Work context and clinical manifestations of COVID-19 in health professionals

To analyze associations between work context and clinical manifestations of COVID-19 in health professionals. Methods: This is a cross-sectional study, with health professionals from the northeast of Brazil, from the medical, nursing and physiotherapy categories from different areas of expertise. A Google Forms questionnaire was sent through social networks, gathering demographic, academic, work context, clinical manifestations and data related to testing for COVID-19 (the test performed was not specified) and whether the result confirmed infection active or presence of antibodies (categorized as positive). Pearson's chi-square test and multivariate binary logistic regression analysis were performed, with Wald's chi-square test, considering p-value <0.05, Odds Ratio and 95% confidence interval. Results: A total of 1,354 professionals agreed to participate in the study. Of these, 324 reported a positive test for COVID-19, with a prevalence of 23.9% (324/1,354). There was a statistical association between symptom onset and positive result (p=0.000). The work context characteristics related to the number of jobs, practice setting, contact with critically ill patients and employment in the capital were the independent variables associated with a positive result for COVID-19 (p<0.05). It was identified that 54.8% of the dependent variable can be related to the work sector, number of jobs, fever, loss of smell and taste. Conclusion: Health professionals from urban centers, hospitals, critical care units and those with more than one job are more affected by COVID-19, with the positive test result being closely related to the symptoms of fever, loss of smell and taste that are characteristic of the illness. © 2022 Departamento de Enfermagem/Universidade Federal de Sao Paulo. All rights reserved.

Adherence to protective mechanical ventilation in COVID-19 versus non-COVID-19-associated acute respiratory distress syndrome: Comparison between two prospective cohorts.

OBJECTIVE: To compare adherence to protective mechanical ventilation (MV) parameters in patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 with patients with ARDS from other etiologies. DESIGN: Multiple prospective cohort study. SETTING: Two Brazilian cohorts of ARDS patients were evaluated. One with COVID-19 patients admitted to two Brazilian intensive care units (ICUs) in 2020 and 2021 (C-ARDS, n=282), the other with ARDS-patients from other etiologies admitted to 37 Brazilian ICUs in 2016 (NC-ARDS, n=120). PATIENTS: ARDS patients under MV. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Adherence to protective MV (tidal volume ≤8mL/kg PBW; plateau pressure ≤30cmH2O; and driving pressure ≤15cmH2O), adherence to each individual component of the protective MV, and the association between protective MV and mortality. RESULTS: Adherence to protective MV was higher in C-ARDS than in NC-ARDS patients (65.8% vs. 50.0%, p=0.005), mainly due to a higher adherence to driving pressure ≤15cmH2O (75.0% vs. 62.4%, p=0.02). Multivariable logistic regression showed that the C-ARDS cohort was independently associated with adherence to protective MV. Among the components of the protective MV, only limiting driving pressure was independently associated with lower ICU mortality. CONCLUSIONS: Higher adherence to protective MV in patients with C-ARDS was secondary to higher adherence to limiting driving pressure. Additionally, lower driving pressure was independently associated with lower ICU mortality, which suggests that limiting exposure to driving pressure may improve survival in these patients.

OPORTUNIDADE DE ENVOLVIMENTO DO CORPO CLÍNICO DE UM HOSPITAL UNIVERSITÁRIO DE MÉDIA E ALTA COMPLEXIDADE, NA CAPTAÇÃO INTRA-HOSPITALAR DE DOADORES DE SANGUE

Objetivos: Em vigência da pandemia COVID-19, foi implementada uma rotina de captação intra-hospitalar de doadores de sangue no Hospital Universitário Pedro Ernesto (HUPE), tendo o corpo clínico do hospital como ponto focal através do engajamento de equipes das diversos setores clínicos e cirúrgicos, em campanhas mensais de doação de sangue, visando a manutenção do estoque de sangue no núcleo de hemoterapia do hospital. Material e métodos: Entre março e julho de 2021, identificadas as clínicas de maior demanda por hemocomponentes no hospital, foram realizadas reuniões de sensibilização para a doação de sangue entre as equipes, com atividades lúdicas e educacionais. O recurso de mídias sociais, principalmente Instagram® e FaceBook® foi utilizado para divulgação das ações visando a captação de doador. Foram contabilizados o número de setores e pessoas atingidas em cada ação, assim como número de doações de sangue nos respectivos meses de atividades de captação intra-hospitalar. Foi feita avaliação qualitativa sobre o conhecimento, sentimento e curiosidade das equipes sobre doação de sangue. Resultados: Os setores envolvidos foram 7, sendo eles, neurocirurgia, cirurgia cardíaca, pediatria, reumatologia, urologia, cirurgia vascular e hematologia. Foram realizadas 20 reuniões, atingindo 169 pessoas do corpo clínico dos diversos setores envolvidos. Cada equipe criou e desenvolveu atividades lúdicas educacionais nos respectivos setores, visando motivar a equipe para a doação de sangue. As principais dúvidas foram quanto aos critérios de inaptidão à doação, apesar de haverem doadores de sangue entre eles. Requisitos básicos para a doação, presença de tatuagem e mais recentemente, a doação de sangue por homem que tem sexo com homem, foram as dúvidas mais frequentes. As equipes não realizavam atividades de captação intra-hospitalar e não estavam diretamente envolvidas neste tipo de ação até as intervenções em questão. O número de candidatos aptos à doação entre março a julho de 2021, foi 17,6% maior, quando comparado com o mesmo período em 2020. Discussão: Apesar da captação intra-hospitalar não ser o modelo ideal para sensibilização à doação, diante de um recurso escasso e em vigência da pandemia COVID-19, considerou-se necessário incluir este tema de discussão, dentro de um hospital de elevado potencial transfusional. O não conhecimento sobre critérios básicos para doação de sangue entre a equipe de saúde, revela a necessidade de disseminar o conhecimento sobre esta atitude na sociedade como um todo, com ênfase neste grupo de pessoas. Mesmo durante atividades diárias extenuantes, os profissionais de saúde mostraram-se dispostos a participar do processo transfusional, seja como captador, ou como doador. Conclusão: Em vigência de situações que tragam risco para a manutenção do estoque de hemocomponentes, a captação intra-hospitalar parece viável e pode ser encorajada entre a equipe de saúde. Estas atividades são oportunidades educativas e devem ser estimuladas, incluindo o corpo clínico no processo transfusional.

Acute Pulmonary Histoplasmosis Following COVID-19: Novel Laboratorial Methods Aiding Diagnosis

The acute form of histoplasmosis usually occurs after the exposition of more than one individual to a common environmental source harboring Histoplasma capsulatum. Here, we present two cases of acute pulmonary histoplasmosis seen within two weeks at a reference center for infectious diseases at Rio de Janeiro, Brazil. The patients did not present a common epidemiologic history for histoplasmosis, however both presented COVID-19 before the onset of histoplasmosis symptoms. Due to the difficulties in the diagnosis of acute histoplasmosis, novel laboratory methods such as Western Blot and PCR were included in the investigation of these cases. Both patients presented negative cultures for H. capsulatum and negative urinary galactomannan. However, they presented H and M bands in the Western blot as well as a positive H. capsulatum DNA detection in sputum. These results were available approximately 36 h after sample collection, fastening the beginning of treatment of one patient. Both patients progressed well with itraconazole treatment. These cases suggest that COVID-19 may facilitate the development of acute pulmonary histoplasmosis and, therefore, clinicians must be aware of this differential diagnosis in patients from endemic areas with fever and coughing after recovery from COVID-19.

Work context and clinical manifestations of COVID-19 in health professionals Contexto de trabajo y manifestaciones clinicas de la COVID-19 en profesionales de salud

Objective: To analyze associations between work context and clinical manifestations of COVID-19 in health professionals. Methods: This is a cross-sectional study, with health professionals from the northeast of Brazil, from the medical, nursing and physiotherapy categories from different areas of expertise. A Google Forms questionnaire was sent through social networks, gathering demographic, academic, work context, clinical manifestations and data related to testing for COVID-19 (the test performed was not specified) and whether the result confirmed infection active or presence of antibodies (categorized as positive). Pearson's chi-square test and multivariate binary logistic regression analysis were performed, with Wald's chi-square test, considering p-value <0.05, Odds Ratio and 95% confidence interval. Results: A total of 1,354 professionals agreed to participate in the study. Of these, 324 reported a positive test for COVID-19, with a prevalence of 23.9% (324/1,354). There was a statistical association between symptom onset and positive result (p=0.000). The work context characteristics related to the number of jobs, practice setting, contact with critically ill patients and employment in the capital were the independent variables associated with a positive result for COVID-19 (p<0.05). It was identified that 54.8% of the dependent variable can be related to the work sector, number of jobs, fever, loss of smell and taste. Conclusion: Health professionals from urban centers, hospitals, critical care units and those with more than one job are more affected by COVID-19, with the positive test result being closely related to the symptoms of fever, loss of smell and taste that are characteristic of the illness.

Bedside echocardiography to predict mortality of COVID-19 patients beyond clinical data: Data from the PROVAR-COVID study

INTRODUCTION: Cardiac involvement seems to impact prognosis of COVID-19, being more frequent in critically ill patients. We aimed to assess the prognostic value of right ventricular (RV) and left ventricular (LV) dysfunction, evaluated by bedside echocardiography (echo), in patients hospitalized with COVID-19. METHODS: Patients admitted in 2 reference hospitals in Brazil from Jul to Sept/2020 with confirmed COVID-19 and moderate/severe presentations underwent clinical and laboratory evaluation, and focused bedside echo (GE Vivid-IQ), at the earliest convenience, with remote interpretation. The association between demographics, clinical comorbidities and echo variables with all-cause hospital mortality was assessed, and factors significant at p<0.10 were put into multivariable models. RESULTS: Total 163 patients were enrolled, 59% were men, mean age 64+/-16 years, and 107 (66%) were admitted to intensive care. Comorbidities were present in 144 (88%) patients: hypertension 115 (71%), diabetes 61 (37%) and heart failure 22 (14%). In-hospital mortality was 34% (N=56). In univariate analysis, echo variables significantly associated with death were: LV ejection fraction (LVEF, OR=0.94), RV fractional area change (OR=0.96), tricuspid annular plane systolic excursion (TAPSE, OR=0.83) and RV dysfunction (OR=5.3). In multivariate analysis, after adjustment for clinical and demographic variables, independent predictors of mortality were age>=63 years (OR=5.53, 95%CI 1.52-20.17), LVEF<64% (OR=7.37, 95%CI 2.10-25.94) and TAPSE<18.5 mm (OR=9.43, 95% CI 2.57-35.03), and the final model had good discrimination, with C-statistic=0.83 (95%CI 0.75-0.91). CONCLUSION: Markers of RV and LV dysfunction assessed by bedside echo are independent predictors of mortality in hospitalized COVID-19 patients, after adjustment for clinical variables.