Clinical profile and outcomes of patients with COVID-19 respiratory failure requiring renal replacement therapy: a machine learning analysis of 13,576 patients

Introduction: Acute kidney injury (AKI) is a frequent and severe complication of COVID-19 infection in ICU patients. We propose a structured data-driven methodology and develop a model to predict the use of renal replacement therapy for patients on respiratory support with Covid-19 in 126 ICUs from 42 Brazilian hospitals. Method(s): Adult ICU patients (March 2020-December 2021) with confirmed SARS-CoV-2 infection and need of ventilatory support at D1 admission in the ICU. Main outcome was the need of RRT. We estimated 3 prediction models: Logistic Regression (LR), Random Forest (RF) and XGB Boosting. Models were derived in the training set and evaluated in the test set following an 80/20 split ratio, and models' parameters were selected using fivefold cross-validation. We evaluated and selected the best model in terms of discrimination (AUC) and calibration (Brier's Score). Variable importance was estimated for each predictor variable. Result(s): 13,575 ICU patients with need of respiratory support, of which 1828 (14%) needed RRT. ICU and hospital mortality were respectively 15.7%, 20.3% (non-RRT) and 54.3%, 69% (RRT). Mean age was 63.9 and 55.3 years (RRT vs non-RRT). Mean ICU LOS was 27.8 vs. 12 days, in RRT vs non-RRT. RF and XGB models both showed higher discrimination performance compared to LR (95% confidence interval [95% CI]: 0.84 [0.81-0.85] and 0.83 [0.80-0.85] vs 0.78 [0.75-0.80]). RF and XGB models presented similar calibration (Brier's Score: ([95% CI]: 0.09 [0.09- 0.10] and 0.09 [0.09-0.10]), also better than in LR (0.11 [0.10-0.12]). The final model (RF) showed no sign of under or overestimation of predicted probabilities in calibration plots. Conclusion(s): The need of RRT among patients on respiratory support diagnosed with Covid-19 was accurately predicted through machine learning methods. RF and XGB based models using data from general intensive care databases provides an accurate and practical approach for the early prediction of use of RRT in COVID-19 patients.

The family and the school in times of pandemic: guidelines to assist the studies of children at home

Covid-19 has made families search for ways to assist their children in their online studies, so their learning should not be interrupted. The present article aimed to identify the difficulties faced in the teaching-learning process from the homes. Symptoms such as depression and stress caused by the lack of social interaction could be identified. During the analysis of the results, three categories were conceived: apprehension regarding the students' health (physical and/or mental), concern about the child's learning, and how to motivate students in the remote teaching period. From the data generated, it was possible to obtain elements for the elaboration of an orientation guide with the intention of helping other families. The results obtained suggest possible ways to guide and motivate pupils and how it has become important during online teaching, as well as the support and welcoming of the educational institutions to which the students belong.

Protein Blend Suppress Inflammatory Response from Bronchial Epithelial Cells Induced by SARS-Cov-2

Even after virus elimination, coronavirus disease 2019 (COVID-2019) leaves numerous sequelae. Growing evidence demonstrates that massive release of proinflammatory cytokines, which drives COVID-19 progression, severity, and mortality, remains elevated after acute phase of COVID-2019, playing a central role in the disease' sequelae. In this way, bronchial epithelial cells are the first cells hyperactivated by coronavirus-2 (SARS-Cov-2) leading to massive cytokine release, triggering leukocytes and other cells hyperactivation, mediating COVID-19 sequelae. So, proinflammatory cytokines are initiated by the host. Thus, this in vitro study tested the hypothesis that ImmuneRecovTM, a protein blend, could inhibit the hyperactivation of human bronchial epithelial cells (BEAS-2B) induced by SARS-Cov-2. BEAS-2B (5x104/mL/well) cells were co-cultivated with 1ml of blood of a SARS-Cov-2 infected patient for 4 hours and protein blend (1ug/mL) was added in the first minute of the co-culture. After 4 hours, the cells were recovered and used for analysis of cytotoxicity by MTT and for mRNA expression of IL-1beta, IL-6, IL-10. The supernatant was used to measure cytokines. SARS-Cov-2 incubation resulted in increased levels of IL-1beta and IL-6 by BEAS-2B cells (p<0.001). Treatment with the protein blend resulted in reduced levels of pro-inflammatory IL1beta and IL-6 (p<0.001), and increased the levels of anti-inflammatory IL-10 (p<0.001). Protein blend reduced SARS Cov-2-increased the mRNA expression of IL-1beta and IL-6, and increased the expression of IL-10 and IFN-gamma. In conclusion, protein blend presents important anti-inflammatory effects in the context of SARS-Cov-2 infection.

Spatial clustering of low rates of COVID-19 vaccination among children and adolescents and their relationship with social determinants of health in Brazil: a nationwide population-based ecological study.

OBJECTIVE: This study aimed to investigate the spatial clusters of high and low COVID-19 vaccination rates among children and adolescents across Brazilian municipalities and their relationship to social determinants of health. STUDY DESIGN: This is a nationwide population-based ecological study. METHODS: We have obtained for each of the 5570 Brazilian municipalities data on the COVID-19 vaccination rate of children and adolescents by August 16, 2022, the Gini index, the social vulnerability index and the municipal human development index. A Bayesian empirical local model was used to identify fluctuations in the COVID-19 vaccination rates. Spatial clusters were identified using scan spatial statistic tests. The relationship among COVID-19 vaccination rates and social determinants of health was explored by using multiple linear regression models. RESULTS: Overall, 52.1% of children aged 5-11 years and 72.8% of adolescents aged 12-17 years have been fully vaccinated against COVID-19 in Brazil by mid-August 2022. There was spatial dependence on the smoothed rates for both children (I Moran 0.66; P < 0.001) and adolescent (I Moran 0.65; P < 0.001) groups. The lowest rates occurred in municipalities in the North and Northeast regions. Municipalities with a higher Gini Index, higher social vulnerability index and lower municipal human development index were more likely to have a lower COVID-19 vaccination rate for both children and adolescent groups. CONCLUSION: COVID-19 vaccination of children and adolescents was heterogeneously distributed, with spatial clusters of the lowest vaccination rates occurring mainly in municipalities with marked socio-economic disparities and social vulnerability, especially in the North and Northeast regions.

O Desabastecimento De Imunoglobulina Intravenosa E O Uso De Plasmaferese Em Primeira Linha Na Sindrome De Guillain - Barre Em Paciente Pediatrico: Relato De Caso E Revisao De Literatura

Objetivos: Relatar um caso de Guillain - Barre em paciente de 12 anos de idade que utilizou plasmaferese terapeutica como primeira linha, focando nos aspectos tecnicos do procedimento;Discutir as possiveis causas para o desabastecimento de imunoglobulina intravenosa (IGIV) atual. Metodologia: Coleta de dados clinicos no prontuario. Revisao de literatura, com enfase em plasmaferese na populacao pediatrica, suas indicacoes, paticularidades tecnicas e eventos adversos. Resultados: Paciente de 12 anos de idade, sexo feminino, 35 quilos, previamente higida, deu entrada no pronto - socorro com quadro de tetraparesia desproporcional - forca grau III em MMII e grau IV em MMSS - associada a mialgia difusa. Sem quadro infeccioso ou vacinacao recente antecedendo. Equipe da neurologia levantou hipotese de sindrome de Guillain- Barre e solicitou plasmaferese terapeutica, pois nao havia disponibilidade de IGIV. Foram realizadas 04 sessoes utilizando o sistema COM.TEC (Fresenius Kabi) com troca de uma volemia cada. O fluxo medio de extracao foi de 37,5ml/min (30-45ml/min). A taxa media de ACD infundido na paciente foi de 234ml e a proporcao ACD:sangue foi de 1:16. A duracao media foi de 73 minutos por procedimento. Em todas as sessoes foi utilizado reposicao profilatica com solucao de 10ml de gluconato de calcio 10%. A paciente apresentou tontura e parestesia perioral nas duas primeiras sessoes. Sem outros eventos adversos. Recebeu alta apos quarta sessao, ja sendo capaz de deambular sem auxilio. Discussao: A Sindrome de Guillain Barre corresponde a um grupo de polirradiculopatias autoimunes, inflamatorias e desmielinizantes. Os tratamentos de primeira linha constituem IGIV e plasmaferese. A IGIV costuma ser preferida principalmente em criancas por maior facilidade posologica e nao envolver uso de dispositivos invasivos. O desabastecimento de IGIV desde 2019 em diversos paises do mundo, inclusive no Brasil, tem dificultado o acesso a este tratamento. Entre as possiveis causas para este desabastecimento, podemos citar: aumento da demanda nao acompanhada por aumento na producao, impactos da pandemia de COVID- 19 sobre materia-prima (doadores de sangue) e logistica (transporte, etc), descontinuacao do produto por alguns laboratorios, entre outros. Segundo o ultimo guideline da Sociedade Americana de Aferese nao ha diferenca no desfecho entre IGIV e plasmaferese. Entre os principais eventos adversos da plasmaferese em pacientes pediatricos, destacam- se os relacionados ao acesso central (infeccoes, complicacoes mecanicas, entre outros), hipocalcemia, o volume extracorporeo utilizado no procedimento e riscos de intoxicacao por citrato. A paciente do caso apresentou apenas sintomas leves de hipocalcemia, que melhoraram apos reducao do fluxo de extracao. Conclusao: A plasmaferese terapeutica em pacientes pediatricos tem se mostrado eficaz, seja em primeira linha ou como tratamento complementar. Ajustes na taxa de extracao, reposicao profilatica de calcio e cuidados com o acesso central aumentam a seguranca do procedimento. Copyright © 2022

Perceptions and practices of e-learning from the viewpoint of managers of the hotel network of Natal-RN [Brazil]: a multiple cases study

This study aims to analyze the use of e-learning in training and development of people in the hotel sector in Natal [Brazil]. A qualitative and multiple case study was conducted with ten hotels among the best rated in the city. Data collection took place through an interview script applied with managers responsible for managing people in each hotel. For data analysis, we proceeded with the content analysis technique and support of the NVivo software. As a result, it was found that e-learning is present in the learning processes of employees, however in most cases this occurs from online courses proposed by external entities. Of the ten hotels, only three have corporate universities based on the use of technology. Finally, it is concluded that e-learning is a trend as a learning tool, which may be intensified in the coming years due to the pandemic crisis caused by COVID-19, which promises to modify the relationship between technology and tourism companies.

MENTAL ILLNESS: INTERFACES WITH THE WORKING ENVIRONMENT DURING THE COVID-19 PANDEMIC, FROM THE PERSPECTIVE OF NURSING PROFESSIONALS

The growth of invisible pathologies resulting from the psychological exhaustion of nursing professionals raises an alert to the lack of labor policies in institutions with a focus on prevention. This study aims to assess the perception of nursing professionals about mental illness in their work environment, enhanced by the current pandemic moment. It also aims to identify the actions that contracting health institutions adopt, as a preventive measure. This is a cross-sectional and descriptive study, in which the snowball technique was used, using the Google Forms® tool. The research complied with the ethical precepts of Resolution CNS 466/2012, being held in July and August 2020. 45 nurses and 56 nursing technicians answered the questions, with a prevalence of 85.14% being women. The high workload, the pressure in the work routine, the low pay and the precarious conditions for the exercise of the activity were the factors listed that most contribute to mental illness. Although 73 of the respondents did not leave work for prolonged periods, 30 were absent due to mental illness. It should be noted that 61 nursing professionals, who responded, are not aware of preventive initiatives for mental illness in their companies. This study reveals that the work environment, poor conditions for performing activities, work overload and fear of the unknown, such as the disease caused by the coronavirus, are considered the main factors that contribute to the mental illness of nursing professionals. Thus, it is essential that protective measures for self-care in mental health are offered by health institutions. © 2021 Slovak Academy of Sciences. All rights reserved.

Best practices for covid-19 test process in a hospital emergency department

Detection tests for COVID-19 are important to mitigate its spread. However, it is not yet clear what are the best practices for its realization. This paper aims to propose best practices to avoid possible failures in the points of contact of the samples collection for Reverse Transcription Polymerase Chain Reaction (RT-PCR) process in an emergency department of a hospital for the care of patients who are suspected or diagnosed with the new coronavirus. For this purpose, we performed a process mapping of the RT-PCR collection process using the Service Blueprint tool to identify the points of contact between the patients and the hospital staff. Thus, we identified the possible failures in these points, with the process actors, and we prioritized them according to their perception about Gravity, Urgency, and Tendency matrix. Our results show that the most critical failures are related to the information and communication between the process actors and the patients. In this way, improvements were proposed related to the standardization, information material, continued training, development of specialized teams, creation of protocols, and use of information technology. © IEOM Society International.

Using transfer learning in object detection for regions of the human face in thermographic images of health barriers

The COVID-19 pandemic has affected people's lives as well as the economies of several countries, the health, education, and transportation sectors, among others. To try to contain the spread of the virus, several countries have implemented health barriers at airports, bus stations, stations, company entrance halls, and other shared spaces to detect patients with any symptom of the viral infection. Since fever is one of the most recurrent symptoms of the disease, a rush to the markets for devices to measure body temperature has begun. Thermal imaging cameras, also known as thermal imagers, are other devices used to measure temperature, employing technology known as infrared thermography, a non-invasive, fast and objective tool. In this study, we applied machine learning transfer on YOLO to detect the hottest regions of the human face in thermographic images, allowing the identification of feverish state in humans. To do this, the artificial intelligence algorithms detect the regions of interest in thermographic images, which are: the eyes, forehead and ears, and then the temperatures in these regions are analyzed. The developed software showed excellent performance in detecting the established regions of interest, which adequately indicates the maximum temperature within the regions of interest, and that the choice of the maximum temperature method was adequate.

Comparative analysis of the use of pyrometers and thermal imagers in sanitary barriers for screening febrile people

Due to the Covid-19 pandemic, many places with high traffic of people set up sanitary barriers to screening febrile people. Thermal imagers and pyrometers are the equipment commonly used to measure temperature in these barriers. In this paper, Temperature measurements performed by these instruments were compared considering the regions usually monitored in these barriers: forehead, ear, and wrist. The temperatures of volunteers were recorded after initial acclimatization, a short period of physical exercise, and a rest period after exercise, evaluating the instruments and regions of measurement and the influence of the condition of rest and physical exercise of the person. The compatibility of the performed measurements in each of these three moments was then compared using statistical and metrological tools. The outcomes showed that the pyrometer has low repeatability since its results vary widely among different measurements due to the temperature variation existing within the analyzed region and the difficulty of guaranteeing the same measurement point. As a result, a thermal imager is more recommended for taking body temperature measurements on the forehead and, preferably, on the ear. It was also determined that the wrist, in particular, has a significantly lower temperature than the central body temperature, and thus this is not a recommended region to measure body temperature when screening febrile people.

Teaching in pandemic times

The Covid-19 pandemic has been causing a strong impact on the global economy. Supply chains, factories, and the financial market feel its effects although its reach is still to be known. Considerable efforts have been made by governments, civil society organizations, companies and professionals to understand the crisis, adapt to it, minimize its impacts, and predict what is to come next. A scenario of drastic changes is therefore constituted, directly reflecting on education, specifically when it comes to teachers and students' use of technologies in the so-called "remote education". Based on studies about the scientific production related to the educational context that we are experiencing due to the Covid-19 pandemic, which has demanded that educators have new ways of looking at education and rethink teaching and learning, this article provides reflections on the challenges faced by higher education teachers with the purpose of sharing theoretical and practical knowledge as well as the difficulties they have been experiencing.

Impacts of COVID-19 on production chains and daily life in traditional communities in Central Amazonia

To provide information on the impact of the COVID-19 pandemic in the interior of Amazonas state, we present a case report from the Amana Sustainable Development Reserve (RDSA), in the Middle Solimfies region. The primary objective of this study was to investigate the impacts of the pandemic on local residents' daily lives, identifying the difficulties they face, changes in dietary practices, and impacts on agricultural production chains. Information was obtained through semi-structured interviews conducted with nine family members from four communities and one locality the RDSA. In addition to documenting impacts, we sought to identify jointly with interlocutors possible actions to guarantee the health and well-being of local families and their ability continue marketing their production. Actions were divided into immediate proposals for this moment of pandemic and longer-term actions. Results demonstrate that at the beginning of the pandemic, residents adjusted their dietary habits and quickly adapted to social isolation recommendations and other preventive measures. Although data point to losses in families' income and in production, interlocutors bring forth innovative proposals to weather the immediate crisis and promote marketing through alternative supply chains in the long term. Thus, the results reflect the flexibility typically associated with Amazonian ribeirinho communities. Self-organization, promoted by the creation of broad collaborative networks, takes on a larger dimension in this context, necessary to face the current crisis in the absence of the State and in face of historical regional inequalities.

Remote physical therapy during COVID-19 pandemic: guidelines in the Brazilian context

Introduction: On March 11, 2020, Covid-19 was characterized by the World Health Organization as a pandemic. In this context, different health professional councils have adopted initiatives to use communication technologies to provide services at a distance. Specifically, for physiotherapy, the Federal Council of Physiotherapy and Occupational Therapy (COFFITO) made possible the modalities of teleconsultation, teleconsulting, and telemonitoring. Objective: This study aimed to develop guidelines for physiotherapists who provide teleservices, which will help ensure the safety and quality of their professional practice during the COVID-19 pandemic. Methods: An integrative literature review was conducted through PubMed (National Library of Medicine), Cochrane Library, Higher Education Personnel Improvement Coordination Portal - CAPES, Virtual Health Library, Google Scholar, and personal experience within the team to develop guidelines for remote physical therapy during the COVID-19 pandemic. Results: Initially, 3,298 articles were selected from all cited search bases, scaled to 2,031 after exclusion due to repetition, 78 were in compliance with the proposed study, 73 of which were excluded for not answering the guiding question;therefore, 5 articles were accepted for the final analysis and used for the elaboration of the guidelines. Conclusion: The results provide an overview of the literature and guidelines for physiotherapists to implement physiotherapy teleconsultation, as well as some of the challenges that need to be considered © 2022, Fisioterapia em Movimento.All Rights Reserved.