Sociodemographic factors associated with COVID-19 in-hospital mortality in Brazil.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has highlighted inequalities in access to healthcare systems, increasing racial disparities and worsening health outcomes in these populations. This study analysed the association between sociodemographic characteristics and COVID-19 in-hospital mortality in Brazil. STUDY DESIGN: A retrospective analysis was conducted on quantitative reverse transcription polymerase chain reaction-confirmed hospitalised adult patients with COVID-19 with a defined outcome (i.e. hospital discharge or death) in Brazil. Data were retrieved from the national surveillance system database (SIVEP-Gripe) between February 16 and August 8, 2020. METHODS: Clinical characteristics, sociodemographic variables, use of hospital resources and outcomes of hospitalised adult patients with COVID-19, stratified by self-reported race, were investigated. The primary outcome was in-hospital mortality. The association between self-reported race and in-hospital mortality, after adjusting for clinical characteristics and comorbidities, was evaluated using a logistic regression model. RESULTS: During the study period, Brazil had 3,018,397 confirmed COVID-19 cases and 100,648 deaths. The study population included 228,196 COVID-19-positive adult in-hospital patients with a defined outcome; the median age was 61 years, 57% were men, 35% (79,914) self-reported as Black/Brown and 35.4% (80,853) self-reported as White. The total in-hospital mortality was 37% (85,171/228,196). Black/Brown patients showed higher in-hospital mortality than White patients (42% vs 37%, respectively), were admitted less frequently to the intensive care unit (ICU) (32% vs 36%, respectively) and used more invasive mechanical ventilation (21% vs 19%, respectively), especially outside the ICU (17% vs 11%, respectively). Black/Brown race was independently associated with high in-hospital mortality after adjusting for sex, age, level of education, region of residence and comorbidities (odds ratio = 1.15; 95% confidence interval = 1.09-1.22). CONCLUSIONS: Among hospitalised Brazilian adults with COVID-19, Black/Brown patients showed higher in-hospital mortality, less frequently used hospital resources and had potentially more severe conditions than White patients. Racial disparities in health outcomes and access to health care highlight the need to actively implement strategies to reduce inequities caused by the wider health determinants, ultimately leading to a sustainable change in the health system.

Optimization and scale-up of an LED-illuminated microalgal photobioreactor for wastewater treatment.

The use of light-emitting diode (LED)-illuminated photobioreactors with microalgae has been extensively studied for wastewater treatment. Most studies have used isolated microalgae species; however, this practice does not match the reality of conditions in wastewater treatment plants. Operational conditions that promote greater growth of algal biomass and that remove pollutants most effectively are disputed in the literature. In this context, LED-illuminated photobioreactors with microalgae were evaluated using multivariate analysis in order to optimize removal of pollutants (nitrogen, phosphorus, and carbonaceous organic matter). Three variables were evaluated: operating time, LED wavelength, and luminous flux intensity. A microalgae consortium was used in the photobioreactor. In addition to the LED-illuminated photobioreactors, control photobioreactors illuminated by sunlight were also operated. Using the results obtained in the optimization, a scaled-up reactor approximately 8.5 times larger in volume was operated to evaluate if the behavior would be maintained. The best operational conditions for the removal of pollutants were observed in LED-illuminated photobioreactors operated under a light intensity of 700 µmol·m-2s-1 for 15 days. Under these conditions, it was possible to remove 89.97% of carbonaceous organic matter, 86.50% of nitrogen, and 30.64% of phosphorus. The scaled-up photobioreactor operated with similar performance.

Zika in Rio de Janeiro: Assessment of basic reproduction number and comparison with dengue outbreaks.

Zika virus infection was declared a public health emergency of international concern in February 2016 in response to the outbreak in Brazil and its suspected link with congenital anomalies. In this study, we use notification data and disease natural history parameters to estimate the basic reproduction number (R 0) of Zika in Rio de Janeiro, Brazil. We also obtain estimates of R 0 of dengue from time series of dengue cases in the outbreaks registered in 2002 and 2012 in the city, when DENV-3 and DENV-4 serotypes, respectively, had just emerged. Our estimates of the basic reproduction number for Zika in Rio de Janeiro based on surveillance notifications (R 0 = 2·33, 95% CI: 1·97-2·97) were higher than those obtained for dengue in the city (year 2002: R 0 = 1·70 [1·50-2·02]; year 2012: R 0 = 1·25 [1·18-1·36]). Given the role of Aedes aegypti as vector of both the Zika and dengue viruses, we also derive R 0 of Zika as a function of both dengue reproduction number and entomological and epidemiological parameters for dengue and Zika. Using the dengue outbreaks from previous years allowed us to estimate the potential R 0 of Zika. Our estimates were closely in agreement with our first Zika's R 0 estimation from notification data. Hence, these results validate deriving the potential risk of Zika transmission in areas with recurring dengue outbreaks. Whether transmission routes other than vector-based can sustain a Zika epidemic still deserves attention, but our results suggest that the Zika outbreak in Rio de Janeiro emerged due to population susceptibility and ubiquitous presence of Ae. aegypti.

Integrated assessment of biomarker responses and microbiological analysis of oysters from São Luís Island, Brazil.

This study was conducted to evaluate the use of biochemical biomarkers and microbiological analysis to identify levels of oyster contamination at different ports in São Luís Island (Maranhão), Brazil. Oysters were analyzed for total coliforms, thermotolerant coliforms, Escherichia coli and Aeromonas spp. In addition, tissue was removed from the digestive gland to determine the glutathione-S-transferase (GST) and catalase (CAT) activity. The highest percentage of microbiological contamination of oyster samples occurred during the rainy season. The activity of GST and catalase in oysters was also higher in the rainy season, coinciding with the greatest abundance of total and thermotolerant coliforms. Among the prospective biomarkers, GST showed the best results for identification of areas with higher levels of contamination.

Worms and allergy.

Worms and asthma are associated with a type 2 immune response, but evidence has accumulated that helminth infection is negatively associated with atopy, prevalence of allergic diseases and severity of asthma. One important difference between these polarized type 2 responses is that in allergy modulation of the immunological response is not appropriate, whereas in infection with helminths, several host mechanisms down-regulate the host immune response. As a result, patients infected with worms have a decrease in both type 1 and type 2 responses. The main mechanism involved in this down-modulation is increased production of IL-10, but expansion of regulatory T cells and NKT cells may also participate. Regarding the interaction between worms and allergy, a few variables need to be taken in account: phase (acute or chronic) of helminth infection, parasite load and species of helminth. In animals and humans, acute helminth infection may increase manifestations of allergy, whereas chronic infection with parasites decreases atopy. The modulation of the immune response by helminths is dependent on having an adequate parasite load. Moreover, although several helminth species have been shown to modulate immune responses, most in vitro and in vivo studies have focused on the importance of Schistosoma mansoni in down-modulating allergic reactions.