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Introduction: The association of tracheostomy timing and clinical outcomes in ventilated COVID-19 patients remains controversial. Data from the pre-pandemic era has demonstrated the use of tracheostomy for ventilator weaning [1]. However, the use of tracheostomy in COVID- 19 patients was a subject of discussion [2]. Nevertheless, evidence of the impact of tracheostomy on the outcome in critically ill COVID patients is still lacking. This study aims to evaluate the impact on Intensive Care Unit (ICU) outcome (survival) of tracheostomy in COVID- 19 ventilated patients. Method(s): Monocentric descriptive observational study. Demographic and clinical data, timing of tracheostomy and outcome (ICU mortality) from 1st January to 31st December 2021 were registered. Analysis of descriptive statistics for continuous variables and survival analysis (log rank test). Result(s): 115 patients were included (72% males), all mechanically ventilated, 7 (6%) were subjected to tracheostomy. The mean age was 67.2 years (range 36-84 years). The ICU mortality was 62% (71). The group of patients not submitted to tracheostomy had a mean survival time of 24.4 days (SD +/- 1.5) and median survival time of 22 days (SD +/- 1.7). The group of patients that were subjected to tracheostomy, the mean survival time was 68.5 days (SD +/- 12.2) and median survival time was 50 days (SD +/- 2). This comparison is significative (Log Rank test, p = 0.0001). Conclusion(s): The present study demonstrates a better survival likelihood of the tracheostomized subpopulation. Tracheostomy was only done in 6% of patients, which elucidates a need to further prospective, randomized studies to assess the impact on the outcome of tracheostomy in ventilated COVID19 patients.
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Objective: to understand the concatenation of acts related to technological innovation in the face of the Covid-19 pandemic and its possible positive consequences for Brazil. Thus, the scenario resulting from the spread of the new coronavirus and vaccine development processes for its eradication will be analyzed, as well as the role of regulatory agencies, comparing pre-and post-pandemic procedures. Next, considerations will be brought about the ChAdOx1 nCoV-19 vaccine, the result of a partnership between the University of Oxford and the biopharmaceutical AstraZeneca, from the United Kingdom, with the Oswaldo Cruz Foundation, from Brazil, and the international technology transfer agreement signed between the institutions. Methodology: national and international data will be examined, as well as Brazilian regulations, collected from official electronic pages of health agencies and institutions responsible for developing the vaccine, in addition to using legal dogmatics, specifically doctrine, with a deductive approach. Results: it is observed that the acts practiced by the Brazilian parties appropriately considered the consequences of the decisions taken and advanced towards fulfilling their intrinsic value and achieving positive results for the country and its people, such as obtaining new technologies, future autonomy in production of vaccines and the resulting economic, social and public health gains from such achievements. Contributions: it should be noted that the work is original and contributes to mastering the transformations experienced worldwide, since, in the global search for a solution that can eradicate the disease, there has been a significant acceleration in national and international movements and cooperation, which are being of greater importance to contribute to the advancement of studies in order to stop the pandemic, also promoting human dignity and enabling social and economic development. © 2023, Centro Universitario Curitiba - UNICURITIBA. All rights reserved.
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Health and wellness tourism had a growing interest in the Portuguese population until 2019. However, with the ap-pearance of Covid-19, several establishments had to close over these two years, this segment being one of the most affected areas. Many water users looked forward to the opening of the spa resorts to continue their treatments. Giv- en the importance of this theme, this work has as its main goal the definition of a consumer profile and to identify the determinants of satisfaction of the thermal tourists, as well as to gauge the degree of knowledge of thermal tourism and specifically of spas in the Portuguese context. In methodological terms, a questionnaire survey was conducted among the tourists to achieve the research objectives. The results show a younger, healthier and diversified thermal tourism practitioner. It also reveals similarities with other profile and motivations studies. However, it is possible to notice a few differences. Practitioners are seeking a combination of a leisure and health dimension and valorise fac- tors such as location and access of the establishments, quality of the services provided and rest and tranquillity. An issue regarding their length of stay has been identified. As they are locals and live in the same country as the thermal spa, most respondents do not stay overnight at the destination. In the future, it would be interesting to research product development and market strategies for diversified thermal practitioners.
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PurposeThe purpose of this study is to unpack the relationship between employees' perceptions of organizational politics and their counterproductive work behaviour, by postulating a mediating role of organizational disidentification and a moderating role of perceived external crisis threats to work. Design/methodology/approachThe empirical assessment of the hypotheses relies on survey data collected among employees who work in a large banking organization. FindingsPerceptions that organizational decision-making is marked by self-serving behaviour increase the probability that employees seek to cause harm to their employer, because they feel embarrassed by their organizational membership. This mediating role of organizational disidentification is especially prominent when they ruminate about the negative impact of external crises on their work. Practical implicationsThis study details an important danger for employees who feel upset with dysfunctional politics: They psychologically distance themselves from their employer, which then prompts them to formulate counterproductive responses that likely make it more difficult to take on the problem in a credible manner. This detrimental dynamic is particularly risky if an external crisis negatively interferes with their work functioning. Originality/valueThis study adds to prior research by detailing an unexplored but relevant mechanism (organizational disidentification) and moderator (external crisis threats) by which perceived organizational politics translates into enhanced counterproductive work behaviour.
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Death has become increasingly visible on social networks, especially after COVID-19, and Facebook addresses that with double standards: while some profiles remain active, others turn into memorials. This article investigates how Facebook's system deals with dead users' profiles either to support or restrict interactions concerning users' deaths. Our qualitative analysis of data from 54 public profiles of people who died between June 2020 and March 2021 showed that (i) Facebook fails to communicate the criteria for transforming profiles into memorials;(ii) no information about their contacts of deceased users' profiles is given;(iii) the frequency of interaction with memorials and with active profiles is different;(iv) profiles' privacy settings shape interaction. Our results exemplify how a sociotechnical system influences people's interactions with dead users' profiles. We herein highlight implications for interaction design and evaluation, besides the need to consider interaction as existence, which raises big challenges to the Human Computer Interaction (HCI) community.
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Background: Telemedicine (TM) has grown substantially worldwide during COVID-19 pandemic, with numerous advantages in healthcare. Specific governmental recommendations and society guidelines are currently stablished to direct a safe and efficient use of TM. The aim of this study was to assess the characteristics of TM practices among Brazilian allergists/immunologists (A/I) doctors and to evaluate their knowledge on the regulatory recommendations. Method(s): An electronic, self-reported survey (27 questions regarding demographic data, TM practices and knowledge about regulatory recommendations) was e-mailed once a week between August and October/2021 to 2600 Brazilian A/I doctors. Result(s): 205 (7.9%) participants fulfill the forms. One form was excluded due to be duplicate. 143/204 (70.2%) are currently using TM in their daily practice, and 184 (89.9%) had never used it before COVID-19 pandemic. 192 A/I doctors (93.8%) used TM for follow-up appointments, 186 (91%) to check complementary tests, and 136 (66.7%) used it in first consultations. 143 A/I doctors (70.2%) felt safe on their diagnostic through TM, and 7 (3.5%) answered that they could not find a correct diagnostic using TM. The main benefits of TM reported were: greater accessibility, mainly in more distant areas 159 (77.6%), reduced traveling costs 158 (77.1%) and safety regarding COVID-19 transmission 145 (71.2%). On the other hand, some disadvantages of TM were listed by participants: absence of physical examination 183 (89.7%), weakened patient-physician relationship 59 (28.8%) and internet issues 45 (22%). Regarding legal/ ethic field, 105 (51.4%) of the specialists applied the consent terms and 34 (16.7%) recorded the teleconsultation, both required steps in a TM appointment, according to local regulatory recommendations. Additionally, inappropriate online platforms for TM, such as social media apps and non-specific online meeting programs, were reported to be used by 131 (64.1%) of participants. Eighty (40%) did not read the official statements and recommendations which regulate TM practice in Brazil. Conclusion(s): An increasing use of TM in Brazil was observed, mainly influenced by COVID-19 pandemic. Its benefits are clear;however, it is primordial to ensure all the correct and recommended practices are being followed when using this modality of healthcare service, in order to avoid ethical, legal and medical issues that may arise.
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Background: Coronavirus disease 2019 (COVID-19) has been associated with significant morbidity and mortality, with cardiovascular involvement being usual. Elevations in cardiac Troponin-I level has proposed as an independent biomarker for mortality among patients with COVID-19. Aim(s): To evaluate the role of high sensivity Troponin-I (hs-TnI) level at hospital admission in predicting 30 day in-hospital mortality and 6-month mortality in patients hospitalized with a COVID-19 diagnosis. Method(s): We performed a retrospective single-center cohort study including consecutive patients aged 18 years and older who were admitted for COVID-19, during a 1-year period (n=818). We excluded patients with acute coronary syndrome (n=23), patients with acute heart failure (n=42), and patients in which hs-TnI level was not dosed at admission (n=163). Patients were divided into two groups according to hs-TnI levels: Hs-TnI <19.8 vs hs-TnI >=19.8 pg/mL. Primary outcomes were 30-day in-hospital mortality and 6-months mortality. According to the data distribution, appropriate statistical tests were conducted to compare independent samples. Multivariable logistic regression was used to analyze mortality risk. Receiver operator characteristics (ROC) curve and area under the curve (AUC) were obtained to determine the discriminative power of hs-TnI as a predictor of mortality. (Figure 1). Result(s): This cohort included 590 patients. Mean age was 71 >=+/-15 years and 52.4% were men. Overall, 209 patients (35.4%) had elevated hs- TnI levels and 381 patients had normal hs-TnI levels. Individuals in the hs-TnI >=19.8 pg/mL group were older (80+/-11 vs 66+/-14 years, p<0.001) and presented higher prevalence of chronic heart failure (24.9% vs 7.1%, p<0.001), hypertension (77.0% vs 57.5%, p<0.001), atrial fibrillation/flutter (19.1% vs 5.5%, p<0.001), prior stroke (12.4% vs 5.2%, p=0.001) and ischemic heart disease (12.4% vs 3.7%, p<0.001). There was no difference in length of hospital stay between the groups (8.0 [IQR 9.6] in hs-TnI 19.8 pg/mL group vs 9.0 [IQR 8.0] normal hs-TnI group, p=0.669). Troponin-I was the only independent predictor of in-hospital mortality (OR 3.80, CI 95%: 2.44-5.93, p<0.001), see Table 1. The troponin levels had the highest area under the receiver operating characteristic curv (AUC) with an AUC of 0.705 (95% CI: 0.667-0.742, p<0.001) for association with the inhospital mortality (figure 1). There was no difference in 6-months mortality between the two groups. Conclusion(s): Acute myocardial injury is common in patients hospitalized with COVID-19. In the present study a TnI level >=19.8 pg/mL was predictor of 30 days in-hospital mortality, suggesting that raised levels of this biomarker is associated with adverse prognosis. This tool might be useful for COVID-19 patient risk stratification. Further studies are needed to provide robust data and reliable recommendations on this theme.
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Background. Autoimmune rheumatic diseases (ARD) include various chronic conditions with high morbidity and mortality rates, and an increased risk of infections, including the new COVID-19. It is possible that adolescents with ARD have higher levels of psychological distress which may affect their mental health and life conditions. The objectives were to assess mental health and life conditions in adolescents with autoimmune rheumatic diseases (ARD) and healthy controls in social isolation, emphasizing some demographic aspects and daily routine of adolescents with juvenile dermatomyositis (JDM) during the COVID-19 quarantine. Methods. A cross-sectional study, performed from July 2020 to October 2020, included 155 ARD adolescents and 105 healthy controls. Online survey composed by self-reported strengths and difficulties questionnaire (SDQ) and a semi-structured questionnaire was filled in regarding demographic data, daily home and school routine, physical activities and COVID-19 information during the pandemic. Results. The patients included in the study presented the following underlying diseases: 15% JDM, 29% juvenile systemic lupus erythematosus (JSLE) and 56% juvenile idiopathic arthritis (JIA). Among adolescents with JDM, 71% were female, 54% Caucasian and the median age was 14 years (range 10-18). Regarding school data, 92% JDM participants attended school before pandemic, 75% studied in public schools and up to 17% did not present home schooling during the quarantine. All JDM patients agreed with stay-home policy after pandemic outbreak, and they reported change in life routine (96%), sleep problems (29%), sleep after midnight (75%) and increased screen time (87%). Worsening of family financial situation (37%) and increased family violence (8%) were also observed. Concerning mental health assessment, it was verified that one third of JDM subjects presented abnormal total difficulties and emotional scores of SDQ. No differences were found regarding sex, ethnicity and current age between ARD patients and controls (p>0.05). The frequencies of abnormal SDQ total (32% vs. 32%, p=0.901) and emotional (38% vs. 35%, p=0.653) were similar in both groups. Logistic regression analyses in ARD patients demonstrated that female (OR=2.4;95%CI 1.0-6.0;p=0.044) was associated with severe emotional SDQ dysfunction, whereas poor sleep quality was considered risk factor for both worse total SDQ (OR 2.6;95% CI 1.2-5.5;p=0.009) and emotional SDQ scores (OR=4.6;95%CI 2.2-9.7;p<0.001). Comparisons between ARD patients with and without current prednisone use showed higher median scores of peer problems in the first group [3(0-10) vs. 2(0-7), p=0.049]. The median and frequencies of SDQ scores and domains were similar between JDM, JSLE and JIA (p>0.05). Conclusions. Approximately one third of JDM, JSLE and JIA patients presented abnormal total difficulties and emotional scores of SDQ. Female sex and poor sleep quality were the main factor associated with emotional impact in these ARD adolescents.
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Objective: To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal. Methods: This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined. Results: Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39;p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136;p = 0.6), antibiotic therapy (57% versus 64%;p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%;p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5];p = 0.002) and presented a higher use of vasopressors (47% versus 36%;p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%;p < 0.001) at admission, prone positioning (45% versus 36%;p = 0.04), and hydroxychloroquine (59% versus 10%;p < 0.001) and lopinavir/ ritonavir (41% versus 10%;p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%;p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau. Conclusion: There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave. © 2023 Associacao de Medicina Intensiva Brasileira - AMIB. All rights reserved.
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Background: The key impact of SARS-CoV-2 is its ability to cause a life-threatening infection in the lung. Aim(s): Using spatially resolved multiplex imaging the present study decodes the immunopathological complexity of severe COVID-19. Method(s): Autopsy lung tissue from 18 COVID-19 patients was used to map immune and structural cells in acute/exudative, intermediate and advanced diffuse alveolar damage (DAD) through multiplex immunohistochemistry and spatial statistical analyses. Cytokine profiling, viral, bacteria and fungi detection and transcriptome analyses were also performed. Result(s): All cases displayed concomitant patterns of DAD. The spatially resolved multiplex data revealed intricate patchworks of mm -size microenvironments representing distinct immunological niches. In-depth analysis of DAD areas revealed that the temporal/spatial DAD progression is associated with expansion of adaptive immune cells, macrophages, CD8 T cells, fibroblasts, angiogenesis and lymphangiogenesis. Viral load correlated positively with acute DAD and negatively with disease/hospital length. Cytokines correlated mainly with macrophages and CD8 T cells. Pro-coagulation and acute repair markers were enriched in acute DAD whereas intermediate/advanced DAD had a molecular profile of elevated humoral and innate immune responses and extracellular matrix production. Conclusion(s): Our unraveling of the spatio-temporal immunopathology in COVID-19 cases exposes the heterogeneous dynamics of acute viral infection and subsequent responses that occur side-by-side in the lungs. This complex disease feature has important implications for disease management and development of novel immunemodulatory treatments.
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Severe COVID-19 induces DAD, a condition with temporal-spatial heterogeneity. We determined the differentially expressed genes (DEGs) in the histological patterns of DAD. Twelve fatal COVID-19 cases were classified in acute DAD (n=5) and intermediate/advanced (IA) DAD (n=7). Autopsy lung RNA was extracted from COVID-19 and 4 control cases. RNA sequencing was performed on the Illumina NovaSeq 6000. Enrichment analysis was performed with clusterProfiler using Genome-wide annotation for Human R package. GO terms and KEGG pathways were considered enriched if adjusted p<=0.05. Principal component analysis showed that IA-DAD samples were grouped, while acute DAD samples were scattered. The differential expression analysis between these two groups and the control cases revealed: 261 DEGs in the acute DAD (143 Up- and 53 Down-regulated), 244 DEGs in the IA- DAD tissues (67 Up- and 116 Down-regulated), and 61 DEGs were shared between them (45 Up- and 16 Downregulated). Patients with acute DAD had up-regulated genes related to oxidative phosphorylation, blood coagulation, megakaryocytes differentiation/regulation, and platelet degranulation/activation. Patients with IA-DAD had DEGs related to immunoglobulins and extracellular matrix. The shared up-regulated DEGs between both patterns are involved in innate and adaptive immune responses. We selected 3 DEGs in each DAD pattern for validation by realtime PCR. There were no differences in acute DAD DEGs, but DEGs overexpressed in intermediate DAD (COL3A1, IGLV3-19, IGHV1-58) were significantly higher. Genes related to thrombotic events occur at the acute stage of DAD, whereas immunoglobulin production and remodeling occur at later stages of DAD.
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SARS-CoV2 infection induces a complex interaction between virus and host immune system, activating multiple inflammatory pathways and leading to hyperinflammation, diffuse alveolar damage (DAD), ARDS, and multiorgan failure. We aimed to correlate the quantification of viral load, inflammatory cells and cytokines in lung tissue of fatal COVID-19. We assessed inflammatory cells by multiplex immunohistochemistry, cytokines by Luminex xMAP Assay and viral load by real time PCR in autopsy lung tissue of 18 COVID-19 patients. Correlations were considered statistically significant if p<0.05. Macrophages correlated with IL-1beta (r=0.54), IL-10 (r=0.5), IFN-alpha2 (r=0.72), IFN-gamma (r=0.6), CCL20 (r=0.5), TGF-beta1 (r=0.6), TGF-beta2 (r=0.6). CD4+T cells correlated with CCL20 (r=0.6), MDC/CCL2 (r=0.53), CCL17 (r=0.5), IP-10 (r=0.6), CXCL9 (r=0.6). CD8+T cells correlated with IL-1beta (r=0.54), IL-4 (r=0.63), IL-6 (r=0.7), IL-8 (r=0.63), IL-10 (r=0.6), TNF-alpha (r=0.6), IFN-gamma (r=0.74), CCL20 (r=0.7), TGF-beta1 (r=0.7), TGF-beta2 (r=0.56), TGF-beta3 (r=0.54), MDC/CCL2 (r=0.7), CCL17 (r=0.64). Langerin dendritic cells (DC) correlated with symptom onset to death interval (r=0.6), hospitalization length (r=0.65), mechanical ventilation (MV) length (r=0.6), ICU stay (r=0.6), exudative DAD (r=-0.5), viral load (r=-0.6). Myeloid DC correlated with symptom onset to death interval (r=0.8), hospitalization length (r=0.8), MV length (r=0.8), ICU stay (r=0.8), exudative DAD (r=-0.5), viral load (r=-0.7). Viral load correlated with symptom onset to death interval (r=-0.7), hospitalization length (r=-0.8), MV length (r=-0.7), ICU stay (r=-0.8), exudative DAD (r=0.6). There is a complex temporal inflammatory modulation in severe COVID-19.
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Background: In large-scale community transmission, such as severe acute respiratory syndrome of the COVID-19, monitoring geographic trends and estimating the transmission intensity is critical to support decisions on actions to be taken. Though major efforts are concentrated on testing the populations, the availability and timing of this data pose a clear limitation to realtime monitoring. Purpose(s): This study proposes a retrospective analysis to develop a novel methodology to detect and monitor the COVID-19 epidemiological activity using a selected subset of over-the-counter (OTC) products sold in community pharmacies in Portugal. Previous studies have successfully demonstrated this approach to different epidemiological outbreaks as individuals tend to self-manage the symptoms. Method(s): The subset of OTC products was selected considering therapeutic indication for symptoms of infection by SARS-CoV-2 and the trends observed for diagnosed cases in Portugal. The similarities between the trends of the subset of products and the daily new-suspected and new-confirmed cases of COVID-19, respectively, were assessed using lagged spearman correlation analysis. The trend of the subset of products selected presented high and statistically significant correlations to new-suspected and new-confirmed cases lagging 14-16 days (correl.>0.82;p<0.001). Highest correlation to both new-suspected and new-confirmed cases was found lagging 15 days (0.879 and 0.888, respectively;p<0.001). Conclusion(s): The study supports the use of the methodology presented to anticipate the trends of COVID-19 outbreaks in Portugal, both locally and nationwide, considering representativity of the presence of community pharmacies to the distribution of populations.
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Aim: Since the early phases of the COVID-19 pandemic, health systems tried to adapt to ensure the continuity of care of oncological patients. This study aimed to describe the impact of SARS-CoV- 2 on rectal cancer screening and staging. Method(s): A two-year (March 2019 to March 2021) retrospective study concerning rectal cancer patients from a referral center was conducted. Patients clinical data from pre-COVID (March 2019 -February 2020) and COVID time (March 2020 -March 2021) was compared. Descriptive and inferential analysis was performed (Chi-Square test). Result(s): One hundred and sixty-five patients were discussed at the multidisciplinary meetings during the 2-year study period (mean age 69 years [+/- 11.1];M: 64%;F:36%). Upon comparative analysis both pre-COVID and COVID patients were found to have similar demographic characteristics, however during the pandemic a higher proportion of patients presented with low rectal cancers (36% vs. 42%;P = 0.1). Moreover, during the COVID period, fewer patients (minus 26%;npre-covid= 95 vs. ncovid = 70) were referred to the hospital, and a larger number of patients presented in Stage IV of the disease (17,9% (n = 17) in pre COVID period vs. 28,6% (n = 20) in COVID period (P = 0.07)). Lastly, the authors run a comparative sub-analysis between the above results and data from the 3 years prior to the pandemic (2017-2019) and still came across with lesser rectal cancer referrals during the pandemic year. Conclusion(s): Our data clearly shows that, during the COVID period, fewer patients received in-hospital care and a higher number were referred in Stage IV. This represents a red flag for the community and should alert the government to implement public health policies to reestablish colorectal cancer standard of care.
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Background: Patients with rheumatoid arthritis (RA) on methotrexate have reduced vaccine responses. Temporary discontinuation has improved immuno-genicity of anti-infuenza vaccine, but this strategy has not been evaluated in anti-SARS-CoV-2 vaccines. Objectives: To evaluate the effect on immunogenicity and safety of 2-week methotrexate (MTX) discontinuation after each dose of the Sinovac-CoronaVac vaccine versus MTX maintenance in rheumatoid arthritis (RA) patients. Methods: This was a single-center, prospective, randomized, investigator-blinded, intervention study (#NCT04754698, CoronavRheum), including adult RA patients (stable CDAI≤10, prednisone ≤7.5mg/day), randomized (1:1) to withdraw MTX (MTX-hold) for 2 weeks after each vaccine dose or maintain MTX (MTX-maintain), evaluated at D0, D28 and D69. Co-primary outcomes were anti-SARS-CoV-2 S1/S2 IgG seroconversion(SC) and neutralizing antibody (NAb) positivity at D69. Secondary outcomes were geometric mean titers (GMT) and fare rates. For immunogenicity analyses, we excluded patients with baseline positive IgG/NAb, and, for safety reasons, those who fared at D28 (CDAI>10) and did not withdraw MTX twice. Results: Randomization included 138 patients with 9 exclusions (5 COVID-19, 4 protocol violations). Safety evaluation included 60 (MTX-hold) and 69 (MTX-maintain) patients. Further exclusions: 27 patients [13 (21.7%) vs. 14 (20.3%), p=0.848] with positive baseline IgG/NAb and 10 patients (21.3%) in MTX-hold with CDAI>10 at D28. At D69, MTX-hold (n=37) had a higher rate of seroconversion than MTX-maintain (n=55) group [29 (78.4%) vs 30 (54.5%), p=0.019], with parallel augmentation in GMT [34.2 (25.2-46.4) vs 16.8 (11.9-23.6), p=0.006]. No differences were observed for NAb positivity [23 (62.2%) vs 27 (49.1%), p=0.217]. At D28 fare, rates were comparable in both groups (CDAI, p=0.122;DAS28-CRP, p=0.576), whereas CDAI>10 was more frequent in MTX-hold at D69 (p=0.024). Conclusion: We provide novel data that 2-week MTX withdrawal after each Sinovac-CoronaVac vaccine dose improves anti-SARS-CoV-2 IgG response. The increased fare rates after second MTX withdrawal may be attributed to the short-term interval between vaccine doses. This strategy requires close surveillance and shared decision making due to the possibility of fares.
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The pandemic of Covid-19 began in Brazil in February 2020. To evaluate the evolution of pandemics some metrics can be estimated, such as the reproduction number, Rt, and the basic reproduction number, R0. Due to the delay in the notifications, these estimates may present a bias. Taking the reported data, besides a sample of individuals who reported the day of symptoms onset, it is possible to estimate delay probabilities and to perform a deconvolution to correct the notifications' delay. In this work, it was performed a corrected estimate of Rt. This estimate is done based on the curve of notifications corrected through deconvolution. The approach is applied in three country cities and in the capital of Minas Gerais state. The behavior of Rt concerning the Minas Consciente program was evaluated. It was observed that the corrected Rt was more suitable to measure the effect of the program when compared to the raw Rt. When it was determined a more rigid mobility and activities regime by the program, it was observed a decrease in the median of the variation of the Rt of the cities studied. © 2003-2012 IEEE.
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Researchers dealing with real-world data - such as in the healthcare domain - tend to face class imbalance issues. More specifically, publicly available datasets containing Chest X-Ray (CXR) of Pneumonia diseases (including COVID-19) usually have an imbalanced class distribution. This dataset imbalance causes automatic diagnosis systems to classify majority classes with much more accuracy than the minority ones. Several resampling algorithms were proposed in the past to deal with the class imbalance issue. Hierarchical classifiers have also been proposed to increase the predictive performance of classifiers, but there is little research in the literature verifying if using existing resampling algorithms with hierarchical classifiers are a good alternative to improve classification performance. This work proposes an experimental classification schema to investigate the effectiveness of using resampling algorithms in the identification of COVID-19 and other types of Pneumonia through CXR images. The proposed schema uses resampling algorithms to rebalance the class distribution, in a Local Hierarchical Classification scenario. The experimental evaluation, which is supported by inferential statistical analysis, showed that using specific resampling algorithms with Local Hierarchical Classifiers brings a statistically significant increase to the macro-averaged F1-Score, and improves the predictive performance for the minority classes.
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Background. Bloodstream infection (BSI) - Central and Non-Central Line Associated - and infections of the lower respiratory tract (RESP) - pneumonia and non pneumonia lower respiratory infections - are some of the main causes of unexpected death in Intensive Care Units (ICUs). Although the leading causes of these infections are already known, risk prediction models can be used to identify unexpected cases. This study aims to investigate whether or not it is possible to build multivariate models to predict BSI and RESP events. Methods. Univariate and multivariate analysis using multiple logistic regression models were built to predict BSI and RESP events. ROC curve analysis was used to validate each model. Independent variables: 29 quantitative parameters and 131 categorical variables. BSI and RESP were identified using Brazilian Health Regulatory Agency protocols with data collected between January and November 2020 from a medical-surgical ICU in a Brazilian Hospital. Definitions: if an infection is 5% or less likely to occur according to the model used and it eventually occurs, it will be classified as "unexpected", or else, if an infection is 10% or less likely to occur, it will be classified as "probably unexpected". Otherwise, infections will be classified as "expected". Patients with a 30% or more risk for BSI or RESP will be classified as "high risk". Results. A total of 1,171 patients were accessed: 70 patients with BSI (95% confidence interval [CI], 3.1%-5%), 66 patients with RESP (95% CI, 2.9%-4.7%), 235 deaths (95% CI, 11.8%-14.9%). Of the 160 potential risk factors evaluated, logistic models for BSI and RESP identified respectively five and seven predictors (Tables 1 and 2, and Figure 1). Patients admitted to the ICU with Covid-19 had a three fold BSI risk and five times more RESP risk than patients without this diagnosis. Conclusion. The built models make possible the identification of the expected infections and the unexpected ones. Three main course of actions can be taken using these models and associated data: (1) Before the occurrence of BSI and RESP: to place high risk patients under more rigorous infection surveillance. (2) After the occurrence of BSI or RESP: to investigate "unexpected" infections. (3) At discharge: to identify high risk patients with no infections for further studies.