Clinical, epidemiological and laboratory characteristics of cases of Covid-19-related maternal near miss and death at referral units in northeastern Brazil: a cohort study.

Objective: Covid-19 poses a major risk during pregnancy and postpartum, resulting in an increase in maternal mortality worldwide, including in Brazil; however, little research has been conducted into cases of a near miss. This study aimed to describe the frequency of COVID-19-related near miss and deaths during pregnancy or in the postpartum in referral centers in northeastern Brazil, as well as the clinical, epidemiological, and laboratory characteristics of the women who experienced a severe maternal outcome.Methods: A retrospective and prospective cohort study was performed between April 2020 and June 2021 with hospitalized pregnant and postpartum women with a diagnosis of COVID-19 confirmed by real-time polymerase chain reaction (RT-PCR). Data from five tertiary hospitals in northeastern Brazil were evaluated. Descriptive statistical analysis was performed using Epi Info, version 7.2.5.0.Results: A total of 463 patients were included. Of these, 64 (14% of the sample) had a severe maternal outcome, with 42 cases of near miss (9%) and 22 maternal deaths (5%). Patients who had a severe maternal outcome were predominantly young (median age 30 years) and 65.6% were black or brown-skinned. The women had between 6 and 16 years of schooling; 45.3% had a stable partner; 81.3% were pregnant at the time of admission to the study; and 76.6% required a Cesarean section. The great majority (82.8%) had severe acute respiratory syndrome (SARS). Other complications included hypertensive syndromes (40.6%), pneumonia (37.5%), urinary tract infections (29.7%), acute renal failure (25.0%) and postpartum hemorrhage (21.9%). Sepsis developed in 18.8% of cases, neurological dysfunction in 15.6%, and hepatic dysfunction and septic shock in 14.1% of cases each. The relative frequency of admission to an intensive care unit was 87.5%, while 67.2% of the patients required assisted mechanical ventilation, and 54.7% required noninvasive ventilation. Antibiotics were prescribed in 93.8% of cases and corticosteroids in 71.9%, while blood transfusion was required in 25.0% of cases and renal replacement therapy in 15.6%. Therapeutic anticoagulants were administered to 12.5% of the patients. Of the patients who had a severe maternal outcome, the frequency of respiratory dysfunction was 93.8%, with 50.0% developing neurological dysfunction and 37.5% cardiovascular dysfunction. Hematological dysfunction was found in 29.7%, renal dysfunction in 18.8%, and uterine dysfunction in 14.1%. Hepatic dysfunction occurred in 7.8% of the sample. The near-miss ratio for Covid-19 was 1.6/1000 live births and the maternal mortality ratio for Covid-19 was 84.8/100,000 live births, with a mortality index of 34.4% in the sample.Conclusion: This study revealed a low Covid-19-related maternal near miss (MNM) ratio of 1.6/1000 live births and a high Covid-19-related maternal mortality ratio (MMR) of 84.81/100,000 live births. The mortality index was also high. Most of the patients were admitted while pregnant, were young, married and black or brown-skinned, and none had completed university education. The majority had SARS and required admission to an intensive care unit and mechanical ventilation. Most were submitted to a Cesarean section.

SARS-CoV-2 Seroconversion in Response to Infection and Vaccination: a Time Series Local Study in Brazil.

The investigation of antibodies raised against different severe acute respiratory syndrome coronavirus (SARS-CoV-2) antigens can help to determine the extent of previous SARS-CoV-2 infections in the population and track the humoral response to vaccination. Therefore, serological surveys can provide key information to better manage the pandemic and/or to implement the most effective vaccination program. Here we describe a time series anti-nucleocapsid, anti-spike IgG serological survey analysis in the city of Matinhos, PR, Brazil during the year of 2021. Seroconversion rates to the nucleocapsid antigen were not influenced by gender or age. The serological data support that the coronavirus disease 2019 (COVID-19) infection rate is ~50% higher than official numbers. Furthermore, by applying serological data, the corrected infection fatality rate was estimated to be lower than 2.4% in contrast with the official estimative of 3.6%. The rates of IgG reactive to spike antigen resembled the curve of the fraction the population that had taken the second vaccine dose. Up to 82% of spike seroconversion was detected in the end of 2021, confirming the effectiveness of the COVID-19 vaccination program in the city. This SARS-CoV-2 serological study unraveled the SARS-CoV-2 infection rates and the response to vaccination in the city of Matinhos. IMPORTANCE The investigation of antibodies raised against SARS-CoV-2 can help to determine the extent of previous SARS-CoV-2 infections and track the humoral response to vaccination. Here we describe a time series anti-nucleocapsid, anti-spike IgG serological survey in the city of Matinhos, PR, Brazil during the year of 2021. The data depicted the progression of SARS-CoV-2 infections in the city allowing the correction of the number of citizens who experienced COVID-19 and the disease fatality rate. The seroconversion rates to the spike antigen resembled the curve of the fraction of the population that had taken the second vaccine dose, thereby confirming the effectiveness of the COVID-19 vaccination program in the city.

Palatability and nycterohemeral patterns of ingestive behavior of sheep fed different roughage sources.

The aim of this study was to evaluate the nycterohemeral patterns of ingestive behavior at 24, 48, and 72 h (Trial I) of sheep fed different roughages and the palatability index (Trial II) for sheep and goats fed different roughages used in a semiarid region. In the study, five sources of roughage were evaluated, namely: (1) Nopalea cochenillifera (L.) Salm-Dyck cladodes + urea + sugarcane bagasse (NUB); (2) Opuntia stricta (Haw.) Haw cladodes + urea + sugarcane bagasse (OUB); (3) Tifton hay; (4) corn silage; and (5) sorghum silage. Five Soinga sheep were used and arranged in a 5 × 5 Latin square design in Trial I. Six female Santa Ines sheep and six female Saanen goats were used to study the preferences for different roughages in Trial II, and three tests were carried out to determine the palatability index, comparing two roughage types at a time: test 1 - corn silage versus Nopalea cladodes + urea + sugarcane bagasse (NUB); test 2 - corn silage versus Opuntia cladodes + urea + sugarcane bagasse (OUB); and test 3 - NUB versus OUB. The highest dry matter (DM) intake was for diets composed by NUB. Feeding time (min/d) was higher for sorghum silage (291 min d-1), while rumination time was higher (P < 0.05) for corn silage (604.0 min d-1), sorghum silage (561.7 min d-1), and Tifton hay (529.7 min d-1). No difference (P > 0.05) was observed for feeding, rumination, and idleness time between species (sheep and goats), and there was no roughage × species interaction (P > 0.05). The palatability indexes were 76 and 77% (tests 1 and 2) for NUB and OUB, respectively. Sheep fed with roughage containing cactus cladodes associated with urea and sugarcane bagasse spent less time on ingestion and rumination activities. The ingestive behavior can be evaluated in a period of 48 h, using instantaneous scanning.

Population-Based Analysis of the Immunoglobulin G Response to Different COVID-19 Vaccines in Brazil.

(1) Background: COVID-19 vaccination in Brazil has been performed mostly with CoronaVac (Sinovac), ChAdOx1-S (AstraZeneca-University of Oxford) and BNT162b2 (Pfizer-BioNTech) vaccines. The titers of IgG antibodies reactive to the SARS-CoV-2 spike protein correlate with vaccine efficacy. Studies comparing vaccine immunogenicity in a real-world scenario are lacking. (2) Methods: We performed a population-based study to analyze the immunoglobulin G response to different COVID-19 vaccines. Citizens older than 18 years (n = 2376) provided personal data, a self-declaration of any previous COVID-19 positive tests and information regarding COVID-19 vaccination: the vaccine popular name and the date of each dose. Blood samples were collected and the levels of IgG reactive to SARS-CoV-2 antigens were determined and compared between different vaccine groups. (3) Results: The seroconversion for anti-spike IgG achieved > 95% by February 2022 and maintained stable until June 2022. Higher anti-spike IgG titers were detected in individuals vaccinated with BNT162b2, followed by ChAdOx1-S and CoronaVac. The anti-spike IgG response was negatively correlated with age and interval after the second dose for the BNT162b2 vaccine. Natural infections boosted anti-spike IgG in those individuals who completed primary vaccination with ChAdOx1-S and CoronaVac, but not with BNT162b2. The levels of anti-spike IgG increased with the number of vaccine doses administered. The application of BNT162b2 as a 3rd booster dose resulted in high anti-spike IgG antibody titers, despite the type of vaccine used during primary vaccination. (4) Conclusions: Our data confirmed the effectiveness of the Brazilian vaccination program. Of the vaccines used in Brazil, BNT162b2 performed better to elicit anti-spike protein IgG after primary vaccination and as a booster dose and thus should be recommended as a booster whenever available. A continuous COVID-19 vaccination program will be required to sustain anti-spike IgG antibodies in the population.

Lung Lesion Burden found on Chest CT as a Prognostic Marker in Hospitalized Patients with High Clinical Suspicion of COVID-19 Pneumonia: a Brazilian experience.

OBJECTIVE: To investigate the relationship between lung lesion burden (LLB) found on chest computed tomography (CT) and 30-day mortality in hospitalized patients with high clinical suspicion of coronavirus disease 2019 (COVID-19), accounting for tomographic dynamic changes. METHODS: Patients hospitalized with high clinical suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a dedicated and reference hospital for COVID-19, having undergone at least one RT-PCR test, regardless of the result, and with one CT compatible with COVID-19, were retrospectively studied. Clinical and laboratory data upon admission were assessed, and LLB found on CT was semi-quantitatively evaluated through visual analysis. The primary outcome was 30-day mortality after admission. Secondary outcomes, including the intensive care unit (ICU) admission, mechanical ventilation used, and length of stay (LOS), were assessed. RESULTS: A total of 457 patients with a mean age of 57±15 years were included. Among these, 58% presented with positive RT-PCR result for COVID-19. The median time from symptom onset to RT-PCR was 8 days [interquartile range 6-11 days]. An initial LLB of ≥50% using CT was found in 201 patients (44%), which was associated with an increased crude at 30-day mortality (31% vs. 15% in patients with LLB of <50%, p<0.001). An LLB of ≥50% was also associated with an increase in the ICU admission, the need for mechanical ventilation, and a prolonged LOS after adjusting for baseline covariates and accounting for the CT findings as a time-varying covariate; hence, patients with an LLB of ≥50% remained at a higher risk at 30-day mortality (adjusted hazard ratio 2.17, 95% confidence interval 1.47-3.18, p<0.001). CONCLUSION: Even after accounting for dynamic CT changes in patients with both clinical and imaging findings consistent with COVID-19, an LLB of ≥50% might be associated with a higher risk of mortality.

Chest computed tomography in the diagnosis of COVID-19 in patients with false negative RT-PCR.

OBJECTIVE: To evaluate the role of chest computed tomography in patients with COVID-19 who presented initial negative result in reverse transcriptase-polymerase chain reaction (RT-PCR). METHODS: A single-center, retrospective study that evaluated 39 patients with negative RT-PCR for COVID-19, who underwent chest computed tomography and had a final clinical or serological diagnosis of COVID-19. The visual tomographic classification was evaluated according to the Consensus of the Radiological Society of North America and software developed with artificial intelligence for automatic detection of findings and chance estimation of COVID-19. RESULTS: In the visual tomographic analysis, only one of them (3%) presented computed tomography classified as negative, 69% were classified as typical and 28% as indeterminate. In the evaluation using the software, only four (about 10%) had a probability of COVID-19 <25%. CONCLUSION: Computed tomography can play an important role in management of suspected cases of COVID-19 with initial negative results in RT-PCR, especially considering those patients outside the ideal window for sample collection for RT-PCR.

The role of the radiologist in the assessment of thoracic changes after radiotherapy.

Radiotherapy plays a central role in the palliative and curative treatment of neoplasms of the chest wall or intrathoracic structures. However, despite technical advances, radiotherapy can alter previously normal organs and tissues, those alterations presenting as various types of imaging findings. Post-radiation alterations must be promptly recognized by radiologists, in order to avoid confusion between complications of radiotherapy and the recurrence of a tumor. This pictorial essay aims to illustrate different thoracic changes after radiotherapy.

A radioterapia tem papel fundamental no tratamento curativo ou paliativo de neoplasias da parede torácica ou intratorácicas. No entanto, mesmo com o avanço das técnicas, órgãos e tecidos vizinhos podem ser acometidos e apresentar alterações que devem ser reconhecidas pelos radiologistas, de maneira a evitar confusão com recidiva das lesões inicialmente tratadas, ou mesmo com outras complicações do tratamento oncológico. O objetivo deste ensaio iconográfico é ilustrar as diferentes consequências torácicas da radioterapia.

Miúda (Nopalea cochenillifera (L.) Salm-Dyck)-The Best Forage Cactus Genotype for Feeding Lactating Dairy Cows in Semiarid Regions.

This study aimed to investigate the effects on nutrient intake and digestibility, milk yield (MY) and composition, milk fatty acids profile, and microbial protein synthesis caused by feeding lactating dairy cows four different forage cactus genotypes. Eight Girolando cows (5/8 Holstein × 3/8 Gyr), weighing 490 ± 69.0 kg (means ± standard deviation), and producing 15.5 ± 1.0 kg/d of milk during pretrial were distributed to two contemporaneous 4 × 4 Latin squares. The cows were fed a total mixed ration composed of sorghum silage (385 g/kg of dry matter (DM)), concentrated mix (175 g/kg DM), and forage cactus (440 g/kg DM). The experimental treatments consisted of different cactus genotypes, such as Gigante cactus (GC), Miúda cactus (MC), IPA Sertânia cactus (SC), and Orelha de Elefante Mexicana cactus (OEMC). The feeding of MC provided a higher intake of DM, organic matter (OM), and total digestible nutrients, as well as higher MY, energy-corrected milk, and microbial protein synthesis in comparison with those resulting from the other genotypes tested. The GC promoted lower DM and OM, and the apparent digestibility of neutral detergent fiber. The cows fed with OEMC showed lower MY and milk protein yield and content, and higher unsaturated over saturated fatty acid ratio in milk. Miúda forage cactus increased nutrient intake, digestibility of DM and OM, and microbial synthesis without impairing the milk fatty acid profile.

Evaluation of the RSNA and CORADS classifications for COVID-19 on chest computed tomography in the Brazilian population.

OBJECTIVE: To determine the correlation between the two tomographic classifications for coronavirus disease (COVID-19), COVID-19 Reporting and Data System (CORADS) and Radiological Society of North America Expert Consensus Statement on Reporting Chest Computed Tomography (CT) Findings Related to COVID-19 (RSNA), in the Brazilian population and to assess the agreement between reviewers with different experience levels. METHODS: Chest CT images of patients with reverse transcriptase-polymerase chain reaction (RT-PCR)-positive COVID-19 were categorized according to the CORADS and RSNA classifications by radiologists with different levels of experience and who were initially unaware of the RT-PCR results. The inter- and intra-observer concordances for each of the classifications were calculated, as were the concordances between classifications. RESULTS: A total of 100 patients were included in this study. The RSNA classification showed an almost perfect inter-observer agreement between reviewers with similar experience levels, with a kappa coefficient of 0.892 (95% confidence interval [CI], 0.788-0.995). CORADS showed substantial agreement among reviewers with similar experience levels, with a kappa coefficient of 0.642 (95% CI, 0.491-0.793). There was inter-observer variation when comparing less experienced reviewers with more experienced reviewers, with the highest kappa coefficient of 0.396 (95% CI, 0.255-0.588). There was a significant correlation between both classifications, with a Kendall coefficient of 0.899 (p<0.001) and substantial intra-observer agreement for both classifications. CONCLUSION: The RSNA and CORADS classifications showed excellent inter-observer agreement for reviewers with the same level of experience, although the agreement between less experience reviewers and the reviewer with the most experience was only reasonable. Combined analysis of both classifications with the first RT-PCR results did not reveal any false-negative results for detecting COVID-19 in patients.

Vitamin and mineral supplementation improves erythrocytic recovery and productive performance of infected by gastrointestinal parasites / A suplementação de vitaminas e minerais melhora a recuperação eritrocítica e o desempenho produtivo de cordeiros infectados por parasitas gastrointestinais

The objective of the present study was to evaluate the effect of a vitamin and mineral complex, associated with the application of an efficient anthelmintic, in parasitized lambs, with characteristic signs of gastrointestinal nematode infection, on hematological clinical parameters of clinical improvementand weight gain. 60 lambs Australian Merino breed, with 8 and 9 months of age, were segregated in four groups: control (no supplemetation); formula 1 (Iron Dextran, Organic Phosphorus, Cyanocobalamin and Vitamin k); formula 2 (Iron Dextran, Organic Phosphorus and Cyanocobalamin); and formula 3 (Vitamin k). Hematocrit, prothrombin time, total plasma proteins, color of the conjunctiva and weight gain were analyzed. The results were submitted to analysis of variance (ANOVA) through the repeated measures test. There was no statistical difference between treatments for the variables of hematocrit (P = 0.564), prothrombin time (P = 0.911) and plasma proteins (P = 0.6), for the conjunctiva color variable there was a difference (P = 0.052 ), with greater results for the groups supplemented with Vitamin K, Butafosfan, Cyanocobalamin and Iron (groups F1 and F3), as well as those same groups reached higher body weight at D35 (P = 0.023). It can be concluded that the administration of vitamin and mineral complex, associated with efficient anthelmintic, promoted a better performance in parasitized lambs.

O objetivo do presente estudo foi avaliar o efeito da aplicação de um complexo vitamínico e mineral, aplicado junto com a administração de um anti-helmíntico eficiente, em cordeiros parasitados, com sinais característicos de infecção por nematóide gastrointestinal, sobre os parâmetros clínicos hematológicos de melhora clínica e ganho de peso. Foram utilizados 60 cordeiros da raça Merino Australiano, com 8 e 9 meses de idade, segregados em quatro grupos: controle (não suplementado); fórmula 1 (Ferro Dextrano, Fósforo Orgânico, Cianocobalamina e Vitamina k); fórmula 2 (Ferro Dextrano, Fósforo Orgânico e Cianocobalamina); e fórmula 3 (Vitamina k). Foram analisados hematócrito, tempo de protrombina, proteínas plasmáticas totais (PPT), coloração da conjuntiva e ganho de peso. Os resultados foram submetidos à análise de variância (ANOVA) através do teste de medidas repetidas. Não houve diferença estatísticas entre os tratamentos para as variáveis de hematócrito (P=0,564), tempo de protrombina (P=0,911) e PPT (P=0,6), para a variável de coloração da conjuntiva houve diferença (P=0,052), com resultados superiores para os grupos suplementados com Vitamina K, Butafosfan, Cianocobalamina e Ferro (grupos F1 e F3), assim como esses mesmos grupos atingiram peso vivo no D35 superior (P=0,023). Podendo concluir que a administração de complexo vitamínico e mineral, administrado em conjunto com anti-helmíntico eficiente, promoveu um melhor desempenho em cordeiros parasitados.

Vitamin and mineral supplementation improves erythrocytic recovery and productive performance of infected by gastrointestinal parasites

ABSTRACT The objective of the present study was to evaluate the effect of a vitamin and mineral complex, associated with the application of an efficient anthelmintic, in parasitized lambs, with characteristic signs of gastrointestinal nematode infection, on hematological clinical parameters of clinical improvementand weight gain. 60 lambs Australian Merino breed, with 8 and 9 months of age, were segregated in four groups: control (no supplemetation); formula 1 (Iron Dextran, Organic Phosphorus, Cyanocobalamin and Vitamin k); formula 2 (Iron Dextran, Organic Phosphorus and Cyanocobalamin); and formula 3 (Vitamin k). Hematocrit, prothrombin time, total plasma proteins, color of the conjunctiva and weight gain were analyzed. The results were submitted to analysis of variance (ANOVA) through the repeated measures test. There was no statistical difference between treatments for the variables of hematocrit (P = 0.564), prothrombin time (P = 0.911) and plasma proteins (P = 0.6), for the conjunctiva color variable there was a difference (P = 0.052 ), with greater results for the groups supplemented with Vitamin K, Butafosfan, Cyanocobalamin and Iron (groups F1 and F3), as well as those same groups reached higher body weight at D35 (P = 0.023). It can be concluded that the administration of vitamin and mineral complex, associated with efficient anthelmintic, promoted a better performance in parasitized lambs.

RESUMO O objetivo do presente estudo foi avaliar o efeito da aplicação de um complexo vitamínico e mineral, aplicado junto com a administração de um anti-helmíntico eficiente, em cordeiros parasitados, com sinais característicos de infecção por nematóide gastrointestinal, sobre os parâmetros clínicos hematológicos de melhora clínica e ganho de peso. Foram utilizados 60 cordeiros da raça Merino Australiano, com 8 e 9 meses de idade, segregados em quatro grupos: controle (não suplementado); fórmula 1 (Ferro Dextrano, Fósforo Orgânico, Cianocobalamina e Vitamina k); fórmula 2 (Ferro Dextrano, Fósforo Orgânico e Cianocobalamina); e fórmula 3 (Vitamina k). Foram analisados hematócrito, tempo de protrombina, proteínas plasmáticas totais (PPT), coloração da conjuntiva e ganho de peso. Os resultados foram submetidos à análise de variância (ANOVA) através do teste de medidas repetidas. Não houve diferença estatísticas entre os tratamentos para as variáveis de hematócrito (P=0,564), tempo de protrombina (P=0,911) e PPT (P=0,6), para a variável de coloração da conjuntiva houve diferença (P=0,052), com resultados superiores para os grupos suplementados com Vitamina K, Butafosfan, Cianocobalamina e Ferro (grupos F1 e F3), assim como esses mesmos grupos atingiram peso vivo no D35 superior (P=0,023). Podendo concluir que a administração de complexo vitamínico e mineral, administrado em conjunto com anti-helmíntico eficiente, promoveu um melhor desempenho em cordeiros parasitados.

Vitamin and mineral supplementation improves erythrocytic recovery and productive performance of infected by gastrointestinal parasites / A suplementação de vitaminas e minerais melhora a recuperação eritrocítica e o desempenho produtivo de cordeiros infectados por parasitas gastrointestinais

The objective of the present study was to evaluate the effect of a vitamin and mineral complex, associated with the application of an efficient anthelmintic, in parasitized lambs, with characteristic signs of gastrointestinal nematode infection, on hematological clinical parameters of clinical improvementand weight gain. 60 lambs Australian Merino breed, with 8 and 9 months of age, were segregated in four groups: control (no supplemetation); formula 1 (Iron Dextran, Organic Phosphorus, Cyanocobalamin and Vitamin k); formula 2 (Iron Dextran, Organic Phosphorus and Cyanocobalamin); and formula 3 (Vitamin k). Hematocrit, prothrombin time, total plasma proteins, color of the conjunctiva and weight gain were analyzed. The results were submitted to analysis of variance (ANOVA) through the repeated measures test. There was no statistical difference between treatments for the variables of hematocrit (P = 0.564), prothrombin time (P = 0.911) and plasma proteins (P = 0.6), for the conjunctiva color variable there was a difference (P = 0.052 ), with greater results for the groups supplemented with Vitamin K, Butafosfan, Cyanocobalamin and Iron (groups F1 and F3), as well as those same groups reached higher body weight at D35 (P = 0.023). It can be concluded that the administration of vitamin and mineral complex, associated with efficient anthelmintic, promoted a better performance in parasitized lambs.(AU)

O objetivo do presente estudo foi avaliar o efeito da aplicação de um complexo vitamínico e mineral, aplicado junto com a administração de um anti-helmíntico eficiente, em cordeiros parasitados, com sinais característicos de infecção por nematóide gastrointestinal, sobre os parâmetros clínicos hematológicos de melhora clínica e ganho de peso. Foram utilizados 60 cordeiros da raça Merino Australiano, com 8 e 9 meses de idade, segregados em quatro grupos: controle (não suplementado); fórmula 1 (Ferro Dextrano, Fósforo Orgânico, Cianocobalamina e Vitamina k); fórmula 2 (Ferro Dextrano, Fósforo Orgânico e Cianocobalamina); e fórmula 3 (Vitamina k). Foram analisados hematócrito, tempo de protrombina, proteínas plasmáticas totais (PPT), coloração da conjuntiva e ganho de peso. Os resultados foram submetidos à análise de variância (ANOVA) através do teste de medidas repetidas. Não houve diferença estatísticas entre os tratamentos para as variáveis de hematócrito (P=0,564), tempo de protrombina (P=0,911) e PPT (P=0,6), para a variável de coloração da conjuntiva houve diferença (P=0,052), com resultados superiores para os grupos suplementados com Vitamina K, Butafosfan, Cianocobalamina e Ferro (grupos F1 e F3), assim como esses mesmos grupos atingiram peso vivo no D35 superior (P=0,023). Podendo concluir que a administração de complexo vitamínico e mineral, administrado em conjunto com anti-helmíntico eficiente, promoveu um melhor desempenho em cordeiros parasitados.(AU)

Lung lesion burden found on chest ct as a prognostic marker in hospitalized patients with high clinical suspicion of COVID-19 pneumonia: a brazilian experience

OBJECTIVE: To investigate the relationship between lung lesion burden (LLB) found on chest computed tomography (CT) and 30-day mortality in hospitalized patients with high clinical suspicion of coronavirus disease 2019 (COVID-19), accounting for tomographic dynamic changes. METHODS: Patients hospitalized with high clinical suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a dedicated and reference hospital for COVID-19, having undergone at least one RT-PCR test, regardless of the result, and with one CT compatible with COVID-19, were retrospectively studied. Clinical and laboratory data upon admission were assessed, and LLB found on CT was semi-quantitatively evaluated through visual analysis. The primary outcome was 30-day mortality after admission. Secondary outcomes, including the intensive care unit (ICU) admission, mechanical ventilation used, and length of stay (LOS), were assessed. RESULTS: A total of 457 patients with a mean age of 57±15 years were included. Among these, 58% presented with positive RT-PCR result for COVID-19. The median time from symptom onset to RT-PCR was 8 days [interquartile range 6-11 days]. An initial LLB of ≥50% using CT was found in 201 patients (44%), which was associated with an increased crude at 30-day mortality (31% vs. 15% in patients with LLB of <50%, p<0.001). An LLB of ≥50% was also associated with an increase in the ICU admission, the need for mechanical ventilation, and a prolonged LOS after adjusting for baseline covariates and accounting for the CT findings as a time-varying covariate; hence, patients with an LLB of ≥50% remained at a higher risk at 30-day mortality (adjusted hazard ratio 2.17, 95% confidence interval 1.47-3.18, p<0.001). CONCLUSION: Even after accounting for dynamic CT changes in patients with both clinical and imaging findings consistent with COVID-19, an LLB of ≥50% might be associated with a higher risk of mortality.

Evaluation of the RSNA and CORADS classifications for COVID-19 on chest computed tomography in the Brazilian population

OBJECTIVE: To determine the correlation between the two tomographic classifications for coronavirus disease (COVID-19), COVID-19 Reporting and Data System (CORADS) and Radiological Society of North America Expert Consensus Statement on Reporting Chest Computed Tomography (CT) Findings Related to COVID-19 (RSNA), in the Brazilian population and to assess the agreement between reviewers with different experience levels. METHODS: Chest CT images of patients with reverse transcriptase-polymerase chain reaction (RT-PCR)-positive COVID-19 were categorized according to the CORADS and RSNA classifications by radiologists with different levels of experience and who were initially unaware of the RT-PCR results. The inter- and intra-observer concordances for each of the classifications were calculated, as were the concordances between classifications. RESULTS: A total of 100 patients were included in this study. The RSNA classification showed an almost perfect inter-observer agreement between reviewers with similar experience levels, with a kappa coefficient of 0.892 (95% confidence interval [CI], 0.788-0.995). CORADS showed substantial agreement among reviewers with similar experience levels, with a kappa coefficient of 0.642 (95% CI, 0.491-0.793). There was inter-observer variation when comparing less experienced reviewers with more experienced reviewers, with the highest kappa coefficient of 0.396 (95% CI, 0.255-0.588). There was a significant correlation between both classifications, with a Kendall coefficient of 0.899 (p<0.001) and substantial intra-observer agreement for both classifications. CONCLUSION: The RSNA and CORADS classifications showed excellent inter-observer agreement for reviewers with the same level of experience, although the agreement between less experience reviewers and the reviewer with the most experience was only reasonable. Combined analysis of both classifications with the first RT-PCR results did not reveal any false-negative results for detecting COVID-19 in patients.