiple machine learning models on various combinations of structured and non-structured features, calibrated to reflect a probability distribution while predicting the desired clinical outcome. Subsequently, we analyzed the relationship between this model ' s predicted confidence score and the fraction of false negatives in the test sample to devise a splitting point where no false negatives would occur, thus calibrating for sensitivity over specificity. The study was approved by the National Research Ethics Commission waiving off the application of informed consent. Results: The dataset included 6421 patients (median age 61 [P25-75 48-73] years-old, 54.8% men), 4.5% of them developed venous thromboembolic disease. Patient ' s age, sex and comorbidities, as well as their list of household prescription drugs, history of recent surgery and laboratory tests were significant predictors. Given a proper confidence level, our model predicted 100% of the true positive cases while eliminating a significant portion of the true negatives (Figure 1). (Figure Presented) Conclusions: This study suggests that an ensemble of decision rules can effectively predict COVID patients with high risk of VTE. It might be possible to decrease the use of anticoagulants while still treating patients with an appreciable likelihood of thromboembolism.
ABSTRACT
Background : COVID-19 patients are at increased risk of venous thromboembolism (VTE), and this complication leads to a worse prognosis. However, to diagnose VTE on COVID-19 patients is a challenge to physicians, as the symptoms of pulmonary embolism can often be mistaken for the overlapped viral pneumonia. Herein, there is still little information on VTE incidence and associated risk factors specifically for this population. Aims : To assess the incidence and associated risk factors for VTE in hospitalized COVID-19 patients in Brazilian hospitals. Methods : Retrospective multicenter cohort in 15 Brazilian hospitals. Consecutive adult patients (≥ 18 years-old) with laboratoryconfirmed COVID-19 between March and September 2020 were included. Study data were collected from medical records using Research Electronic Data Capture (REDCap) tools. The study was approved by the National Research Ethics Commission waiving off the application of informed consent. Results : Of 4,021 patients included, 234 (5.8%) had VTE. When comparing VTE and non-VTE groups (Tables 1 and 2), there was no statistical difference in terms of sex and age between groups. The median age was 63 years-old (IQR 51-72 years-old) in VTE group. The most common comorbidities for both groups were hypertension and diabetes. Obesity, chronic pulmonary obstructive disease, previous VTE and recent surgery were more frequent in VTE group. D-dimer, C-reactive protein, lactate dehydrogenase levels and lymphocyte count were higher in the VTE group. Admission to intensive care units (37.6% vs 69.7%;P < 0,001) and in-hospital mortality (19.0% vs 28.3%;P < 0,01) were significantly higher in those who had VTE. Conclusions : Overall, 5.8% of COVID-19 hospitalized patients had VTE. Elevated laboratory values were associated with increased risk of this condition. VTE was associated with higher rates of intensive care admission and in-hospital mortality.
ABSTRACT
The immersion of sensors in the industry, through Internet of Things (IoT) concept, has brought many opportunities for operational improvements in power electrical sector. In a more specific sense, the on-field activities carried out by utilities workforce, can become safer with the use of IoT sensors. This technology transmits data related to courses capacitation and electricians' certification. This type of data is regulated and supervised by regulatory agents in the electrical sector, and inspection are performed periodically by the utilities in order to guarantee the safety criteria established by the regulation. In that sense, this paper aims to present the implementation of a smart badge, which communicates with the inspector's mobile devices in order to make a more dynamic and feasible inspection solution for field activities. The presented solution implements courses and PPE (Personal protective equipment) management features, in order to guarantee and safeguard the life of employees who perform in on-field activities. In addition, it provides an update of inspection information in real time, in order to improve the management of training and PPE. The obtained results are derived from the Urban Futurability project, carried out by ENEL Sao Paulo Distribuicao in the framework of the Brazilian regulator's R&D program.
ABSTRACT
Coronaviruses can cause a diverse array of clinical manifestations, from fever with symptoms of the common cold to highly lethal severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS). SARS-CoV-2, the coronavirus discovered in Hubei province, China, at the end of 2019, became known worldwide for causing coronavirus disease 2019 (COVID-19). Over one year's time period, the scientific community has produced a large bulk of knowledge about this disease and countless reports about its immune-pathological aspects. This knowledge, including data obtained in postmortem studies, points unequivocally to a hypercoagulability state. However, the name COVID-19 tells us very little about the true meaning of the disease. Our proposal is more comprehensive;it intends to frame COVID-19 in more clinical terminology, making an analogy to viral haemorrhagic fever (VHF). Thus, we found irrefutable evidence in the current literature that COVID-19 is the first viral disease that can be branded as a viral thrombotic fever. This manuscript points out that SARS-CoV-2 goes far beyond pneumonia or SARS. COVID-19 infections promote remarkable interactions among the endothelium, coagulation, and immune response, building up a background capable of promoting a "thrombotic storm," much more than a "cytokine storm." The importance of a viral protease called main protease (Mpro) is highlighted as a critical component for its replication in the host cell. A deeper analysis of this protease and its importance on the coagulation system is also discussed for the first time, mainly because of its similarity with the thrombin and factor Xa molecules, as recently pointed out by structural comparison crystallographic structures.