Septic shock 3.0 criteria application in severe COVID-19 patients: An unattended sepsis population with high mortality risk.

BACKGROUND: Coronavirus disease 2019 (COVID-19) can be associated with life-threatening organ dysfunction due to septic shock, frequently requiring intensive care unit (ICU) admission, respiratory and vasopressor support. Therefore, clear clinical criteria are pivotal for early recognition of patients more likely to need prompt organ support. Although most patients with severe COVID-19 meet the Sepsis-3.0 criteria for septic shock, it has been increasingly recognized that hyperlactatemia is frequently absent, possibly leading to an underestimation of illness severity and mortality risk. AIM: To identify the proportion of severe COVID-19 patients with vasopressor support requirements, with and without hyperlactatemia, and describe their clinical outcomes and mortality. METHODS: We performed a single-center prospective cohort study. All adult patients admitted to the ICU with COVID-19 were included in the analysis and were further divided into three groups: Sepsis group, without both criteria; Vasoplegic Shock group, with persistent hypotension and vasopressor support without hyperlactatemia; and Septic Shock 3.0 group, with both criteria. COVID-19 was diagnosed using clinical and radiologic criteria with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive RT-PCR test. RESULTS: 118 patients (mean age 63 years, 87% males) were included in the analysis (n = 51 Sepsis group, n = 26 Vasoplegic Shock group, and n = 41 Septic Shock 3.0 group). SOFA score at ICU admission and ICU length of stay were different between the groups (P < 0.001). Mortality was significantly higher in the Vasoplegic Shock and Septic Shock 3.0 groups when compared with the Sepsis group (P < 0.001) without a significant difference between the former two groups (P = 0.713). The log rank tests of Kaplan-Meier survival curves were also different (P = 0.007). Ventilator-free days and vasopressor-free days were different between the Sepsis vs Vasoplegic Shock and Septic Shock 3.0 groups (both P < 0.001), and similar in the last two groups (P = 0.128 and P = 0.133, respectively). Logistic regression identified the maximum dose of vasopressor therapy used (AOR 1.046; 95%CI: 1.012-1.082, P = 0.008) and serum lactate level (AOR 1.542; 95%CI: 1.055-2.255, P = 0.02) as the major explanatory variables of mortality rates (R 2 0.79). CONCLUSION: In severe COVID-19 patients, the Sepsis 3.0 criteria of septic shock may exclude approximately one third of patients with a similarly high risk of a poor outcome and mortality rate, which should be equally addressed.

Identification of Zika virus in immature phases of Aedes aegypti and Aedes albopictus: a surveillance strategy for outbreak anticipation.

A progressive increase in the circulation of arboviruses in tropical countries has been observed, accounting for 700,000 yearly deaths in the world. The main objective of this article was to identify the presence of Zika (ZIKV), dengue (DENV), and Chikungunya (CHIKV) viruses in immature stages of Aedes aegypti and Ae. albopictus. Household collections of immature phases of the vectors were carried out in the years 2015 and 2016. A total of 2902 dwellings were visited and the rate of infestation with larvae and pupae of Aedes mosquitoes was 283/1462 (19.4%) in March 2015 and 55/1440 (3.8%) in June 2015. In March 2015, 907 larvae/pupae were collected (583 or 64.3% of Ae. aegypti and 324 or 35.7% of Ae. albopictus) while in June 2015 there was a reduction in the number of immature forms found: 197 larvae/pupae (121 or 61.4% of Ae. aegypti and 76 or 38.6% of Ae. albopictus). This reduction was accompanied by a decrease in suspected human ZIKV cases from March to June 2015. The RT-qPCR performed in 18 pools identified that three (two of Ae. aegypti and one of Ae. albopictus) were positive for ZIKV, and none were positive for DENV or CHIKV. Our findings demonstrated that ZIKV was present in immature stages of insect vectors in the study region at least five months prior to the peak of ZIKV associated cases. Xenomonitoring of immature phases of the vectors may prove useful for predicting outbreaks.

Mitomycin C 0.02 and 0.002% efficacy in preventing haze after photorefractive keratectomy.

PURPOSE: To compare MMC 0.002% efficacy in preventing haze after PRK in relation to MMC 0.02%. PATIENTS AND METHODS: We conducted a prospective study with patients with myopia or myopic astigmatism undergoing PRK in the same conditions. After PRK, MMC was applied for 30 s in a concentration of 0.02% on the right eye (group 1) and 0.002% on the left eye (group 2). Age, gender, spherical equivalent and haze intensity (1, 3, 6 and 12 months postoperatively) were assessed. Haze was quantified at biomicroscopy (0-4 +). P < 0.05 was considered statistical significant. RESULTS: We evaluated 130 patients, 77 women and 53 men, with a mean age of 30.2 ± 9 years. The spherical equivalent was - 3.66 D in the group 1 and - 3.77 D in the group 2. In the 1st month after PRK, incidence of haze was 13.9% eyes in group 1 and 14.6% in group 2. In the 3rd month, incidence of haze was 50.0% eyes in group 1 and 48.5% in group 2 which presented with 3 +/4 + traces of haze. In the 12th month, incidence of haze was 7.7% eyes in group 1 and 5.4% in group 2. There was no correlation between haze and age (p = 0.279/0.333), gender (p = 0.345/0.367) or spherical equivalent (p = 0.100/0.054) in groups 1 and 2, respectively. There was no difference in haze between groups 1 and 2 (p = 0.56). CONCLUSION: MMC 0.002% was effective in preventing haze after PRK. As MMC long-term safety has not been proved, we suggest its use in a lower concentration, in order to prevent potential complications.

Identification of Zika virus in immature phases of Aedes aegypti and Aedes albopictus: a surveillance strategy for outbreak anticipation

A progressive increase in the circulation of arboviruses in tropical countries has been observed, accounting for 700,000 yearly deaths in the world. The main objective of this article was to identify the presence of Zika (ZIKV), dengue (DENV), and Chikungunya (CHIKV) viruses in immature stages of Aedes aegypti and Ae. albopictus. Household collections of immature phases of the vectors were carried out in the years 2015 and 2016. A total of 2902 dwellings were visited and the rate of infestation with larvae and pupae of Aedes mosquitoes was 283/1462 (19.4%) in March 2015 and 55/1440 (3.8%) in June 2015. In March 2015, 907 larvae/pupae were collected (583 or 64.3% of Ae. aegypti and 324 or 35.7% of Ae. albopictus) while in June 2015 there was a reduction in the number of immature forms found: 197 larvae/pupae (121 or 61.4% of Ae. aegypti and 76 or 38.6% of Ae. albopictus). This reduction was accompanied by a decrease in suspected human ZIKV cases from March to June 2015. The RT-qPCR performed in 18 pools identified that three (two of Ae. aegypti and one of Ae. albopictus) were positive for ZIKV, and none were positive for DENV or CHIKV. Our findings demonstrated that ZIKV was present in immature stages of insect vectors in the study region at least five months prior to the peak of ZIKV associated cases. Xenomonitoring of immature phases of the vectors may prove useful for predicting outbreaks.

Developing a methodology to predict PM10 concentrations in urban areas using generalized linear models.

A methodology to predict PM10 concentrations in urban outdoor environments is developed based on the generalized linear models (GLMs). The methodology is based on the relationship developed between atmospheric concentrations of air pollutants (i.e. CO, NO2, NOx, VOCs, SO2) and meteorological variables (i.e. ambient temperature, relative humidity (RH) and wind speed) for a city (Barreiro) of Portugal. The model uses air pollution and meteorological data from the Portuguese monitoring air quality station networks. The developed GLM considers PM10 concentrations as a dependent variable, and both the gaseous pollutants and meteorological variables as explanatory independent variables. A logarithmic link function was considered with a Poisson probability distribution. Particular attention was given to cases with air temperatures both below and above 25°C. The best performance for modelled results against the measured data was achieved for the model with values of air temperature above 25°C compared with the model considering all ranges of air temperatures and with the model considering only temperature below 25°C. The model was also tested with similar data from another Portuguese city, Oporto, and results found to behave similarly. It is concluded that this model and the methodology could be adopted for other cities to predict PM10 concentrations when these data are not available by measurements from air quality monitoring stations or other acquisition means.

Dependence of the geriatric depression scores on age, nutritional status, and haematologic variables in elderly institutionalized patients.

OBJECTIVE: To evaluate the relationships between depression and ageing, nutrition, and selected haematologic variables. MEASUREMENTS: A cross-sectional study was performed in elderly institutionalized patients (n=100) of all nursing homes in the Brazilian city of Uberlandia, with determination of the Geriatric Depression Scale (GDS) and the Mini-Nutritional Assessment (MNA) scores, and selected haematologic variables. RESULTS: GDS had a significant negative dependence with the MNA for the entire institutionalized population. The prevalence of depression was higher among females, but significant correlations existed between GDS scores and erythrocytes counts, haemoglobin levels, or haematocrit values for the males only. However, a borderline correlation existed between GDS and the mean corpuscular volume (MCV) values in the females. CONCLUSIONS: Depression was associated with worsening of nutritional status and the degree of anemia of the entire elderly population and the male, but not the female subjects. The borderline correlation observed between the GDS and MCV for the female subjects suggests that the nutritional deficiencies responsible for the MCV increase are a cause, and not an effect, of depression.

Determination of arsenic compounds in beverages by high-performance liquid chromatography-inductively coupled plasma mass spectrometry.

Arsenic compounds including arsenous acid (As(III)), arsenic acid (As(V)), dimethylarsinic acid (DMA) and monomethylarsonic acid (MMA) were separated by high-performance liquid chromatography (HPLC) and detected by inductively coupled plasma mass spectrometry (ICP-MS). A Hamilton PRX-100 anionic-exchange column and a pH 8.5 K(2)HPO(4)/KH(2)PO(4) 5.0x10(-3)molL(-1) mobile phase were used to achieve arsenic speciation. The separation of arsenic species provided peaks of As(III) at 2.75min, DMA at 3.33min, MMA at 5.17min and As(V) at 12.5min. The detection limits, defined as three times the standard deviation of the lowest standard measurements, were found to be 0.2, 0.2, 0.3 and 0.5ngmL(-1) for As(III), DMA, MMA and As(V), respectively. The relative standard deviation values for a solution containing 5.0mugL(-1) of As(III), DMA, MMA and As(V) were 1.2, 2.1, 2.5 and 3.0%, respectively. This analytical procedure was applied to the speciation of arsenic compounds in drinking (soft drink, beer, juice) samples. The validation of the procedure was achieved through the analysis of arsenic compounds in water and sediment certified reference materials.

[Detection of transmissible forms of enteroparasites in water and vegetables consumed at schools in Sorocaba, São Paulo state, Brazil]. / Detecção de formas transmissíveis de enteroparasitas na água e nas hortaliças consumidas em comunidades escolares de Sorocaba, São Paulo, Brasil.

Water and raw vegetables consumed in ten nursery schools were evaluated for the presence of transmissible forms of enteroparasites. The water was submitted to filtration through membranes. The washed membrane water was submitted to the Faust method. The in natura and washed vegetables were washed and the water analyzed by the sedimentation method. Contamination was not detected in one school; in two schools, all the materials were contaminated; in four schools, two items were contaminated and in three, one material presented contamination. The water presented a contamination index of 0.7% contamination (Hymenolepis diminuta, Strongyloides stercoralis and Ancylostomatidae); the vegetables in natura, 3.9% (Strongyloides stercoralis, Ancylostomatidae, Ascaris lumbricoides and Giardia lamblia) and the washed samples 1.3% (Strongyloides stercoralis, Ascaris lumbricoides and Giardia lamblia). The water and vegetables are enteroparasites vehicles. The larval form predominated. The vegetables in natura presented higher contamination than those that were washed. Elimination of these forms in vegetables was not guaranteed by washing.

Toxocara spp. eggs in public squares of Sorocaba, São Paulo State, Brazil.

The visceral larva migrans (VLM) is a syndrome observed in human infection with helminth larval eggs such as the Toxocara spp. that usually infects dogs and cats. Among the risk factors involved in the occurrence of VLM, particularly important is the size of these animal populations. Sorocaba is a city with a dog population twice as large as that recommended by the World Health Organization. This fact has led to a survey of the presence of Toxocara spp. eggs in public square soils of this city. Thirty squares were selected, fifteen located in the outskirts of the city and fifteen downtown. Soil samples were collected from five distinct sites in the same area. The material was homogenized and drained and 100 g was mixed with a saturated solution of magnesium sulfate and 5% potassium iodine. The floating material was analyzed under the light microscope. Toxocara spp. eggs were found in 16 squares, nine of which were located in the outskirts of the city and seven downtown. It was concluded that Sorocaba squares present a high rate of contamination with Toxocara spp. eggs. The squares in the outskirts of the city presented a higher occurrence of these eggs in comparison with those downtown, although the difference was not statistically significant (p > 0.05).

[Helminth eggs and larvae in restrooms at municipal nursery schools in Sorocaba, SP, Brazil, and their frequency in children feces]. / Ovos e larvas de helmintos nos sanitários de pré-escolas municipais de Sorocaba, SP e suas freqüências nas fezes das crianças.

The purpose of this research was to establish a relationship between the presence of helminth eggs in the water closet elements and the frequency of these eggs in the feces of their users. 1050 kindergarten children's feces were examined by the spontaneous sedimentation method in three samples of feces, which were positive in 162 children presenting 184 eggs or helmints larvs. From the 465 water closet elements, constituted of : toilet seat, internal and external door knobs, latch, faucet handle and discharge valve, of 12 Infant Educational Centers of Sorocaba, examined by sticking some transparent adhesive tape on microscopy slides, were found 18 eggs of Ascaris lumbricoides; 1 of Enterobius vermicularis and 4 larvs of nemathoids partially deformed were found in 23 infected elements. There wasn't significance relationship between the elements of water closets and user's feces contamination.

[Frequency of intestinal helminth eggs in public restrooms in Sorocaba, SP]. / Estudo da freqüência de ovos de helmintos intestinais em sanitários de uso público de Sorocaba, SP.

Four hundred and five water closets were investigated: 11 located at public squares, 2 at the railroad station, 4 at the bus station, 55 at bars and restaurants, 146 at state schools, 116 at municipal schools, 8 at private schools, 36 at public health centers, 16 at sports centers, 8 at orphanages and 3 at shopping malls. Microscopy slides with adhesive tape were used. The material was obtained by sticking the tape onto the following elements: 4 spots on the toilet seat, internal and external door knobs, latch, faucet handle and discharge valve (push button or pulling string). Out of the 405 water closets studied, 22 (5.43%) were contaminated. Eggs of Ascaris lumbricoides, Ancylostomatidae, Enterobius vermiculares, Taenia sp and Hymenolepis nana were found. In 2 water closets eggs of 2 parasites were found simultaneously.