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1.
American Journal of Translational Research ; 14(5):3525-3532, 2022.
Article in English | EMBASE | ID: covidwho-1955748

ABSTRACT

Objectives: To compare the number of deaths that occurred in the state of Amazonas and in Brazil, from March 16th to August 20th 2020, using the variables skin color, sex, place of death, age group and association with COVID-19, and secondly, to verify whether between 2019 and 2020, in the period from March 16th to August 20th, there was a significant change in the number of deaths from diseases not associated with COVID-19. Methods: We searched the databases of the Brazilian public agency "Transparency Portal" for the data on deaths that occurred in the state of Amazonas and Brazil in the period from March 16th to August 20th, 2019 and 2020. The absolute frequencies and percentages of the variables studied were used for statistical analysis. Results: COVID-19 was responsible for an 11.01% increase in deaths in Brazil;however, this rate quadrupled in the state of Amazonas. In relation to age group, there was a similar percentage between Amazonas and the national average. The stratified analysis showed significant differences between genders and races, with higher death rates in men and people of brown/black skin. The number of deaths at home increased significantly, especially those from causes not associated with COVID-19. Conclusions: The national drop in deaths from diseases not associated with COVID between March and August 2020 in Brazil is misleading and may be due to the result of misreported causes of death.

2.
Nephrology Dialysis Transplantation ; 37(SUPPL 3):i218-i219, 2022.
Article in English | EMBASE | ID: covidwho-1915697

ABSTRACT

BACKGROUND AND AIMS: Coronavirus disease 2019 (COVID-19) is mainly an infectious disease of the respiratory system transmitted through air droplets, and pulmonary symptoms constitute the main presentations of this disease [1]. The first cases of the disease were identified in Wuhan, China, which occurred in early December 2019. Initially, it was called pneumonia of unknown origin, severe acute (SARS-CoV-2) [2]. In addition to being a target of the virus, the kidney also seems to have a substantial influence on the outcomes of the disease [3]. Underlying kidney disease is an emerging risk factor for more severe coronavirus disease 2019 (COVID-19) illness [4]. Identifying patients who require a palliative care approach is challenging for family physicians, even though several identification tools have been developed for this purpose. The Supportive and Palliative Care Indicators Tool (SPICT™) aims at facilitating this identification [5]. The aim of this study is to compare the outcomes presented between patients with nephropathy and lung disease in the first wave of COVID-19 assisted by a reference center in Brazil. METHOD: This study is a data analysis from patients assisted by a reference center in São Paulo, Brazil, which includes 2013 patients from March to July of 2020. This period consists on the first wave of COVID-19 infection in this country. In addition, a literature review was conducted, papers were selected searching PubMed/Medline, SciELO and LILACS databases using the terms (COVID-19) AND (nephropathy) AND (pneumopathy) AND (outcomes) in January 2022. There were no language or publication date restrictions. Also, we used the (SPICT™ to classify the patients for treatment with palliative care. RESULTS: Among 2013 patients included in our study, 223 had nephropathy, 127 males and 96 females. As for pulmonary disease, there were 155 patients, 93 males and 62 females. Furthermore, among pneumopathy patients, 65% were >60 years old, and, among renal patients, 47% approximately were >60 years old. In addition, the mean age of the renal patients' group was lower than the group of patients with lung disease. The outcomes in the nephropathy group consisted in 109 discharges and 114 deaths. In the group of pulmonary patients, 90 were discharged and 59 died;the other patients were transferred to specialized services. Renal patients presented worse outcomes than pulmonary patients, even though COVID-19 mainly affects the lung, our patients had substantial impact of its infection. Despite the fact that SPICT™ identified 41 renal patients eligible for palliative care, only 31 were referred to this service at the hospital where the study was conducted. When compared with the total population of this study, the renal patient's group was the third with the highest number of hospitalizations due to COVID-19. CONCLUSION: Renal patients had a worse prognosis when compared with patients with lung disease and the total population. The outcomes could have been different if all renal patients had been referred and treated with palliative care.

3.
PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-333594

ABSTRACT

BACKGROUND: Health conditions and immune dysfunction associated with trisomy 21 (Down syndrome, DS) may impact the clinical course of COVID-19 once infected by SARS-CoV-2. METHODS: The T21RS COVID-19 Initiative launched an international survey for clinicians or caregivers/family members on patients with COVID-19 and DS (N=1046). De-identified survey data collected between April and October 2020 were analysed and compared with the UK ISARIC4C survey of hospitalized COVID-19 patients with and without DS. COVID-19 patients with DS from the ISARIC4C survey (ISARIC4C DS cases=100) were matched to a random set of patients without DS (ISARIC4C controls=400) and hospitalized DS cases in the T21RS survey (T21RS DS cases=100) based on age, gender, and ethnicity. FINDING: The mean age in the T21RS survey was 29 years (SD=18), 73% lived with their family. Similar to the general population, the most frequent signs and symptoms of COVID-19 were fever, cough, and shortness of breath. Pain and nausea were reported less frequently (p<0.01), whereas altered consciousness/confusion were reported more frequently (p<0.01). Risk factors for hospitalization and mortality were similar to the general population (age, male gender, diabetes, obesity, dementia) with the addition of congenital heart defects as a risk factor for hospitalization. Mortality rates showed a rapid increase from age 40 and were higher than for controls (T21RS DS versus controls: risk ratio (RR)=3.5 (95%-CI=2.6;4.4), ISARIC4C DS versus controls: RR=2.9 (95%-CI=2.1;3.8)) even after adjusting for known risk factors for COVID-19 mortality. INTERPRETATION: Leading signs/symptoms of COVID-19 and risk factors for severe disease course are similar to the general population. However, individuals with DS present significantly higher rates of mortality, especially from age 40. FUNDING: Down Syndrome Affiliates in Action, Down Syndrome Medical Interest Group-USA, GiGi's Playhouse, Jerome Lejeune Foundation, LuMind IDSC Foundation, Matthews Foundation, National Down Syndrome Society, National Task Group on Intellectual Disabilities and Dementia Practices.

4.
Management and Marketing for Improved Competitiveness and Performance in the Healthcare Sector ; : 65-79, 2021.
Article in English | Scopus | ID: covidwho-1792299

ABSTRACT

Healthcare services, in particular, are one of the areas in which Lean can be applied and benefits can be reached through it. In order to analyze the suitability of Lean implementation in healthcare units, this research focused on a case study, namely in Hospital of Santo António emergency area, in the city of Porto, Portugal. The study was conducted in the year 2020, during the pandemic of COVID-19, which forced the change of screening processes. This research analyses and compares the new and previous sorting model and discusses if Lean methodology was applied. It was concluded, through data collected in the interview to the leading nurse, that despite de fact she is not familiar with the Lean concept and methodology, as process simplification and time reduction were taken into account, the new process can be considered Lean. The flow charts that reflect both the sorting structure used in the urgencies before and after were developed. Hospital culture, lack of communication before the new process implementation, and the facilities were some of the identified barriers. © 2021, IGI Global.

7.
HemaSphere ; 5(SUPPL 2):378-379, 2021.
Article in English | EMBASE | ID: covidwho-1393418

ABSTRACT

Background: The COVID-19 pandemic had a high burden in Brazil. To date, data on mortality and prognostic factors of COVID-19 infection in Brazilian patients with hematological disorders are scarce. Aims: To describe the characteristics and outcomes of patients with hematological disorders admitted to the hematological COVID care unit of a reference center in Brazil;to analyze the impact of prognostic factors on in-hospital mortality. Methods: This prospective, single-center study,included 118 patients who have been admitted to the hematological COVID care unit of the Hospital das Clínicas da Faculdade de Medicina da USP, S.o Paulo, Brazil, from March to September 2020.All patients had >18 years,an underlying hematological disease and a moderate or severe COVID- 19 infection.For analyses, patients were grouped in:(1)benign or no oncological treatment(n=43),(2) intensive chemotherapy,including induction protocols for acute leukemia and stem cell transplantation conditioning(n=44) or(3) intermediate chemotherapy,including lymphoma regimens,myeloma triple treatment or continuous treatment( n=31).The primary outcome was in-hospital mortality;secondary outcome was overall survival after admission in the COVID-19 unit.Univariate analysis(UVA) used odds ratio(OR) for baseline characteristics and ROC curve analysis for laboratory tests collected at admission.Multivariate analyses(MVA) were adjusted by age and hematological disease status group.The median follow-up and survival time after COVID-19-unit admission were estimated by Kaplan- Meier method.All statistical tests were two-sided;p-values<0.05 were considered significant. Results: Median age was 58(19-90) years and 55% of patients were male. Most patients(83%)had hematological malignancies,- mainly non-Hodgkin lymphoma(29%) and multiple myeloma(19%). The most frequent benign disease was sickle cell disease(5%).12 patients had undergone hematopoietic stem cell transplantation (HSCT),4 allogeneic and 8 autologous.70% had at least one comorbidity, mostly arterial hypertension and diabetes mellitus. Thromboembolic events occurred in 9%. Median hospital stay in the COVID-19 unit was 12(1-63) days;54% needed intensive care and 41% mechanical ventilation.In-hospital mortality rate was 41%[95%CI 32-50];most deaths occurred in patients with malignancies. Median follow-up was 73(95%CI 61-81) and 54(95%CI 39-66) days after admission and discharge from the COVID-19 unit, respectively.UVA showed a risk of death increased by 25% every 10 years old.The risk of in-hospital death was 3-fold and 5-fold higher in groups 2 and 3 compared with group 1.MVA showed higher risk of death in patients from group 2(OR=11.1,95% CI 2.9- 54.8) or group 3(OR=9.7,95%CI 2.4-47.5]),who had lactate dehydrogenase( LDH)>440 U/L(OR=16.8,95%CI 4.9-71.8),C-reactive protein(CRP)>100 mg/L(OR=4.1,95%CI 1.4-13.6) or platelet count<150x10e9/L(OR=3.7,95%CI 1.3-11.7), regardless of age(OR=1.2,95%CI 1.0-1.5).79% of in-hospital deaths were from COVID-19;others were mainly due to hematological disease.The overall median survival time after admission was 92 days(95% CI 34-NA) and the 75-day survival probability was 51%(95%CI 41-60).25% of patients had hospital readmission,mostly due to other infections. Summary/Conclusion: In line with other reports,patients with hematological diseases are at higher risk of mortality from COVID-19 infection, particularly in low and middle income countries.In our cohort, prognostic factors were status of disease,platelets count,LDH and CRP. These findings might help risk stratification and prioritization of vaccines in this setting.

8.
17th Brazilian Symposium on Information Systems: Intelligent and Ubiquitous Information Systems: New Challenges and Opportunities, SBSI 2021 ; 2021.
Article in English | Scopus | ID: covidwho-1327758

ABSTRACT

The COVID-19 pandemic has been pressuring the whole society and overloading hospital systems. Machine learning models designed to predict hospitalizations, for example, can contribute to better targeting hospital resources. However, as the excess of information, often irrelevant or redundant, can impair the performance of predictive models, we propose in this work a hybrid approach to attribute selection. This method aims to find an optimal attribute subset through a genetic algorithm, which considers the results of a classification model in its evaluation function to improve the hospitalization need prediction of COVID-19 patients. We evaluated this approach in a database of more than 200 thousand COVID-19 patients from the State Health Secretariat of Rio Grande do Sul. We provided an increase of 18% in the classification precision for patients with hospitalization necessities. In a real-time application, this would also mean greater precision in targeting resources, as well as, consequently and mainly, improved service to the infected population. © 2021 ACM.

9.
Epidemiologia E Servicos De Saude ; 30(1):12, 2021.
Article in English | Web of Science | ID: covidwho-1177861

ABSTRACT

Objective: To describe the clinical and epidemiological profile of suspected COVID-19 cases admitted to a federal hospital in Rio de Janeiro, RJ, Brazil, and to identify factors associated with death. Methods: This was a cross-sectional study using local epidemiological surveillance data as at epidemiological week 27 of 2020 and logistic regression. Results: 376 hospitalized suspected COVID-19 cases were included;52.9% were female, 57.4% were 50 years old or over and 80.1% had comorbidities. 195 (51.9%) COVID-19 cases were confirmed and their lethality was higher (37.9%) than among discarded cases (24.2%). In the adjusted analysis, death among confirmed cases was associated with being in the 50-69 age group (OR= 11.65 - 95%CI 1.69;80.33), being aged 70 or over (OR= 8.43 - 95%CI 1.22;58.14), presence of neoplasms (OR= 4.34 - 95%CI 1.28;14.76) and use of invasive ventilatory support (OR= 70.20 - 95%CI 19.09;258.19). Conclusion: High prevalence of comorbidities and lethality was found;the main factors associated with death were being older, neoplasms and invasive ventilatory support.

12.
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