Acute Kidney Injury in Critical Care COVID-19 Patients on Invasive Mechanical Ventilation: The Potential Preventive Role of Dexamethasone.

Background: A high incidence of acute kidney injury (AKI) has been reported in coronavirus disease 2019 (COVID-19) patients in critical care units and those undergoing invasive mechanical ventilation (IMV). The introduction of dexamethasone (DXM) as treatment for severe COVID-19 has improved mortality, but its effects in other organs remain under study. Objective: The objective of this study was to evaluate the association between DXM and AKI in COVID-19. Methods: In this prospective observational cohort study, we evaluated the incidence of AKI in critically ill COVID-19 patients undergoing mechanical ventilation, and the association of DXM treatment with the incidence, severity, and outcomes of AKI. The association between DXM treatment and AKI was evaluated by multivariable logistic regression. The association of the combination of DXM treatment and AKI on mortality was evaluated by Cox-regression analysis. Results: We included 552 patients. AKI was diagnosed in 311 (56%), of which 196 (63%) corresponded to severe (stage 2 or 3) AKI, and 46 (14.8%) received kidney replacement therapy. Two hundred and sixty-seven (48%) patients were treated with DXM. This treatment was associated to lower incidence of AKI (Odds Radio 0.34, 95% Confidence intervals [CI] 0.22-0.52, p < 0.001) after adjusting for age, body mass index, laboratory parameters, SOFA score, and vasopressor use. DXM treatment significantly reduced mortality in patients with severe AKI (HR 0.63, 95%CI 0.41-0.96, p = 0.032). Conclusions: The incidence of AKI is high in COVID-19 patients under IMV. DXM treatment is associated with a lower incidence of AKI and a lower mortality in the group with severe AKI.

Impacto Da Pandemia Por Covid-19 No Cadastro De Doadores Voluntarios De Medula Ossea No Laboratorio De Hla Do Hemocentro De Ribeirao Preto

Resumo: O transplante de medula ossea traz bons resultados em sua terapeutica para tratamento de doencas onco-hematologicas. Contudo, encontram-se alguns pacientes com indicacao de transplante de medula ossea que nao possuem doadores compativeis em sua familia, que dependem de doadores voluntarios. A doacao voluntaria se da atraves de cadastro no Redome. Com a pandemia do COVID-19 os cadastros foram afetados, impactando no numero de doadores. Portanto, faz-se necessario demonstrar os impactos causados pela pandemia no numero de doadores de medula ossea. Logo, realizou-se estudo de dados fornecidos pelo REDOME entre 2019 a 2020, relacionados as coletaS e cadastro na Fundacao Hemocentro de Ribeirao Preto junto ao Laboratorio de HLA. Autores: Santos VT, Deghaide NHS, Martins GV, Correa APB, Domeneghetti MS, Roque ACM, Sartori LG. Instituicao: Fundacao Hemocentro de Ribeirao Preto. Justificativa: Frente a pandemia(COVID-19), o Laboratorio de HLA se adaptou as medidas de prevencao e recomendacoes do Hospital das Clinicas de Ribeirao Preto e protocolos do Ministerio da Saude, com reducao no cadastro de doadores voluntarios de medula ossea. O objetivo deste trabalho foi identificar o numero de doadores voluntarios que foram cadastrados como doadores de medula ossea antes da pandemia, e analisar os cadastros durante esta. Materiais e Metodos: Utilizou-se um estudo observacional de criterio longitudinal e retrospectivo, do tipo serie temporal, utilizando a base dados fornecidos pelo REDOME, referentes ao numero de cadastro de novos doadores de medula ossea no Hemocentro de Ribeirao Preto, entre 2019 e 2020. Os cadastros de janeiro a dezembro de 2020 foram comparados ao ano de 2019. Resultados: Segundo o REDOME, o numero de doadores no Brasil e de 5.522.346. O numero de doadores cadastrados a Fundacao Hemocentro de Ribeirao Preto esta acima de 265.000, o que corresponde a 4,8% do total de doadores cadastrados no pais. Os total doadores em Ribeirao Preto em 2019 foi 24.130 e 18.737 em 2020. Em 2019, no Brasil foram 291.361 novos doadores, onde o Hemocentro representa 8,28% do pais. A pandemia influenciou essa reducao frente isolamento social e dificultou a realizacao de campanhas. Discussao: O transplante de medula ossea e uma terapeutica de resultados positivos em sua terapeutica, no entanto, necessita-se de doadores compativeis. O numero de doadores de transplante de medula ossea aumenta e no Brasil, ha locais de cadastro e de coleta, chamado de hemocentro. A educacao em saude e recurso importante para informar e atualizar a populacao quanto a relevancia do cadastro para formacao do banco de doadores. Conforme dados do Ministerio da Saude, as doacoes de medula ossea e transplantes nao chegaram a ser interrompidos na pandemia, porem foram aplicadas restricoes de seguranca, publicadas no portal da Agencia Nacional de Vigilancia Sanitaria. O decrescimo de cadastros de doadores de medula ossea no Hemocentro de Ribeirao Preto e em todo o Brasil, pode estar fortemente relacionado com a interrupcao de campanhas em virtude da pandemia. Conclusao: Ao comparar o registro de doadores de medula ossea no Hemocentro com dados de cadastro no Brasil, entre 2019 e 2020, nota-se que houve reducao nos registros. No estado de Sao Paulo, a reducao foi de 12,7%, passando de 69.567 para 60.744 o numero de cadastros. No Brasil, de 25,66%, total de 291.361 em 2019 para 170.287 ate dezembro de 2020. As restricoes do periodo de isolamento social devido COVID-19 impactaram nos registros de doadores, assim como a nao realizacao de cadastro e campanhas do Hemocentro, que foram suspensas em 2020. Copyright © 2022

Évaluation de la séroprévalence du SARS-CoV-2 en détention

Introduction La promiscuité et la surpopulation dans les prisons sont considérées comme des facteurs de risque de transmission des virus respiratoires, mais les données sur l'étendue de l'épidémie de COVID-19 en prison sont limitées. Matériels et méthodes Etude transversale multicentrique menée dans les 12 établissements pénitentiaires de janvier à juillet 2021. L'objectif principal était d'évaluer la séroprévalence au SRAS-CoV-2 dans un échantillon représentatif de cette population. Sur les 11 413 détenus âgés de 18 à 80 ans présents dans les prisons de la région d'étude au 6 janvier 2021, 3 545 ont été tirés au sort. Résultats La population analysée comprenait 1 014 participants (âge moyen, 36,2 ans ; hommes 80,5 % ; fumeurs, 60,3 % ; obésité, 11,7 % ; vaccination COVID-19, 6,5 %). Dans l'ensemble, 18,4 % (IC95 % 16,1- 20,8) des participants étaient séropositifs pour le SRAS-CoV-2. En février 2021 (semaine 6), le taux de séroprévalence était de 20,6 % (IC95 % 16,6–24,9) dans la population générale de la région de l'étude et de 18,4 % (IC95 % 16,8–20,1) dans notre étude. Les participants séropositifs ont signalé plus fréquemment une perte d'odorat (16,7 % vs. 4,7 %) et une perte de goût (17,7 % vs. 4,1 %) depuis mars 2020. La séropositivité était significativement associée à un nombre moyen plus élevé de détenus par cellule (1,9 vs. 1,8 ; p=0,0088) et présence plus fréquente de co-détenus malades (41,3 % vs. 32,4 % ; p=0,003). Conclusion La séroprévalence du SRAS-CoV-2 dans les prisons de la région d'étude est apparue comparable à la population générale, très probablement en raison de la libération massive précoce des détenus et des mesures barrières préventives. La limitation de l'incarcération et la promotion des mesures habituelles de contrôle des infections sont des facteurs importants pour contrôler l'épidémie de COVID-19 en prison. Aucun lien d'intérêt

One year of SARS-CoV-2 Pandemic: a characterization of infected healthcare workers in a peripheral hospital of Lisbon, Portugal

Introduction: After more than one year of coronavirus disease 2019 (COVID-19) pandemic, there are still scarce studies on healthcare workers and particular risk factors for infection, with most published papers focusing on the psychological impact of the pandemic. Our group analyzed infection rates by professional category, hospital service, as well as initial symptom onset and description in our hospital center. Material and Methods: We conducted a descriptive study of our hospital center’s healthcare workers that were infected with COVID-19 from the 13th of march of 2020 until the 31st of march of 2021. The information was mostly based on the occupational health service’s database and confirmed by consulting TRACE-COVID, a platform that gathered information on every COVID-19 patient, nationwide. Results: From March 2020 to March 2021, about 13.7% of our hospital’s staff was diagnosed with COVID-19, with the most affected being nurses and nurses’ aides, and healthcare professionals working in the emergency department, as well as infirmaries of internal medicine and general surgery. Conclusions: In our center, known high risk scenarios in the workplace were not particularly met with high incidence rate of infection, probably because of a particular compliance in the use of personal protective equipment. Although the SARS-Cov-2 pandemic remains a challenging event for hospital centers worldwide, occupational health services should use this opportunity to better study infection rates in their work environment and optimize prevention measures to further protect our professional’s health and safety.

Sustainable Environmental Geotechnics Practices for a Green Economy

The revitalization of the global economy after the COVID-19 era presents Environmental Geotechnics with the opportunity to reinforce the need for a change in paradigm toward a green, circular economy and to promote aggressively the use and development of sustainable technologies and management practices. This paper aims to assist in this effort by concentrating on several thematic areas where sustainability solutions and future improvements are sought. These include the re-entry of construction and demolition waste, excavated material, industrial waste, and marine sediments into the production cycle and the reuse of existing foundations. Despite the recent trend in advanced countries toward recycling and waste-to-energy thermal treatment, landfills still constitute the most common municipal solid waste management practice, especially in low-and-middle-income countries, and technological solutions to improve their environmental footprint are presented. At the same time, remediation solutions are required to address the multitude of contaminated sites worldwide. Advanced developments that incorporate environmental, economic, and social dimensions are expounded, together with sustainable ground improvement solutions for infrastructure projects conducted in soft and weak soils. The topic of thermo-active geostructures concludes this paper, where, apart from their infrastructure utility, these structures have the potential to contribute as a renewable energy source. © 2021 ICE Publishing: All rights reserved.

Persistance et protection des anticorps neutralisants 12 mois après l’infection à SARS-COV-2 chez les sujets âgés

Introduction La pandémie de COVID-19 a gravement affecté les personnes âgées. Rares études ont évalué la réponse anticorpale anti-SARS-CoV-2 dans cette population, qui a une diminution attendue des réponses immunitaires humorales et cellulaires due à l’immunosénescence. Matériels et méthodes Nous décrivons les caractéristiques cliniques et sérologiques de patients âgés hospitalisés dans cinq unités de soins de longue durée d’un CHU, touchés par deux grandes flambées épidémiques de COVID-19, en mars et novembre 2020. Dans un contexte d’urgence hospitalière, des tests sérologiques ont été réalisés pour le dépistage, le diagnostic et la réorganisation des services. Quatre-vingt-onze patients infectés en mars-avril ont été inclus rétrospectivement et suivis, cliniquement et par sérologies, pendant 12 mois. La réponse anticorpale a été évaluée 3, 6, 9 et 12 mois après l’infection, en utilisant le test Roche Elecsys pour détecter les anticorps anti-Spike et le test GenScript cPass comme test de neutralisation du virus. Résultats L’âge moyen des 91 patients était 86±7 ans, 68 % étaient des femmes. Les comorbidités les plus fréquentes étaient le diabète (23 %), l’hypertension artérielle (67 %), la coronaropathie (13%) ou le cancer (3%). La médiane d’indice de Charlson était 7 [6–8]. Tous les patients étaient fortement dépendants avec des ADL<2. L’infection à SARS-CoV-2 était diagnostiquée par une RT-qPCR nasopharyngée chez 75 d’eux ou par une sérologie positive. 85 % d’eux étaient symtpomatiques et 25 % nécessitaient d’une oxygénothérapie. À trois, 6 et 9 mois le titre moyen d’anti-Spike était respectivement de 207±84, 189±90, 181±93U/mL et la moyenne du pourcentage d’inhibition de la cPass était respectivement de 86±15, 77±20, 71±24 %. Les résultats sérologiques à 12 mois sont en cours d’analyse. Le titre d’anti-Spike et le pourcentage d’inhibition étaient fortement corrélés (r=0,85, p<0,0001). À 9 mois, tous les patients avaient des anti-Spike détectables, mais seulement 5 patients (5 %) avaient des titres inférieurs au seuil d’inhibition de 30% du test cPass. Aucun n’a développé de réinfection après la réexposition au SARS-CoV2 lors de la deuxième flambée épidémique. Conclusion Cette étude montre que, chez les personnes âgées, les anticorps neutralisants, évalués avec le test de neutralisation cPass, persistent au moins 9 mois après l’infection et semblent protéger contre une réinfection. À la lumière de ces données et dans un contexte global de pénurie de vaccins, un suivi sérologique pourrait être proposé pour évaluer la protection des personnes âgées précédemment infectées et économiser des doses de vaccins.

Community- and Hospital-Acquired Acute Kidney Injury in COVID-19: Different Phenotypes and Dismal Prognosis.

INTRODUCTION: Acute kidney injury (AKI) is common in coronavirus disease 2019 (COVID-19). It is unknown if hospital-acquired AKI (HA-AKI) and community-acquired AKI (CA-AKI) convey a distinct prognosis. METHODS: The study aim was to evaluate the incidence and risk factors associated with both CA-AKI and HA-AKI. Consecutive patients hospitalized at a reference center for COVID-19 were included in this prospective cohort study. RESULTS: We registered 349 (30%) AKI episodes in 1,170 hospitalized patients, 224 (19%) corresponded to CA-AKI, and 125 (11%) to HA-AKI. Compared to patients with HA-AKI, subjects with CA-AKI were older (61 years [IQR 49-70] vs. 50 years [IQR 43-61]), had more comorbidities (hypertension [44 vs. 26%], CKD [10 vs. 3%]), higher Charlson Comorbidity Index (2 points [IQR 1-4] vs. 1 point [IQR 0-2]), and presented to the emergency department with more severe disease. Mortality rates were not different between CA-AKI and HA-AKI (119 [53%] vs. 63 [50%], p = 0.66). In multivariate analysis, CA-AKI was strongly associated to a history of CKD (OR 4.17, 95% CI 1.53-11.3), hypertension (OR 1.55, 95% CI 1.01-2.36), Charlson Comorbidity Index (OR 1.16, 95% CI 1.02-1.32), and SOFA score (OR 2.19, 95% CI 1.87-2.57). HA-AKI was associated with the requirement for mechanical ventilation (OR 68.2, 95% CI 37.1-126), elevated troponin I (OR 1.95, 95% CI 1.01-3.83), and glucose levels at admission (OR 1.05, 95% CI 1.02-1.08). DISCUSSION/CONCLUSIONS: CA-AKI and HA-AKI portend an adverse prognosis in CO-VID-19. Nevertheless, CA-AKI was associated with a higher comorbidity burden (including CKD and hypertension), while HA-AKI occurred in younger patients by the time severe multiorgan disease developed.