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The hotel industry has been one of the fastest-growing economic sectors in Portugal in recent years. According to the European Best Destinations website, Portugal has consolidated itself as a destination of excellence. The explanation of the capital structure of firms remains relevant in financial research. However, prior international empirical evidence is not exclusive and is still scarce in the Portuguese hotel sector, which motivated this research. This study aimed to analyse the influence of determinants on the capital structure of 821 Portuguese hotels between 2011 and 2019 (until the constraints of the COVID-19 pandemic affected the international tourism sector) and to determine whether strategies were conducted according to trade-off and pecking order theories. This study used an econometric approach based on the static panel data model, with tests recommending the fixed effects model estimated by the least squares dummy variables (LSDV) within. The analysed determinants were return on assets, size, tangibility, growth opportunities, risk and other tax benefits besides debt in order to explain the indebtedness through three alternative measures. The results of this research show that managers sought an optimal combination of equity and debt, which was weighted between tax savings and the cost of financial distress. However, they pursued this objective through the hierarchical sequencing of funding sources in order to minimise the costs of information asymmetry. © 2023 by the authors.
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In 2021, the Metropolitan Technological University (UTEM) implemented the service-learning methodology with the aim of promoting meaningful learning through the development of generic skills in students and contributing to the resolution of problems of organizations related to their disciplines in the context of the COVID-19 pandemic. Through a descriptive research method and the application of a questionnaire to 346 students, this study investigates the effects of S + L in the development of the competences of effective argumentation, collaborative work, problem solving, creation of solutions and social responsibility. Likewise, it delves into how the experience impacts motivation with the online educational process and presents, characterizes and explains the A + S institutional model and its adaptations for remote emergency education. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Introduction: During COVID-19 pandemic, the massive use of ventilatory support made its complications even more common. This study aimed to analyse the incidence of barotrauma in COVID-19 patients as well as its consequences. Method(s): Retrospective cohort study. All patients undergoing mechanical ventilation in an intensive care unit (ICU) during 2020- 2021 were included. The time of both noninvasive and invasive ventilation was considered together. Statistical analysis was performed using IBM SPSS Statistics 28.0. Result(s): A total of 967 patients were included, with 42 cases of barotrauma being reported (28 men and 14 women, median age 69 years [interval 22-94] and median APACHE 13). Out of those, 40 had severe COVID-19. Regarding patients with and without COVID-19, the incidence of barotrauma (episodes/1000 days of ventilation) was 0.64 and 9.22 (RR 14.86, p < 0.001) and the barotrauma rate (episodes/number of patients) was 0.4% and 8.5% (RR 21.25, p < 0.001), respectively. The most common type of barotrauma was subcutaneous emphysema (52.4%, CI 95% 37.3-67.5%), followed by pneumomediastinum (47.6%, CI 95% 32.5-62.7%) and pneumothorax (35.7%, IC 95% 21.2-50.2%). The median time to diagnosis was 11.5 days after initiation of ventilatory support [interval 1-67]. In the COVID-19 group, barotrauma was associated with longer ventilation (14.06 vs 7.91 days, p < 0.001), longer ICU stay (16.74 vs 8.17 days, p < 0.001) e higher mortality rates (45.0% vs 26.2%, RR 1.72, p 0.011). Conclusion(s): We found a higher susceptibility to developing barotrauma as a potential complication of COVID-19 patients undergoing mechanical ventilation. From those, subcutaneous emphysema and pneumomediastinum seem to be more prevalent than pneumothorax. Barotrauma seems to be associated with longer periods undergoing mechanical ventilation, longer ICU stays and higher hospital mortality rates.
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Vaccines are essential for the eradication of diseases. Yet for many reasons, individuals do not embrace them completely. In the COVID-19 pandemic and with the possibility of the Brazilian population's immunization against the disease, both political and health-related dimensions might have had a role in individual COVID-19 vaccination acceptance. In two studies (n = 974), we tested the hypothesis that participants' vaccination acceptance is related to their past vote in the 2018 Brazilian presidential election (being or not being a Jair Bolsonaro voter) and their different levels of perceived vulnerability to disease (PVD). We further tested whether Bolsonaro's opposition or ambiguous messages towards vaccination (vs. control) increased vaccination rejection among those who have (vs. have not) voted for him and who are low (vs. high) in PVD. Results show that Bolsonaro (vs. non-Bolsonaro) voters accepted less vaccination, with higher rejection rates when participants expressed low (vs. high) PVD. Also, when primed either with Bolsonaro's opposed or ambiguous messages towards COVID-19 vaccination, such participants accepted less vaccines (vs. participants primed with neutral information). These findings are the first to show that the COVID-19 vaccine acceptance is related to their past vote and leadership influence but also different levels of perceived vulnerability to disease. © 2023 International Society of Political Psychology.
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Monitoring how different people–as ‘social sensors'–evaluate and respond to crisis such as pandemics, allows tailoring crisis communication to the social perceptions of the situation, at different moments. To gather such evidence, we proposed a index of social perceptions of systemic risk (SPSR), as an indicator of a situational threat compromising risks to physical health, psychological health, the economy, social relations, health system, and others. This indicator was the core of a social sensing approach applied to crisis situations, implemented during the COVID-19 pandemic through a content analysis of more than 130.000 public comments from Facebook™ users, in COVID-19 related publications. This content coding allowed creating a SPSR index monitored during a one-year descriptive longitudinal analysis. This index correlated with co-occurring events within the social system, namely epidemiological indicators across measurement cycles (e.g. new deaths;cumulative number of infection cases;Intensive Care Unit hospitalizations) and tended to reflect the epidemiological situation severity (e.g. with the highest level registered during the worst pandemic wave). However, discrepancies also occurred, with high SPSR registered in a low severity situation, i.e. low number of hospitalizations and deaths (e.g. school year beginning), or low SPSR in a high severity situation (e.g. 2nd pandemic wave during Christmas), showing other factors beyond the epidemiological situation contributing to the social perceptions. After each ‘crisis period' with SPSR peaking, there was a ‘restoration period', consistently decreasing towards average levels of the previous measurement cycle. This can either indicate social resilience (recovery and resources potentiation) or risk attenuation after a high-severity period. This study serves as preliminary proof of concept of a crises social sensing approach, enabling monitoring of social system dynamics for various crisis types, such as health crisis or the climate crisis. © 2023 Informa UK Limited, trading as Taylor & Francis Group.
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One of the main impacts of technologies in the tourism sector is traveler empowerment. Technology has allowed travelers to be a lot more informed and to take a proactive role in organizing their own trip. Now, tourists are much more demanding, have several options to choose, and have more bargaining power. Tourist has also become not just a mere visitor, but a content generator sharing their experience with other travelers. This research intends to identify the adoption of technologies in the hotel and restaurant sector and secondly to identify smart technologies that can help to eradicate the virus and normalize the hospitality business. The research question is: How COVID-19 could be a trigger for the adoption of new technologies in the hospitality sector? The objectives are: (i) to identify new technologies already adopted in the hotel and restaurant areas, (ii) to pinpoint how new technologies could help in health and cleanness protocols, and (iii) to categorize changes in operational areas after the consecutive lockdowns. To achieve these goals, several case studies were collected to show and explain best practices for the future. The results are expected to help identify outcomes to build a survey to apply to hospitality professionals. Also, those outcomes will be useful in improving professionals' tools, resources, and procedures to help to eradicate the COVID-19 virus. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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After decades of discussions and legislation regarding Special Education, the demands remain urgent and daily. This study, qualitative and documental analysis, interprets how Special Education has been understood in federal and state legislation, from Goias and Tocantins, stressing the challenges brought by the pandemic. After inductive analysis of the data, the results indicate that the Base Nacional Comum Curricular approaches the theme of inclusion in a fragile way and, in the state documents, an alignment of its goals with the Plano Nacional de Educagao is noted, although adaptations are still needed to the existing social demands, previous or that emerged during the pandemic.
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Background: The use of colchicine has been associated with reduction of adverse cardiac events in patients with coronary artery disease (CAD). The role of this drug after percutaneous coronary intervention (PCI) with bare metal stents (BMS) has not been evaluated against isolated PCI with drug eluting stents (DES). Aim(s): The study was designed to test an improved cost-effectiveness with BMS plus colchicine (group BMS+C) compared to DES alone (group DES), provided its noninferiority in terms of major adverse cardiac events (MACE) at 1 year. Method(s): This is a prospective, multicenter, randomized controlled trial performed in 4 centers. The trial has been registered at clinicaltrials.gov (NCT04382443). Study protocol and informed consent have been approved by an Independent Ethical and Review Board Committee and were presented to Argentina National regulatory authorities for Health, Technology and Medications. Patients in the BMS+C group received 0.5mg oral doses twice a day of colchicine for 3 months. Outpatient visits were scheduled at 1, 3, 6 and 12 months as well as at 3 and 5 years. Primary endpoints were to compare cost-effectiveness and MACE defined as composite of death, myocardial infarction (MI), cerebrovascular accident and ischemia-driven target vessel revascularization. Result(s): During February 2020 to April 2022, 412 patients with clinically indicated PCI were randomized in the study. Because 2 patients with COVID 19 at the time of randomization were excluded, the final study population was composed of 410 patients (205 patients in each group). Baseline demographic and angiographic characteristics were well balanced diabetes 19.5% vs 21.4%, Acute Coronary Syndromes 78% vs 75%, ST elevation MI 23% vs 21% multiple vessel CAD 44% vs 46%, culprit left anterior descending artery 58% vs 57.8%, peripheral vascular disease 3.4% in BMS+C and DES groups respectively.2.9% of patients in BMS+C didn't complete the treatment for side effects (diarrhea). Presently, patients were follow at mean of 381 days ( range 45 to 839),1 - year follow-up was completed in 61%. Conclusion(s): A 3-month treatment with colchicine after PCI with BMS was feasible and safe. Final 1- year clinical outcomes and cost-effectiveness results will be available at the time of presentation.
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Objective: This study aimed to determine the effects of a psychomotor program performed during the COVID pandemic on risk factors for falls in nursing home older adults. Method(s): The study involved 10 nursing home older adults (aged 67-91 years old) who integrated two periods without intervention (control: pre-lockdown;and lockdown) and an experimental period (attending the program). Cognitive, emotional and physical functioning risk factors for falling were measured before and after each period. Result(s): Friedman's Test followed by Pairwise Comparison post-test showed that the program induced significant improvements with an effect size (EF) ranging from large to small in the follow risk factors: fear of falling (EF=3.22), depressive states (EF=1.49), static balance (EF=0.83), lower strength (EF=0.76), upper strength (EF=0.73), cognitive status (EF=0.58), upper flexibility (0.52), perception of affordances - real (EF=0.51) and estimated (EF=0.45), agility and balance (EF=0.37), balance and mobility (EF=0.36), lower flexibility (EF=0.24) and aerobic resistance (EF=0.21), (p<0.05). On the other hand, in the no-intervention periods, lower and upper strength, upper flexibility and perception of affordances - estimated significantly decreased (p<0.05). Conclusion(s): Results from the study showed that the psychomotor program was effective in falls prevention by improving cognitive, emotional and physical functioning risk factors for falling. These findings suggest that for older adults' good quality of life, psychomotor programs should be implemented in nursing homes.
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A hemofilia A adquirida (HAa) e uma coagulopatia autoimune rara, associada a deficiencia do fator de coagulacao VIII, diagnosticada em idosos, que apresenta altas taxas de morbidade e mortalidade. Os principais sintomas sao sangramentos recorrentes, espontaneos e prolongados em regioes subcutaneas e mucosas, alem de hematomas musculares. O prolongamento isolado do Tempo de Tromboplastina Parcial Ativada (TTPA) e o Tempo de Protrombina (TP) normal, acompanhados de sangramento anormal, sugerem aprofundar a investigacao diagnostica. Por ser um disturbio autoimune, o paciente desenvolve inibidores contra o fator de coagulacao VIII, tornando o tratamento ainda mais complexo, ja que a reposicao do fator de coagulacao deficiente pode sofrer ataque dos autoanticorpos envolvidos. Medicamentos antifibrinoliticos e imunossupressores sao opcoes terapeuticas complementares. Um homem de 71 anos, branco, com historico profissional na agricultura e construcao civil, foi encaminhado a equipe de Hematologia apresentando dor nas pernas, hemartrose no joelho e hematomas extensos nos membros superiores e inferiores, relatando inicio dos sintomas apos segunda dose vacinal para Sars-Cov-2. Com historico de hipertensao arterial, artrite reumatoide e hiperplasia prostatica benigna, encontrava-se em uso de sinvastatina, enalapril, prednisona, diclofenaco sodico, carisoprodol e doxazosina. Os exames laboratoriais demonstraram hemograma, RNI, TP e plaquetograma dentro dos limites de normalidade. Ja a dosagem de fator de coagulacao VIII foi de 3% e o TTPA de 69,5 segundos, levando ao diagnostico de HAa. Por queixa de dor dentaria, o paciente foi encaminhado a Odontologia. Ao exame fisico, observou-se edentulismo superior e uso de protese total, pseudomembrana removivel a raspagem no palato, compativel clinicamente com candidose pseudomembranosa, presenca de quatro dentes inferiores com mobilidade, acumulo de biofilme bacteriano e caries. Alem disso, apresentava pequena ulceracao em labio inferior, indolor, nao endurecida a palpacao, compativel clinicamente com queilite actinica. Para as manifestacoes estomatologicas, prescreveu-se dexpantenol labial, fator de protecao solar e nistatina suspensao oral (100.000UI) para bochecho durante 7 dias, ocasionando a melhora incompleta da lesao labial e resolucao completa da infeccao fungica. Apesar da conduta indicada ter sido a extracao de todos os dentes, o quadro hematologico instavel nao permitiu tais procedimentos, ja que agentes antifibrinoliticos foram considerados insuficientes para controlar a hemorragia e o uso de alfaeptacogue ativado nao foi liberado pelo Ministerio da Saude para realizacao das exodontias. Assim, optou-se pela prescricao de analgesicos e proservacao do caso, enquanto as condicoes hematologicas aguardavam estabilizacao. Esse fato limitou a acao da equipe multiprofissional, uma vez que os focos infecciosos dentarios podem ocasionar episodios de dor intensa e sangramentos espontaneos, agravando ainda mais a condicao geral. O caso demonstra a complexidade do manejo hematologico de um paciente com HAa, levando a dificuldade do tratamento odontologico, nao sendo possivel atender imediatamente as necessidades do paciente mesmo em condicoes onde a intervencao odontologica nao podia ser considerada eletiva. Copyright © 2022
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One of the main impacts of technologies in the tourism sector is traveler empowerment. Technology has allowed travelers to be a lot more informed and to take a proactive role in organizing their own trip. Now, tourists are much more demanding, have several options to choose, and have more bargaining power. Tourist has also become not just a mere visitor, but a content generator sharing their experience with other travelers. This research intends to identify the adoption of technologies in the hotel and restaurant sector and secondly to identify smart technologies that can help to eradicate the virus and normalize the hospitality business. The research question is: How COVID-19 could be a trigger for the adoption of new technologies in the hospitality sector? The objectives are: (i) to identify new technologies already adopted in the hotel and restaurant areas, (ii) to pinpoint how new technologies could help in health and cleanness protocols, and (iii) to categorize changes in operational areas after the consecutive lockdowns. To achieve these goals, several case studies were collected to show and explain best practices for the future. The results are expected to help identify outcomes to build a survey to apply to hospitality professionals. Also, those outcomes will be useful in improving professionals' tools, resources, and procedures to help to eradicate the COVID-19 virus. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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The new centrality of information in organizations leads to question the evolution of the Chief Information Officers (CIO) role, which has been a recurring theme. What are the elements of this change, with the disruptive emergence of digital native organizations? Undoubtedly, the rapid technological evolution and the increased use of Information Technology (IT) are impacting the activities and responsibilities of the CIO's role in organization, something that became even more notorious, recently, when the pandemic COVID-19 turned all attention to the essential character of IT. This article presents an exploratory study describing the responsibilities attributed to the CIO in the light of the technology disruption over time. This study also made it possible to perceive the existence of a collective awareness about the importance of a set of technologies and the confluence of some of them, which, on the one hand, will help to define a strategic orientation and, on the other hand, free the CIO from routines for the emergence of ContinuousNext in line with what Gartner announces2,. © 2021 Associacao Portuguesa de Sistemas de Informacao. All rights reserved.
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Introduction: One team, multiple sites is a principle supporting our Academic Health Sciences Centre (AHSC) partnership vision for academic and clinical excellence. COVID-19 has highlighted the need for co-ordinated crossorganisational working within ICU. There is currently no nationally agreed competency framework for ICU Physiotherapists. Having a streamlined set of competencies across the AHSC would be beneficial for safety, quality of care, training efficiency, workforce development, workforce mobility and further embed collaborative cross-site relationships. Objective: To develop streamlined competencies for ICU Physiotherapists working within an AHSC. Methods: Physiotherapy ICU leads from each site in the AHSC were identified via stakeholder mapping. This work stream was facilitated by a dedicated project lead, using a Plan-Do-Study-Act (PDSA) cycle. Organisational and national competencies1-3 relevant to ICU Physiotherapists were collated. Benchmarking and mapping were completed to identify commonalities and deficits. Initial meetings were conducted weekly via virtual forums to ensure benchmarking and mapping procedures were validated by all members. Two face-to-face meetings were employed to discuss the ideal competency set based on expert clinical opinion alongside the results from benchmarking and mapping. A whiteboard collaboration platform provided by Miro4 enabled all members to contribute whilst negotiations were facilitated by the project lead. Consensus on decisions pertaining to the streamlined document required all members to be in agreement. The method for achieving this centred on open discussion and regular communication. Results: The work stream utilised eighteen organisational competency documents and three national documents.1-3 The final competency set was formulated using common themes which allowed for incorporation of specific competencies from each site. Agreement on each theme and specific competencies were easily reached due to the extent of commonality between existing organisational documents. Rather than using bands to denote progression through competencies the work stream agreed on use of the terms Foundation, Specialist, Advanced and Expert, aligning the document with the Intensive Care Society AHP professional development framework.1 These levels are loosely aligned to the expectations for staff in bands 5-8, though allows staff to develop skills through the levels with no ceiling effect based on paygrade. The group comprehensively devised the foundation level set of competencies and approved a sign-off procedure using elements from organisational documents, including self-reported confidence measures and senior supervised assessment of competence. Conclusion: Using quality improvement methodology, the work stream was able to rapidly produce a comprehensive streamlined competency set for foundation level Physiotherapists in ICU across the AHSC. Next steps include gaining workforce feedback as part of a further PDSA cycle to refine the document prior to implementation. Continued collaboration by the work-stream will enable additional competency levels to be built from the foundation set. Education and training aligned to the document is essential for its success. Development of this will extend and reinforce the cross-organisational working and collaboration which is now embedded within the teams. The methodology to date demonstrates a proof of concept which can be utilised with other AHP groups in ICU, other settings or wider regional areas.
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Objective: The COVID-19 has quickly climbed to a global pandemic and hospitals had to adjust in order to manage the resources available. The aim of this article was to expose our experience and the means used to avoid delay in treating oncologic patients. Methods: Collection of data from all patient who underwent elective colorectal surgery for neoplasia during the state of emergency (between March 16th and May 16th 2020) and compared the surgical outcomes with the outcomes of the previous year. Results: A total of 28 patients received colorectal surgery from March 16th and May 16th 2020. Laparoscopy using the Air-Seal® was the most practiced approach (Pearson Chi-Square 0.014;p value 0.905). The complication rate was not statistically different from the previous year (Pearson Chi-Square 2.640;p value 0.104) as well as the rate of major complications (Pearson Chi-Square 0.754;p value 0.385). During the peak of infections, there was no increase in the number of days of hospitalization comparing to the previous year (p value 0.279). There was no delay in the oncologic surgical treatment (p value 0.010). Conclusion: We were able to demonstrate that it is possible to treat cancer patients during pandemic without compromising its possibility of cure. © 2022 Celsius Publishing House. All rights reserved.
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In early 2020, the COVID-19 pandemic forced the higher education institutions to adapt to a new form of teaching and learning, from presential to full remote, blended and hybrid environment. This challenge had a particular impact in the life sciences field where the courses have a high content of laboratorial classes. The main issue was how to transition from hands-on practical classes to remote instruction, assuring that our students continued engaged and acquiring the necessary skills, in a short amount of time. To address this, we took advantage of already available digital tools that facilitated the interface with the students such as Moodle, Skype, Teams and ZOOM and explored online resources such as virtual labs, simulations and video demonstrations. Additionally, several classes and laboratorial experiments were recorded by the teachers in the school labs and the research labs where we develop our research activity. The creation of teachers' work groups to share experiences and tools was key in the success of this process. To ensure the students evaluation we used preferentially Moodle platform which allowed the used of digital tools to control and prevent fraud by copying, plagiarism or false identity. Despite all efforts from teachers and students, crucial elements of the high education experience, particularly for undergraduates, were disrupted. Namely the student-teacher and student-student contact and interaction and the integration in the academic setting, resulting in stress and feeling of isolation and overwhelm. Even with the difficulties faced by all the academic community, we observed no major changes regarding the academic success reflected in the final grades, comparing with previous years. In our understanding the core skills proposed for these courses were acquired successfully and the digital tools used with exception for the student's evaluation, are now considered an added value and bring flexibility to the teaching-learning process.
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The article is the result of an ethnographic research carried out with Mozambican women living in the city of Maputo. As an objective, we seek to understand some changes in smartphone consumption practices in the context of the Covid-19 pandemic. Throughout the research, which began with face-to-face fieldwork, in 2019, and moved to a second stage of ethnography for the internet (HINE, 2015), participant observation, observation in social media and in-depth interviews were carried out. Our analysis understands that in a pandemic scenario, smartphones became the enablers of remote learning for university students – despite the inequality of access – and that they helped the research interlocutors to build new sources of income. © 2022, Superior School of Advertising and Marketing. All rights reserved.
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The COVID-19, a disease caused by SARS-CoV-2, affected the whole world in 2020 by its pandemic impact. This virus has a very high capacity for contamination through contact with other infected people. One of the main ways to fight the virus is to reduce the possibility of contact with the infected population by avoiding the crowding of people. Within this context, the virtual means of communication are being channels of information about the pandemic and also the externalization of users' feelings and opinions. Through social networks, people assume the role of content generators and not just consumers. This leaves room for the spread of misinformation, biased news, and rumors that are originated from laymanship, political and commercial interests. This work aims to characterize how fact-checking agencies have reacted in the combat against false information about COVID-19 on social networks such as Twitter and Facebook, seeking to broaden the understanding of misinformation propagated over the internet. During the study, we collected fact-checking articles about COVID-19 written by experts from different countries. Through the verified news, we searched social media posts which misinformation began to be spread. After collecting this data, it was verified how long it took the fact-checking agencies to analyze the veracity of the news. In addition, the texts were processed to detect whether the topics being dealt with by the agencies are, in fact, those with the greatest engagement of users within the analyzed social networks, and also the presence of bots on social media. We compared the collection of fact-checking provided by the Poynter Institute and Google's Fact-Checking API, to identify a uniformity between the databases. The results showed that the response time of agencies was around 23 days in the case of misinformation on Twitter and approximately 6 days on Facebook. © 2022 Owner/Author.
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Introdução: A pandemia pelo SARS-CoV-2 (COVID-19) vem desafiando a comunidade científica e os serviços de saúde, superando mais de 4 milhões de mortos no mundo. A idade avançada e a presença de comorbidades cardiovasculares são relacionadas a maior mortalidade em relação a população geral, podendo atingir 15% dos casos infectados. Pacientes onco-hematológicos, devido a doença de base e ao seu tratamento, possuem comprometimento do sistema imune por período de tempo prolongado, o que os torna mais suceptiveis a infecções. A infecção pelo COVID-19 nesse grupo de pacientes tem demonstrado piores desfechos. Nesta série de casos avaliamos os desfechos de pacientes portadores de doenças linfoproliferativas diagnosticados com COVID-19 de Fevereiro de 2020 a Agosto de 2021 em duas instituições de São Paulo. Objetivo: Descrever os desfechos de pacientes com COVID-19 em pacientes com doenças linfoproliferativas. Métodos: Estudo multicêntrico, observacional e retrospectivo. Os dados foram obtidos através do prontuário eletrônico. Os critérios de inclusão foram diagnóstico de doença linfoproliferativa e infecção por COVID-19 confirmada através de teste RT-PCR em pacientes sintomáticos realizados nos centros participantes. Resultados: Em um tempo mediano de seguimento de 399 dias foram incluídos 41 pacientes com mediana de idade de 59 anos (DP 16,8). A maior parte dos pacientes eram portadores de linfoma difuso de grandes células B (LDGCB), representando 24% da amostra, seguidos por linfoma folicular (17%) e linfoma de Hodgkin (17%). Em relação as comorbidades, 9 (22%) pacientes diabéticos, 17 (41%) hipertensos e 9 (22%) obesos. A taxa de admissão hospitalar foi de 75% e, mais da metade dos pacientes foram admitidos em unidade de terapia intensiva (UTI). Metade dos pacientes necessitaram de suporte ventilatório sendo, 15% dos pacientes com ventilação mecânica e outros 35% com cateter nasal de oxigênio. A prevalência de eventos trombóticos foi de 17%. Em relação ao tratamento quimioterápico 85% dos pacientes dessa amostra estava em vigência de tratamento quimioterápico no momento da infecção pelo Covid-19, no entando na análise univariada não houve diferença estataisticamente significativa de mortalidade entre o grupo de pacientes que estavam em tratamento quimioterápico e os que não estavam (HR 1,18;IC 0,26-5,33;p = 0,83). A taxa de sobrevida global em 100 dias foi de 66% (IC95 53-83%). Discussão: A mortalidade de pacientes hematológicos com infecção pelo COVID-19 é superior a população geral e foi estimada em 34% dos casos na metanalise publicada por Vijenthira et all. Em um estudo multicêntrico realizado na Alemanha a mortalidade em pacientes hospitalizados sem antecedente de neoplasias foi em torno de 22%. A ausência do aumento da mortalidade em pacientes com exposição recente a tratamento quimio-imunoterápico é condizente com dados apresentados em literatura, no entando não há estudos prospectivos publicados que exaltem esses achados. A idade superior a 60 anos foi o fator de maior impacto na mortalidade dos pacientes com doenças onco-hematológicos de acordo dados de literatura e em nosso estudo esse dado não foi estatisticamente significante possivelmente devido a uma mediana de idade menor que 60 anos da amostra. É importante ressaltar que esse é um estudo retrospectivo, porém que reafirma o pior desfecho clínico dos pacientes com doença onco-hematológicos com infecção pelo COVID-19.
RESUMEN
Introdução: Estudos apontam relação entre grupos sanguíneos e diversas condições clínicas como, por exemplo, eventos trombóticos, doença de von Willebrande doenças infecciosas como SARS-CoV-1, H. pylori entre outros. Associação entre maior susceptibilidade à COVID-19 e pior evolução em indivíduos do grupo sanguíneo A vem sendo estudada por diversos grupos. Objetivo: Neste estudo, analisamos a correlação entre os grupos sanguíneos ABO e resultado do teste para o vírus SARS-CoV-2 por RT-PCR em um laboratório de análises clínicas com grande fluxo de amostras representativas das cinco regiões do Brasil. Material e métodos: Os dados foram obtidos do banco de dados do laboratório referente a 20 anos de registro, analisados de forma anonimizada e de acordo com as regras que regem a lei geral de proteção de dados (LGPD). Os registros possuem um identificador numérico único que leva em conta CPF e data de nascimento e todas as análises foram feitas considerando-se esta identificação. Foram obtidas as tipagem sanguínea ABO/Rh e os resultados de RT-PCR para SARS-CoV-2. Para este último, os indivíduos foram classificados “covid-positivo”quando ao menos um exame resultou positivo. Os demais foram considerados “covid-negativo”. As análises foram realizadas no banco de dados obtido do cruzamento do banco de indivíduos únicos com tipagem sanguínea e ao menos um teste para COVID-19. Análise estatística foi realizada do teste chi-quadrado de Pearson e V-quadrado de Cramér. Resultados e discussão: Foram identificados 66.181 indivíduos que realizaram tipagem sanguínea e ao menos um teste para SARS-CoV-2. A distribuição global dos grupos ABO é a que segue: grupo O 44%, grupo A 41%, grupo B 11% e grupo AB 4%, compatível com a distribuição dos grupos no Brasil (O 45%, A 42%, B 10% e AB 3%).Do total de indivíduos estudado, 21% (13.617) apresentou ao menos um resultado positivo para SARS-CoV-2, distribuídos da seguinte forma por grupo sanguíneo: tipo O 42%, A 42%, B 12% e AB 4%. A distribuição dos grupos sanguíneos entre os indivíduos negativos para SARS-CoV-2 foi: tipo O 44%, A 41%, B 11% e AB 4%. As análises consideraram grupo ABO e Rh. Foi realizado um teste chi-quadrado de independência de variáveis e verificou-se associação positiva entre o tipo sanguíneo e a infecção por COVID-19 (χ2 = 27,273, df = 7, p = 0,0002975).O teste pós-hoc de comparação entre status de COVID-19 e tipo sanguíneo sugere associação entre o tipo B- e infecção por COVID-19 (p = 0.0407700).Entretanto, este dado não foi confirmado por análise adicional pelo teste V de Cramér, sugerindo que o efeito observado está provavelmente associado ao grande número de amostras do que uma associação real entre as variáveis.Sabe-se que a testagem para COVID-19 pode resultar em falso negativo quando realizada fora da janela de maior sensibilidade para detecção do vírus. Deve-se considerar que, na presente análise, a informação sobre início dos sintomas e data de realização do teste não está disponível. Entretanto, o grande número de casos analisados diminui o impacto da ausência desta informação. Outro ponto importante a ser considerado é que não foram avaliados parâmetros de evolução clínica dos pacientes, sendo os dados restritos à presença ou não de diagnóstico positivo para COVID-19. Conclusão: Não foi demonstrada associação entre o tipo sanguíneo e a suscetibilidade a infecções por COVID-19 no grupo analisado.