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1.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793860

ABSTRACT

Introduction: Patients with COVID-19 admitted to the ICU are at high risk of developing infectious complications during their ICU stay. Data on acquired(AI) in Portuguese critical COVID-19 patients are scarce. The aim of this study was to investigate the characteristics and risk factors for AI in critical patients with COVID-19 pneumonia admitted to the ICU. Methods: Retrospective cohort of patients with COVID-19 pneumonia admitted to an ICU in a tertiary hospital, between September 2020 and June 2021. AI considered were ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT), bacteremia, CVC associated infections, urinary tract infections and soft skin tissue infections. Baseline characteristics, 3-months previous antibiotic (ATB) exposure, ATB treatment at ICU-admission and clinical management of COVID-19 pneumonia were analyzed. Results: Of the 159 patients included, with a median (IQR) age of 66 (57-72) and 63.5% males, 14 (8.8%) had no known comorbidities. A total of 63 patients(39.6%) developed AI: 45(71.4%) VAP, 20(33.3%) VAT, 28 (45.2%) UTI, 6 (9.5%) CVC associated infections and 3(4.8%) soft skin tissue infections. In univariate analysis, both SOFA score at admission (p < 0.001), acute cardiovascular (p = 0.003) and neurologic (p = 0.006) disfunction at ICU admission were associated with the development of AI. AI were also correlated to need of tracheostomy(p < 0.001), development of delirium (p < 0.001) or shock (p < 0.001);and with longer ICU and in-hospital stay (p < 0.001) and ICU and hospital mortality (p = 0.011 and p = 0.011, respectively). None of the COVID-19 pharmacologic treatments considered (remdesivir, steroids and tocilizumab), neither different regimens of ATB therapy at ICU admission were significantly associated with AI. Conclusions: In this cohort, almost 40% of the patients developed AI, that was associated with 4 times higher hazard of needing mechanical ventilation and higher rate of adverse events such as delirium, shock during in-ICU stay and longer length of ICU and in-hospital stay.

2.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793859

ABSTRACT

Introduction: This study aimed to determine the mortality and morbidity of COVID-19 patients in an intensive care unit (ICU) until hospital discharge, and explore the factors that influence in-ICU and in-hospital mortality rates. Methods: Single center retrospective cohort regarding COVID-19 critical patients in a tertiary hospital ICU, from September/20 to June/21. Demographic data, clinical characteristics, admission SOFA score, frailty score (FS) and clinical management were analyzed. Results: We included 159 consecutive COVID-19 critical patients. The median (IQR) age was 66(57-72);101(63.5%) were male. A total of 126 (79.2%) patients received hospital discharge, ICU-mortality rate was 18.9%(30 deaths). The median (IQR) ICU length of stay was 12 days (6-20) and in-hospital stay was 21(13-35), and no significant differences were found in ICU and in-hospital length of stay between survivors and non-survivors. At admission to the ICU total SOFA score was 4(3-7). In univariate analysis, increased age, higher admission SOFA score, acute kidney injury and acute neurologic disfunction at admission were significantly associated with increased hazard of mortality. The need for mechanical ventilation were associated with higher risk of ICU and in-hospital mortality. Previous comorbidities (hypertension, diabetes, obesity, heart failure, COPD, renal, hepatic, oncologic or immunosuppression) or the FS were not significantly associated with in-hospital mortality. None of the COVID-19 pharmacologic treatments (remdesivir, steroids and tocilizumab) were significantly associated with in-hospital mortality. In a multivariable analysis with in-hospital death as the dependent variable, a 10 year increase in age was associated with a mortality OR of 2.9 (95 CI:1.5-5.5)( p = 0.002) and the development of shock during ICU stay was associated with a mortality OR of 8.8 (95 CI:1.5 to 53.3). Conclusions: In this cohort, only age and the development of shock during ICU stay were independently associated with higher risk of inhospital death.

3.
Revista Juridica ; 3(65):227-252, 2021.
Article in Portuguese | Scopus | ID: covidwho-1694993

ABSTRACT

Objectives: Through a doctrinal analysis, this article aims to analyze the impacts and reflexes of Law No. 14.010/20 on the principle of access to justice under the current context, considering the declaration of quarantine and isolation of the citizen, as well as the legislator’s concern in seeking to preserve and guarantee fundamental rights with the legislative innovation. Methodology: The current study has as methodology the exploratory and descriptive research, and its results are treated qualitatively, from the collection of information in secondary sources that aim to clarify the reflections of the new legislation, that is, Law No. 14.010/20, on the principle of access to justice. Results: In the process of conducting the research, it was possible to conclude that the legislation is correct and, when interpreted in accordance with the constitutional principle of access to justice, its main objective is to (i) ensure and strengthen such constitutional principle and (ii) guarantee citizens the exercise of their citizenship in the democratic rule of law. Contributions: The main contribution of the paper consists in recommending that policies of extra fiscal incentives be applied and evaluated considering the normative framework. © 2021, Centro Universitario Curitiba - UNICURITIBA. All rights reserved.

4.
Clinics ; 76:10, 2021.
Article in English | Web of Science | ID: covidwho-1579962

ABSTRACT

OBJECTIVES: Since there are difficulties in establishing effective treatments for COVID-19, a vital way to reduce mortality is an early intervention to prevent disease progression. This study aimed to evaluate the performance of patients with COVID-19 with acute hypoxic respiratory failure according to pulmonary impairment in the awake-prone position, outside of the intensive care unit (ICU). METHODS: A prospective observational cohort study was conducted on COVID-19 patients under noninvasive respiratory support. Clinical and laboratory data were obtained for each patient before the treatment and after they were placed in the awake-prone position. To identify responders and non-responders after the first prone maneuver, receiver operating characteristic curves with sensitivity and specificity of the PaO2/FiO2 and SpO2/FiO2 indices were analyzed. The maneuver was considered positive if the patient did not require endotracheal intubation for ventilatory assistance. RESULTS: Forty-eight patients were included, and 64.6% were categorized as responders. The SpO2/FiO2 index was effective for predicting endotracheal intubation in COVID-19 patients regardless of lung parenchymal damage (area under the curve 0.84, cutoff point 165, sensitivity 85%, specificity 75%). Responders had better outcomes with lower hospital mortality (hazard ratio [HR]=0.107, 95% confidence interval [CI]: 0.012-0.93) and a shorter length of stay (median difference 6 days, HR=0.30, 95% CI: 0.13-0.66) after adjusting for age, body mass index, sex, and comorbidities. CONCLUSIONS: The awake-prone position for COVID-19 patients outside the ICU can improve oxygenation and clinical outcomes regardless of the extent of pulmonary impairment. Furthermore, the SpO2/FiO2 index discriminates responders from non-responders to the prone maneuver predicting endotracheal intubation with a cutoff under or below 165.

5.
Clinics (Sao Paulo, Brazil) ; 76:e3368, 2021.
Article in English | MEDLINE | ID: covidwho-1575614

ABSTRACT

OBJECTIVES: Since there are difficulties in establishing effective treatments for COVID-19, a vital way to reduce mortality is an early intervention to prevent disease progression. This study aimed to evaluate the performance of patients with COVID-19 with acute hypoxic respiratory failure according to pulmonary impairment in the awake-prone position, outside of the intensive care unit (ICU). METHODS: A prospective observational cohort study was conducted on COVID-19 patients under noninvasive respiratory support. Clinical and laboratory data were obtained for each patient before the treatment and after they were placed in the awake-prone position. To identify responders and non-responders after the first prone maneuver, receiver operating characteristic curves with sensitivity and specificity of the PaO2/FiO2 and SpO2/FiO2 indices were analyzed. The maneuver was considered positive if the patient did not require endotracheal intubation for ventilatory assistance. RESULTS: Forty-eight patients were included, and 64.6% were categorized as responders. The SpO2/FiO2 index was effective for predicting endotracheal intubation in COVID-19 patients regardless of lung parenchymal damage (area under the curve 0.84, cutoff point 165, sensitivity 85%, specificity 75%). Responders had better outcomes with lower hospital mortality (hazard ratio [HR]=0.107, 95% confidence interval [CI]: 0.012-0.93) and a shorter length of stay (median difference 6 days, HR=0.30, 95% CI: 0.13-0.66) after adjusting for age, body mass index, sex, and comorbidities. CONCLUSIONS: The awake-prone position for COVID-19 patients outside the ICU can improve oxygenation and clinical outcomes regardless of the extent of pulmonary impairment. Furthermore, the SpO2/FiO2 index discriminates responders from non-responders to the prone maneuver predicting endotracheal intubation with a cutoff under or below 165.

6.
Journal of Medical Imaging and Radiation Oncology ; 65(SUPPL 1):238-239, 2021.
Article in English | EMBASE | ID: covidwho-1458458

ABSTRACT

Purpose: The Australian Clinical Dosimetry Service (ACDS) has been auditing Australian and New Zealand radiotherapy providers for nearly 10 years building the National Dataset of audit measurements. The audits have uncovered numerous issues with varying significance. This paper will present an update of the ACDS audits including trends within the National Dataset and recent audit findings and will then cover recent audit of more advanced modalities such as SRS, SBRT, VMAT and adaptive radiotherapy. The presentation will conclude with a summary of the COVID-19 impact on the ACDS. The audits demonstrably improve the treatment quality and safety for patients undergoing radiotherapy. Methods and Materials: The ACDS began life in November 2010 and has developed a comprehensive three level auditing service which has expanded beyond Australia's borders. To minimize dosimetric uncertainties the ACDS has been using Computerized Imaging Reference Systems (CIRS)1 plastic water and phantoms across all on-site audits. As phantom complexity increased to meet auditing needs, CIRS was engaged to produce bespoke phantoms for the ACDS. The most recent examples of this are the Stereotactic Radio-Surgery (SRS) head phantom, SBRT, and a thorax customized for stereotactic ablative radiotherapy (SABR) auditing. Results: Audits provide two key outcomes for participating facilities. The first is that independent measurements demonstrate whether the facility's predicted dose is being delivered to the phantom within an acceptable tolerance. For an out-of-tolerance finding the ACDS works with the facility to resolve any discrepancies on the day of audit. Examples include inaccurate data entry in a planning system or inaccurate phantom positioning. Sometimes, however, there may be a systemic issue with calculation algorithms. The National Dataset has enables the ACDS to identify characteristic behavior of certain equipment combinations. As the ACDS perform more audits, the statistical power of the dataset increases and trends can be identified. This is the second key capability which a mature auditor provides to the auditee. Conclusion: The ACDS has development a coherent and successful auditing service which is proactively responding to changing technologies and environment.

7.
Annals of Oncology ; 32:S810, 2021.
Article in English | EMBASE | ID: covidwho-1432847

ABSTRACT

Background: Locally advanced head and neck cancer (HNC) treatment promote toxicities that compromise patient’s quality of life (QoL) and treatment efficacy. Exercise training (ET) benefits are reported for many cancer types. To study this supportive care strategy in HNC patients, we designed a two-phase research project: 1) prospective observational cohort study to analyze treatment toxicities and ET preferences;2) randomized-controlled trial to test an ET program (FIT4TREAT). Here we present the results of phase I. Methods: Planned enrollment was 20 patients with stage III/IV HNC proposed for multimodal treatment with curative intent. Patients were assessed in 3 moments: baseline (M0), at the end of treatment (M1) and at 4 months follow-up (M2). Primary endpoint was QoL, evaluated by EORTC QLQ-C30 questionnaire. Secondary endpoints: dysphagia (EAT-10, FOIS), nutritional status (PG-SGA), cognitive function (MoCA), handgrip strength and 6-minute walk test (6MWT). Due to COVID-19 pandemic the study was suspended in March 2020. Comparative analysis (M0 vs M1) took in consideration 7 patients submitted to radical chemoradiotherapy (CRT). Results: From June 2019 to March 2020, 21 patients were recruited (95% men, median age 54 years). The majority recognized the health benefits of an ET program. Most patients were willing to participate in an ET program before (33%), during (52%) and/or after (67%) treatment. The most common exercise preferences were a frequency of 2 times/week, low intensity, 15-30 min/bout. The table shows the acute impact of radical CRT (n=7). [Formula presented] Conclusions: HNC patients are a vulnerable population. Radical CRT declines QoL, physical and nutritional status. These results encouraged the development of ET program FIT4TREAT, which will start recruiting during 2021. We expect to optimize patients’ physical fitness and achieve more efficacy with less toxicity. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

8.
Revista Juridica ; 2(64):203-234, 2021.
Article in English | Scopus | ID: covidwho-1404238

ABSTRACT

Objectives: The instant work investigates the effects of the COVID-19 pandemia on Brazilians entrepreneur, through analysis of two premises: (i) in 2020, the number of judicial reorganization requests would increase exponentially;(ii) the legislative measures promulgated by law #14,112/2020 upon law #11,101/2005, especially, the financing to debtors under judicial reorganization, would be useful and effective to the utilization of judicial recovery as a means of maintaining and preserving the company. Methodology: The deductive method was adopted, as from document research, as well as from analysis of data collected by other official statistical surveys and economic measurements. Results: It is appropriate to state that the sanitary measures for pandemia containment have deeply affected Brazilian entrepreneurs. However, the number of judicial reorganization requests has not increased, as expected, and the changes implemented upon bankruptcy legislation, as to debtor financing, have not yet proven efficient to foster the use of judicial reorganization. Contributions: Despite legal incentives created on behalf of debtor financing under judicial reorganization, there still is a high reputational cost to the entrepreneur which avails itself of this tool, turning the credit granted to this grantee more financially burdensome, on account of regulatory motivations. Finally, it can be mentioned that a judicial recovery request implies, to the debtor, the taking up of several obligations representing a significant tranche of expenses to the entrepreneur in distress, thereby discouraging such requests. © 2021, Centro Universitário Curitiba - UNICURITIBA. All rights reserved.

9.
13th International Symposium on Project Approaches in Engineering Education and 18th Active Learning in Engineering Education Workshop, PAEE/ALE 2021 ; 11:15-22, 2021.
Article in English | Scopus | ID: covidwho-1369853

ABSTRACT

This paper discusses online student assessment which is one of the major concerns of higher education institutions during these pandemic times, forcing teachers to teach and assess in different ways and conditions than when using regular methods. Online assessment brings more challenges for the teachers and the fear that students could cheat more than in on-site or face-to-face conditions. More than a surveillance task, it is a question of having justice among different students’ socio-economic and learning conditions. Ethical issues, respect for the colleagues and trust in their own work and more suitable learning assessment methods could be strong reasons for the students not to cheat. For the teachers, this is a complex and controversial issue. Finding the best ways to prevent this from happening is not easy. This could demand a balance between less time and more complex online tests that require a lot of imagination and creativity. This paper gives some examples of face-to-face written tests and online tests, comparing grades of two cohorts of students (2019_20 and 2020_21) from three different courses. Those courses are lectured in the first and third year of Industrial Engineering and Management (IEM) Integrated Masters degree and the first year of the Masters in Engineering Project Management, at the University of Minho. Some practical tips and suggestions will be given to prepare online tests (e.g. diversity of assessment methods, type of questions included in the tests, tests could not be the only assessment method ...). © 2021 University of Minho. All rights reserved.

12.
European Journal of Neurology ; 28(SUPPL 1):473, 2021.
Article in English | EMBASE | ID: covidwho-1307755

ABSTRACT

Background and aims: Until the 1st week of January / 2021, Brazil is the 3rd country with the highest number of confirmed cases of Coronavirus Disease- 2019 (COVID- 19). Annually, neurological diseases and their complications culminate in approximately 200,000 hospitalisations in the Brazilian public health system. This work intends to investigate the relation between COVID-19 and its effect on the condition of neurological patients. Methods: The research used the descriptors: Coronavirus Infections, Brazil, Nervous System Diseases;in PubMed, Scielo and Virtual Health Library databases. Through DataSUS, epidemiological data was collected about: Parkinson's disease, Multiple Sclerosis and Epilepsy. Results: It was expected an increase in urgent hospitalisations related to the neurological diseases scanned. According to studies carried out in other countries, the exacerbation of neurological symptoms is possible. Contrariwise, there was a significant reduction in hospitalizations related to these diseases (DataSUS), especially between April and October 2020, when the number of COVID-19 cases increased dramatically in Brazil. The cause of reduction in hospitalisations may come from a scenario of systematic underreporting triggered by the pandemic. Hospitalisation due to coronavirus infection, in the Brazilian context, allows complications of pre-existing neurological diseases, resulting from COVID-19, to not be properly registered and notified in the integrated system. Conclusion: Brazil, due to its integrated health system, is able to provide full data collected from all its territory. Had there not been a noticeable reduction in hospital care due to fear of infection, this would enable further research and understanding of the effects of COVID-19 on pre-existing neurological conditions. (Figure Presented).

13.
Sci Rep ; 11(1): 8712, 2021 04 22.
Article in English | MEDLINE | ID: covidwho-1253973

ABSTRACT

Obesity is associated with both chronic and acute respiratory illnesses, such as asthma, chronic obstructive pulmonary disease (COPD) or increased susceptibility to infectious diseases. Anatomical but also systemic and local metabolic alterations are proposed contributors to the pathophysiology of lung diseases in the context of obesity. To bring perspective to this discussion, we used NMR to compare the obesity-associated metabolomic profiles of the lung with those of the liver, heart, skeletal muscles, kidneys, brain and serum from male C57Bl/6J mice fed with a high-fat and high-sucrose (HFHSD) diet vs. standard (SD) chow for 14 weeks. Our results showed that the lung was the second most affected organ after the liver, and that the two organs shared reduced one-carbon (1C) metabolism and increased lipid accumulation. Altered 1C metabolism was found in all organs and in the serum, but serine levels were increased only in the lung of HFHSD compared to SD. Lastly, tricarboxylic acid (TCA)-derived metabolites were specifically and oppositely regulated in the serum and kidneys but not in other organs. Collectively, our data highlighted that HFHSD induced specific metabolic changes in all organs, the lung being the second most affected organ, the main alterations affecting metabolite concentrations of the 1C pathway and, to a minor extend, TCA. The absolute metabolite quantification performed in this study reveals some metabolic specificities affecting both the liver and the lung, that may reveal common metabolic determinants to the ongoing pathological process.


Subject(s)
Diet, High-Fat , Dietary Sucrose/administration & dosage , Lipid Metabolism , Liver/metabolism , Lung/metabolism , Obesity/metabolism , Animals , Magnetic Resonance Spectroscopy , Male , Mice , Mice, Inbred BALB C
14.
Revista De Direito Da Cidade-City Law ; 13(2):700-728, 2021.
Article in Portuguese | Web of Science | ID: covidwho-1244992

ABSTRACT

The article set out to discuss the digital divide and its implications for the right to the city, considering the perspective of smart cities. Since the main innovative aspect related to smart cities is the mediation of urban management and urban life through the use of ICTs. The debate was conducted taking as examples both remote learning initiatives and access to the federal government's emergency in the context of the COVID-19 pandemics - two ICTs mediated services that illustrate how the digital divide affects the availability of these services in a digital way. Such choice was made because exclusion is not a recent phenomenon, but it has become more evident due to the need for social isolation. The analysis of the chosen examples was made by examining bibliographic material and news media. The main conclusion is that in scenarios such as Brazil's, with strong and historical inequality, the use of ICTs for mediation of rights, including the right to the city, may end up reproducing processes of social exclusion, now re-signified in digital exclusion in the context of smart cities. In this sense, it is understood that for digital solutions and services implemented in cities to actually contribute to improving the living conditions of their residents, digital inclusion must be seen as a right, guaranteeing access and knowledge about such technologies and access infrastructure.

16.
Critical Care Medicine ; 49(1 SUPPL 1):98, 2021.
Article in English | EMBASE | ID: covidwho-1193912

ABSTRACT

INTRODUCTION: Since the new coronavirus began to spread throughout the world children and adolescents were affected on a smaller scale than adults, being mostly asymptomatic carriers or having mild to moderate symptoms, with lower risk of developing serious complications. When infected, patients in the pediatric age group presented a range of varied symptoms associated with the virus, different from adults where the main clinical symptom was respiratory. METHODS: Eight patients were admitted to our pediatric intensive care unit with a diagnosis of SARS-CoV-2, confirmed by PCR or serology;of these 3 were asymptomatic or presented mild flu symptoms, 2 had clinical presentation typical of severe acute respiratory distress syndrome, 1 presented abdominal pain associated with multisystemic inflammatory syndrome, 1 had clinical presentation of acute respiratory distress syndrome and later admitted again to our service fulfilling criteria for multisystemic inflammatory syndrome and 1 presented ischemic stroke after SARSCoV- 2. Four patients with severe symptoms required ventilatory support through mechanical ventilation due to respiratory failure, in most cases, difficult to manage and with shock requiring vasoactive drugs. Unlike adults, none of the 8 patients required renal replacement therapy. No outcome evolved to death. RESULTS: The diagnosis and management of SARS-CoV-2 in pediatrics is a challenge, due to this varied clinic and little experience of professionals due to a small number of cases, making this study important for better knowledge about the disease, thus improving care.

17.
Critical Care Medicine ; 49(1 SUPPL 1):87, 2021.
Article in English | EMBASE | ID: covidwho-1193890

ABSTRACT

INTRODUCTION: The World Health Association declared at match 2020 that the disease caused by nCoV-2019, the SARS-Cov-2, became a pandemic infection. The majority of patients infected by this new virus presented fever, cough and dyspnea, but also were reported cases of pneumonia leading to acute distress respiratory syndrome, acute kidney injury and encephalitis. Also, some patients presented a transient ischemic attack or a brain stroke as a complication of the infection. We will report a case of a pediatric patient that evolved with ischemic stroke after infection by nCoV-2019. METHODS: An 8 years old female patient, with previous asymptomatic infection by nCoV-2019 and no past medical history, started headache, abdominal pain and persistent fever for seven days evolving to left hemiparesis. At clinical assessment presented with ocular opening only when called (Glasgow coma scale of 14), tachypnea, dyspnea, hypotension, grade 3 muscular strength on left leg and grade 0 on left arm. Due to hypotension, at emergency sector, were initiated treatment with fluid resuscitation, but patient evolved to refractory shock needing vasoactive drugs and transference to intensive care unit. Performed cranial CT scan that showed recent extensive ischemic injury on territory supplied by left middle cerebral artery and occlusion of right internal carotid artery bifurcation. On laboratory tests patient presented increased C-reactive protein (35,8 mg/dL), ferritin (807 mg/ dL), D-dimer (13,69 μg/mL), ESR (50 mm/h) and troponin (0,097 ng/mL) with negative RT-PCR for SARS-CoV-2 and serology for SARS-CoV-2 with negative IgM, negative IgA and positive IgG. Towards this clinical case, patient fulfilled criteria for Pediatric Multisystem Inflammatory Syndrome temporally associated with SARS-CoV-2 (PIMS-TS), so were initiated treatment with human immunoglobulin 2g/Kg at the 3rd day after the admission of the patient on the intensive care unit. Patient evolved hemodynamically stable, being possible to suspend vasoactive drugs at the 4th day after admission. RESULTS: Although PIMS-TS is still considered a rare outcome, recognize its clinical and laboratorial manifestations and its possible complications, like the ischemic stroke, is essential to make an adequate and a timely management during patient hospitalization.

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