The IMF COVID-19 Surveillance Monitor

Promoting stability is a core component of the International Monetary Fund (IMF) surveillance's mandate. The Covid-19 pandemic hit almost every country worldwide. This article evaluates whether and how the IMF surveillance documents in the aftermath of the health and economic crisis have identified risks and mitigation measures to improve health outcomes, protect vulnerable people and firms, and address climate change. Through the IMF COVID-19 Surveillance Monitor, a textual analysis index, the authors found that these issues received relatively little attention in Article IV consultations in 2019, with fiscal issues dominating the discussion. However, the consultations conducted in 2020 show some timely incremental shifts and more attention toward health systems and protecting vulnerable matters. While climate change has become a key part of senior IMF official narratives, it has not had a significant presence in surveillance activities. The techniques and indices developed here can help the IMF improve its surveillance policy. © 2022 Copyright 2022 by Koninklijke Brill NV, Leiden, The Netherlands.

Sedation Practices in Covid-19 Versus Non-Covid-19 Acute Respiratory Distress Syndrome Patients

INTRODUCTION: Coronavirus disease 2019-associated acute respiratory distress syndrome (CARDS) has been associated with high opioid and sedative requirements in patients requiring mechanical ventilation (MV). The purpose of this study was to characterize opioid and sedative use in patients with CARDS compared to those with non-CARDS. METHOD(S): A retrospective cohort study compared adult patients admitted to an intensive care unit (ICU) on MV with CARDS or non-CARDS between January 2018 and May 2020. Patients receiving at least one opioid or sedative infusion for at least 48 hrs were included. Patients were excluded if they were transferred from an outside hospital while on MV, deemed comfort care, admitted for status epilepticus, ischemic, or hemorrhagic stroke and/ or cardiac arrest, admitted with a tracheostomy, or received extracorporeal membrane oxygenation. Statistical analysis was conducted using descriptive statistics with the appropriate statistical tests depending on the distribution type. The primary objective was to compare the use of opioid and sedative agents administered to patients with CARDS and non-CARDS. Secondary objectives included neuromuscular blocking agent (NMBA) use, time on mechanical ventilation (MV), in-hospital and ICU length of stay (LOS). RESULT(S): A total of 59 CARDS and 19 non-CARDS patients were included. Opioid infusions were used in 100% of non-CARDS patients and 98% of CARDS patients during the first 10 days of MV (p=0.57). There was significantly higher use of propofol in CARDS patients compared to non- CARDS patients (100% vs 89%, p=0.01) and higher median daily dose (3847mg vs 2992mg;p=0.018). No difference in median cumulative dose of BZD was observed in the CARDS group vs non-CARDS group (50mg vs 9mg;p=0.131). Time on mechanical ventilation was significantly longer in the CARDS group compared to the non-CARDS group (17 days vs 11 days, p=0.003). Comparably, 73% of CARDS received NMBA vs 53% in non-CARDS, p=0.05. There was significantly higher in-hospital LOS (36 days vs 48 days, p=0.005) and ICU LOS (15 days vs 31 days, p=0.002) in the CARDS group compared to the non- CARDS group. CONCLUSION(S): Patients with CARDS were more likely to receive NMBA and required higher dosages of propofol. CARDS patients were on MV longer and had longer hospital and ICU LOS.

Linfoma Hepatoesplenico De Celulas T Gamma-Delta: Um Desafio Aos Hematologistas - Relato De Dois Casos

Objetivo: Descrever dois casos com desfechos diferentes de linfoma hepatoesplenico de celulas T gamma-delta (LHECTGD), entidade rara que corresponde a menos de 1% dos linfomas nao-Hodgkin. Caso clinico: Caso 1: Feminina, 71 anos, portadora de artrite reumatoide, HAS e glaucoma, internada por pancitopenia e pneumonia bacteriana sobreposta a infeccao por COVID-19. Fazia seguimento ha 2 anos com hematologia por anemia e plaquetopenia, sem exames diagnosticos. Em avaliacao medular, imunofenotipagem de medula compativel com linfoma T hepatoesplenico (LTHE). Devido intercorrencias infecciosas, paciente evoluiu para obito antes do tratamento da doenca hematologica. Caso 2: Masculino, 47 anos, avaliado em servico de hematologia devido hepatoesplenomegalia, baco ate 15cm do rebordo costal esquerdo (RCE), pancitopenia com neutropenia grau IV em hemograma inicial, descartadas infeccoes virais e leishmaniose visceral. Em avaliacao medular, biopsia de medula ossea evidenciou infiltracao por doenca linfoproliferativa B e imunohistoquimica inconclusiva. Imunofenotipagem de aspirado de medula ossea compativel com infiltracao por LTHE. O paciente recebeu tratamento com 6 ciclos de CHOEP e encontra-se com normalizacao de hemograma apos ultimo nadir, resposta clinica (reducao do baco para 3cm RCE e melhora dos sintomas B), alem de resposta em imagem no exame PET-CT. Atualmente, transplante autologo em andamento no intuito de consolidacao de resposta. Discussao: O LHECTGD tem pico de incidencia em adolescentes e adultos jovens e uma razao homem/mulher de 9:1. E uma doenca rara, visto que a maioria dos linfomas de celulas T expressa receptores alfa-beta e apenas 2-4% expressam receptores gamma-delta. Atualmente ha pouco mais de cem casos descritos na literatura, sendo definido como um linfoma de proliferacao maligna de celulas T nos sinusoides do figado, na polpa vermelha do baco e na medula ossea. O fenotipo frequentemente exposto e de celulas T CD2+, CD3+, CD4-, CD5-, CD7+-, CD8-, com expressao de receptor celula T gama delta ou alfa beta. Dentre as anormalidades citogeneticas associadas, inclui-se o isocromossomo 7q com ou sem trissomia do 8. Clinicamente, os pacientes apresentam sintomas B, alem de hepatoesplenomegalia acentuada, sem adenomegalias suspeita, o que aumenta o desafio diagnostico e leva a inferencias diagnosticas infecciosas e de hipertensao portal antes do diagnostico hematologico. O tratamento engloba desde a intervencao cirurgica, como a esplenectomia - no intuito de controlar o hiperesplenismo e evitar uma das principais causas de obito, a ruptura esplenica -, alem de quimioterapias baseadas em regimes que contenham etoposideo, sem esquemas com relato de superioridade na literatura. O transplante autologo (e em alguns relatos, o alogenico) foram indicados para consolidacao quando ha resposta ao tratamento. Conclusao: O LHETGD e uma doenca rara, de prognostico reservado, com multiplos relatos de atraso diagnostico devido a ausencia de sintomas especificos da doenca. Recomenda-se, assim, que, diante de paciente jovens, com quadro de trombocitopenia ou alteracoes de outras linhagens e hepatoesplenomegalia, a hipotese diagnostica de LHECTGD deve ser considerada. Em relacao ao arsenal terapeutico disponivel atualmente, novos estudos mostram-se necessarios, objetivando melhorar a expectativa e qualidade de vida dos pacientes. Copyright © 2022

Using digital chatbots to close gaps in healthcare access during the COVID-19 pandemic.

INTRODUCTION: Chatbots have emerged as a first link to care in recent years. The COVID-19 pandemic, and consequent health system disruptions, expanded their use. Socios En Salud (SES) introduced chatbots in Peru, which experienced one of the highest excess COVID mortalities in the world. METHODS: SES and the government identified unmet population health needs, which could be amenable to virtual interventions. Chatbots were developed to screen individuals for these conditions; we describe the period of deployment, number of screenings, and number of people who received services. RESULTS: Between April 2020 and May 2021, SES deployed nine ChatBots: four for mental health, two for maternal and child health, and three for chronic diseases: breast cancer, hypertension, diabetes mellitus, and obesity. Mental health services were provided to 42,932 people, 99.99% of those offered services. The other ChatBots reached fewer people. Overall, more than 50% of eligible people accepted chatbot-based services. DISCUSSION: ChatBot use was highest for mental health. Chatbots may increase connections between a vulnerable population and health services; this is likely dependent on several factors, including condition, population, and penetration of smart phones. Future research will be critical to understand user experience and preferences and to ensure that chatbots link vulnerable populations to appropriate, high-quality care.

INTRODUCTION: Les chatbots se sont imposés comme un premier lien aux soins ces dernières années. La pandémie de COVID-19, et les perturbations du système de santé qui en ont résultées, ont élargi leur champ d'application. Socios En Salud (SES) a introduit les chatbots au Pérou, qui a connu l'une des surmortalités dues au COVID les plus élevées au monde. MÉTHODES: SES et le gouvernement ont identifié des besoins non satisfaits en matière de santé de la population, qui pourraient faire l'objet d'interventions virtuelles. Des chatbots ont été développés pour dépister des individus pour ces conditions ; nous décrivons la période de leur déploiement, le nombre de dépistages et le nombre de personnes qui ont reçu ces services. RÉSULTATS: Entre avril 2020 et mai 2021, SES a déployé neuf ChatBots : quatre pour la santé mentale, deux pour la santé maternelle et infantile et trois pour les maladies chroniques, comme le cancer du sein, l'hypertension, le diabète et l'obésité. Des services de santé mentale ont été fournis à 42 932 personnes, soit 99,99% des personnes proposées. Les autres ChatBots ont touché moins de personnes. Dans l'ensemble, plus de 50% des personnes éligibles ont accepté les services proposés par les chatbots. DISCUSSION: L'utilisation des ChatBots était la plus élevée pour la santé mentale. Les chatbots peuvent augmenter les connexions entre une population vulnérable et les services de santé, mais cela dépende de plusieurs facteurs, dont la condition, la type de population et la pénétration des smartphones. Les recherches futures seront essentielles pour comprendre l'expérience et les préférences des utilisateurs et pour s'assurer que les chatbots relient les populations vulnérables vulnérables aux soins appropriés et de qualité.

Omission of meals, nutritional status and metabolic profile of patients with type 2 diabetes mellitus

Introduction: Skipping meals has been associated with cardiometabolic risk factors such as overweight and insulin re-sistance. Despite this, data on the frequency of meals and the influence on the nutritional and metabolic status of individu-als with type 2 Diabetes Mellitus (DM2) are scarce.Objective: To investigate the correlation between missed meals, body mass index (BMI) and metabolic profile of DM2 patients during the COVID-19 pandemic.Methodology: Cross-sectional study with 107 individuals followed at a Nutrition outpatient clinic of a reference hospi-tal in Fortaleza, Ceara. Socioeconomic, clinical, anthropomet-ric and biochemical data were collected. Meal omission was verified using a 24-hour dietary recall. The correlation be-tween the variables was verified by the Spearman and Chi -Square test, considering p<0.05 as significant.Results: The mean age of participants was 62 +/- 11.34 years, where most were women (57.9%). The mean BMI was 28.67 +/- 5.13 kg/m2 and most were overweight (68%). Participants ate an average of 5 +/- 0.94 meals per day. The median number of meals skipped was 1 (0 -3) and 60.7% skipped at least 1 meal. The most missed meals were supper (41%) and a morning snack (38%). There was a significant positive correlation between the number of skipped meals with BMI and weight.Conclusion: The number of skipped meals is directly cor-related with the nutritional status of older adults and elderly people with DM2.

COVID-19 pneumonia. Experience of a public hospital in Argentina

COVID-19 pneumonia represents a challenge for health systems. The objective of this study is to describe the clinical presentation and evolution of hospitalized patients with COVID-19 pneumonia. This is a prospective and descrip tive study. Patients older than 16 years with a PCR confirmed diagnosis of COVID-19 were included in 94.0% (n=395) of the cases. Biochemical and imaging determinations were made. 421 patients were included, 57.0% male (n=240), with a mean age of 56.1 .. 15.1 years. 41.0% (n=172) were older than 60 years. 79.7% (n=333) had comorbidities. They had seven days 7 days (IQR 5) from symptom onset to hospitalization. The most frequent symptoms were: dyspnea (78.1%, n=307), cough (76.5%, n=297) and fever (73.6%, n=289). 50.2% (n=204) presented respiratory failure upon admission. 63.4% (n=173) presented pathological infiltrates on radiography and 96.0% (n=312) on chest tomography. The 4C score was 8 (IQR 6). 31.6% (n=133) had a poor clinical evolution. In-hospital mortality was 18.9% (n=80) and 23.7% (n=100) received mechanical ventilation. 21.9% (n=92) presented in-hospital complications. 39.6% (n=67) of those over 60 years of age were admitted to the Intensive Care Unit and 31.4% (n=54) died. 76.9% (n=319) of the patients received corticosteroids, 69.3% (n=289) antibiotics, and convalescent plasma 10.5% (n=43). This series stands out for the high rate of co morbidities and the severity of the patients included. Mortality was similar to other international series.

Data-assimilation and state estimation for contact-based spreading processes using the ensemble kalman filter: Application to COVID-19.

The main aim of the present paper is threefold. First, it aims at presenting an extended contact-based model for the description of the spread of contagious diseases in complex networks with consideration of asymptomatic evolutions. Second, it presents a parametrization method of the considered model, including validation with data from the actual spread of COVID-19 in Germany, Mexico and the United States of America. Third, it aims at showcasing the fruitful combination of contact-based network spreading models with a modern state estimation and filtering technique to (i) enable real-time monitoring schemes, and (ii) efficiently deal with dimensionality and stochastic uncertainties. The network model is based on an interpretation of the states of the nodes as (statistical) probability densities samples, where nodes can represent individuals, groups or communities, cities or countries, enabling a wide field of application of the presented approach.

LEPTOSPIROSE EM PACIENTE COM ARTRITE REUMATOIDE: UM DESAFIO DIAGNÓSTICO - RELATO DE CASO

O objetivo desse relato de caso foi demonstrar as particularidades no diagnóstico e possíveis diagnósticos diferenciais em pacientes imunossuprimidos com síndrome febril aguda. Paciente feminina, 37 A, auxiliar administrativo, portadora de artrite reumatoide, imunossuprimida em uso de Simponi associado a Metotrexato 10 mg/semana, com diagnóstico anterior de tumor desmóide em 2016. Após a 2ª dose de Simponi, cursa com quadro agudo de cefaleia de característica persistente, refratária a uso de sintomáticos, acompanhado de náuseas, com queda relativa do estado geral, sudorese de característica noturna, mialgia difusa e episódios recorrentes de febre. Durante esse período foi imunizada com a 2ª dose da vacina para o covid-19. Após a vacinação surgiu nova sintomatologia, disúria isolada. Diante disso, conduzimos com a internação hospitalar para rastreio infeccioso e vigilância clínica. Foi interrogado descompensação infecciosa viral, ITU, reação medicamentosa de suspeição pouco provável e doença hematológica. Foi solicitado laboratório completo, incluindo sorologias virais para citomegalovírus, EBV, parvo vírus, toxoplasmose, leptospirose, hemocultura de 2 amostras de sítios diferentes, EAS e urocultura, ferritina e triglicerídeos devido a febre com alterações de transaminase, aventando um possível quadro viral desencadeado por síndrome hematofágica. Complementando com exames de imagem, como USG de abdome total para avaliar a possibilidade de hepatoesplenomegalia e USG de cervical para avaliar linfonodos. Paciente evolui com piora clínica em vigência de dor abdominal. Solicitada tomografia de abdome, apresentando imagem com vesícula parcialmente distendida, associado à presença de líquido perivesicular, A clínica cirúrgica opta por abordagem invasiva, sendo realizado colecistectomia videolaparoscopia. No pós-operatório, ficando aos cuidados intensivos pela UTI e escalonado para tazocin (D10). Após resultado da sorologia para leptospirose com IgM reagente interrompeu uma longa série de exames negativos e febre prolongada, sem diagnóstico. Apresentou evolução clínica satisfatória, resultando em alta hospitalar. A artrite reumatoide é acompanhada de sintomas constitucionais inespecíficos, principalmente a febre baixa em pacientes imunossuprimidos. O diagnóstico de leptospirose foi concluído mais tardiamente, quando os exames da admissão foram disponibilizados. Um caso de uma enfermidade de alto impacto, contudo negligenciada como problema de saúde pública.

CRIANÇAS COM SÍNDROME RESPIRATÓRIA AGUDA GRAVE (SRAG) CONFIRMADA EM HOSPITAL DE REFERÊNCIA PEDIÁTRICA EM BELO HORIZONTE, MINAS GERAIS

Introdução: Descrever o perfil epidemiológico de crianças com infecção confirmada por SRAG internadas no Hospital Infantil João Paulo II (HIJPII), referência em doenças infectocontagiosas, entre março de 2020 e agosto de 2021. Método: Trata-se de um estudo realizado pelo Núcleo de Vigilância Epidemiológica Hospitalar (NUVEH) do HIJPII, utilizando os dados das fichas de notificação de SRAG, Este estudo foi aprovado pelo Comité de Ética em Pesquisa da FHEMIG sob parecer: 4.312.966. Resultados: Entre março de 2020 e agosto de 2021, 2702 crianças internaram no HIJPII e foram notificados com SRAG. Foram realizados 2269 testes RT-PCR para SARS-CoV-2, 1026 pacientes realizaram teste rápido de antígeno e/ou fizeram o painel viral na Fundação Ezequiel Dias. A etiologia viral foi identificada em 692 crianças: 278 (40,2%) positivos para vírus sincicial respiratório (VSR), 174 (25,1%) positivos para rinovírus, 164 (23,7%) positivos para SARS-CoV2, 34 (4,9%) positivos para influenza A e/ou B, e 5,9% foram positivos para outros vírus (25 bocavirus, 3 parainfluenza, 13 adenovírus e 1 coronavírus sazonal). O diagnóstico de VSR foi realizado por RT-PCR em 72% e teste rápido de antígeno em 28%. SARS-CoV-2 foi detectado por RT-PCR em 81% e por teste rápido de antígeno em 19%. A idade variou entre 15 dias de vida e 18 anos, mas 72,9% eram menores de 6 anos, 55,5% do sexo masculino, 82% moravam em Belo Horizonte ou na região metropolitana. Entre as manifestações clínicas mais frequentes foram febre, tosse, diarreia, esforço respiratório, cianose e saturação menor que 95%. Nos casos mais graves as crianças tinham comorbidades, as mais frequentes: displasia broncopulmonar, doença neurológica crônica não progressiva, obesidade, anemia falciforme e cardiopatia. A letalidade por SRAG no HIJPII no período foi de 20,5% (4 crianças com SARS-CoV-2 e uma criança com VRS);entretanto apenas 29,4% dos óbitos por SRAG tiveram a etiologia viral identificada por não terem coletado painel viral. Conclusão: Os resultados encontrados reforçam a necessidade da realização do painel viral, para melhorar os dados da Vigilância Epidemiológica. Sua solicitação foi reduzida na pandemia, devido ao alto número de internações e necessidade de leitos, optou-se por realizar testes rápidos. Entretanto, como no HIJPII estão disponíveis testes rápidos apenas para VRS, SARS-CoV-2 e influenza, muitas crianças com SRAG ficaram sem identificação viral.

Teleconsultation for pediatric patients with type 1 diabetes mellitus during the COVID-19 pandemic: Experience of a university hospital in Brazil

Introduction: The SARS-CoV-2 pandemic expanded rapidly around the world in 2020 and health services needed to be reconfigured to meet the new demand and ensure the care of patients with chronic diseases. For patients with diabetes mellitus, the teleconsultation stood out as a tool for clinical management in this period. Objectives: Evaluate the impact of teleconsultation on glycemic control and prevention of acute complications related to diabetes mellitus in children and adolescents treated in a reference hospital during the COVID-19 pandemic in 2020. Methods: Descriptive study of data from pediatric diabetic patients who received teleconsultation between April and September 2020. Results: During this period, 143 diabetic patients were evaluated, with a median of 3.4 teleconsultations per patient in the studied period;requiring adjustment of insulin doses in 84.6% of cases. The hospital admission rate was 8,4% due to diabetic decompensation. The metabolic control (HbA1c) became worsen in 46% of the sample and improved in 37%. Conclusions: The teleconsultation promoted health care for patients with diabetes mellitus during the COVID-19 pandemic, but was not able to guarantee adequate glycemic control.

Development and validation of the ABC2-SPH risk score for in-hospital mortality in COVID-19 patients

Introduction: Fast and efficient assessment of prognosis of coronavirus disease 19 (COVID-19) is needed to optimize the allocation of health care and human resources, to empower early identification and intervention of patients at higher risk of poor outcome. A proper assessment tool may guide decision making, to develop an appropriate plan of care for each patient. Although different scores have been proposed, the majority of them are limited due to high risk of bias, and there is a lack of reliable prognostic prediction models. Purpose: To develop and validate an easy applicable rapid scoring system that employs routinely available clinical and laboratory data at hospital presentation, to predict in-hospital mortality in patients with COVID-19, able to discriminate high vs non-high risk patients. Additionally, we aimed to compare this score with other existing ones. Method: Cohort study, conducted in 36 Brazilian hospitals in 17 cities. Consecutive symptomatic patients (≥18 years old) with laboratory confirmed COVID-19 admitted to participating hospitals. Primary outcome was in-hospital mortality. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients that were admitted between March-July, 2020. The model was then validated in the 1054 patients admitted during August-September, as well as in an external cohort of 474 Spanish patients. Results: Median (25th-75th percentile) age of the model-derivation cohort was 60 (48-72) years, 53.8% were men, in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. From 20 potential predictors, seven significant variables were included in the in-hospital mortality risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO2/FiO2 ratio, platelet count and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829 to 0.859), which was confirmed in the Brazilian (0.859) and Spanish (0.899) validation cohorts. Our ABC2-SPH score showed good calibration in both Brazilian cohorts, but, in the Spanish cohort, mortality was somewhat underestimated in patients with very high (>25%) risk. The ABC2- SPH score is implemented in a freely available online risk calculator. Conclusions: We designed and validated an easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation, for early stratification for in-hospital mortality risk of patients with COVID-19.

Clinical characteristics and in-hospital outcomes of patients coinfected with Chagas disease and SARS-CoV-2

Background: Underlying comorbidities have been widely associated with a worse prognosis for COVID-19 patients, since viral infections could act as triggers for worsening of chronic diseases. Although Chagas disease (CD) is endemic in Latin America, it has been recognized that the disease is now a worldwide concern. Information on the interplay between COVID-19 and CDis lacking. Purpose: To assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients. Methods: Patients with COVID-19 diagnosis were selected from the Brazilian COVID-19 Registry, a prospective multicenter cohort, from March to September, 2020. CD diagnosis was based on hospital record at the time of admission. Study data were collected by trained hospital staff using Research Electronic Data Capture (REDCap) tools. Genetic matching for sex, age, hypertension, DM and hospital was performed in a 4:1 ratio. Results: Of the 7,018 patients who had confirmed infection with SARSCoV- 2 in the registry, 31 patients with CD and 124 matched controls were included. Overall, the median age was 72 (64.-80) years-old and 44.5% were male. At baseline, heart failure (25.8% vs. 9.7%) and atrial fibrillation (29.0% vs. 5.6%) were more frequent in CD patients than in the controls (p<0.05 for both). C-reactive protein levels were lower in CD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). Seventy-two (46.5%) patients required admission to the intensive care unit. In-hospital management, outcomes and complications were similar between the groups (Table 1). Conclusions: In this large Brazilian COVID-19 Registry, CD patients had a higher prevalence of atrial fibrillation and chronic heart failure compared with non-CD controls, with no differences in-hospital outcomes. The lower C-reactive protein levels in CD patients require further investigation. (Figure Presented).

Development of an artificial intelligence model to predict venous thromboembolic disease in COVID-19 patients at hospital admission

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.

Venous thromboembolism in patients hospitalized with COVID-19: Results from the Brazilian COVID-19 registry

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.

The 2020 power blackout in the brazilian state of amapá: Lessons learned and opportunities

The Brazilian state of Amapa=-notable for having 70% of its area consisting of unexplored Amazonian forests-experienced a massive power blackout in November 2020. An internal short-circuit in a transformer led to an explosion followed by a fire at the Macapa substation. This event left about 90% of the Amapa's population without power for several days in the middle of the COVID-19 pandemic, disrupting the lives of hundreds of thousands of people and raising concerns from several electricity sector stakeholders. This paper discusses select lessons learned from the power blackout and presents future opportunities to improve power system reliability and resilience for the grids in Amapá, and other similar Brazilian states, with a special focus on the increasingly important role of of distributed energy resources and smart grid technologies. © 2021 IEEE.

Inflammatory bowel disease (IBD) and immunosuppression do not worsen the prognosis of COVID-19. Results from the eneida project of Geteccu

Introduction: The exhaustive registry of COVID-19 cases in patients with IBD is a unique opportunity to learn how to deal with this infection, especially in reference to the management of immunosuppressive treatment, isolation measures or if the disease is more severe in IBD patients due to immunosuppression. Aims & Methods: Aims: The aims of this study were to know the incidence and characteristics of COVID-19 in the ENEIDA cohort during the first wave of the pandemic;the outcomes among those under immunosuppressants/ biologics for IBD;the risk factors for contracting the infection and poor outcomes;and the impact of the infection after three-month followup. Methods: Prospective observational cohort study of all IBD patients with COVID-19 included in the ENEIDA registry (with 60.512 patients in that period) between March and July 2020, with at least 3 months of follow-up. Any patient with a confirmed (by PCR or SARS-CoV-2 serology) or probable (suggestive clinical picture) infection was considered as a case. Results: A total of 482 patients with COVID-19 from 63 centres were included: 247 Crohn's disease, 221 ulcerative colitis and 14 unclassified colitis;median age 52 years (IQR: 42-61), 48% women and 44% 1 comorbidity. Diagnosis was made by PCR: 62% and serology: 35%. The most frequent symptoms: fever (69%), followed by cough (63%) and asthenia (38%). During lockdown 78% followed strict isolation. 35% required hospital admission (ICU: 2.7%) and 12% fulfilled criteria for SIRS upon admission. 18 patients died from COVID-19 (mortality:3.7%). 12% stop IBD medication during COVID-19. At 3 months, taken into account all included cases, 76% were in remission of IBD. Age 50 years (OR 2.09;95% CI:1.27-3.4;p=0.004), 1 comorbidities (OR 2.28;95% CI:1.4-3.6;p=0.001), and systemic steroids <3 months before infection (OR 1.3;95%CI:1-1.6;p= 0.003), were risk factors for hospitalisation due to COVID-19. A Charlson score 2 (OR 5.4;95%CI:1.5-20.1;p=0.01) was associated with ICU admission. Age 60 years (OR 7.1;95%CI:1.8-27.4;p=0.004) and having 2 comorbidities (OR 3.9;95% CI:1.3-11.6;p=0.01) were risk factors for COVID- 19 related death. Conclusion: IBD does not seem to worsen the prognosis of COVID-19, even when immunosuppressants and biological drugs are used. Age and comorbidity are the most important prognostic factors for more severe COVID-19 in IBD patients.