Telemedicine in Post-Exposure Prophylaxis to Biological Material During the COVID-19 Pandemic: Impact on Care and Outcome Indicators.

Introduction: The restrictions on face-to-face care for exposure to biological material during the COVID-19 pandemic required alternatives to maintain outpatient assistance. This study evaluated the impact of telemedicine on care and outcome indicators of a reference service for exposure to biological material during the COVID-19 pandemic. Methods: This pre- and post-study compared the effectiveness of telemedicine in the Hospital Correia Picanço in Recife (Pernambuco, Brazil) before (August 2018 to January 2019 [P1]) and during the COVID-19 pandemic (August 2020 to January 2021 [P2]). Individuals above 18 years old exposed to biological material who sought the service during P1 or P2 were included in the study. Results: A total of 4,494 cases were assessed (1,997 in P1 and 2,497 in P2), mostly because of sexual exposure (62.3%). The mean age was 32.2 ± 9.2 years, most individuals were male (64.9%), originated from Recife (56.6%), and the education level was up to 12 years (53.7%). P2 presented 43% more attendances and shorter intervals between the exposure and first attendance (51%), first testing (28%), and discharge (10%) than P1 (p < 0.05), and cases had no difference in discharge rate (p = 0.339). Cases of sexual exposure had the highest dropout rate in both periods. Conclusion: Telemedicine maintained similar outcomes to face-to-face care and improved the indicators, increasing the mean monthly attendance and reducing the time between exposure and follow-up.

Risk factors for death and illness severity in vaccinated versus unvaccinated COVID-2019 inpatients: a retrospective cohort study.

OBJECTIVE: To determine the clinical profile of COVID-19 inpatients who were vaccinated prior to hospitalization and to compare the risk factors for death and the 28-day survival rate of between those inpatients vaccinated with one, two, or three doses and unvaccinated COVID-19 inpatients. METHODS: This was a retrospective observational cohort study involving COVID-19 patients admitted to a referral hospital in the city of Recife, Brazil, between July of 2020 and June of 2022. RESULTS: The sample comprised 1,921 inpatients, 996 of whom (50.8%) were vaccinated prior to hospitalization. After adjusting the mortality risk for vaccinated patients, those undergoing invasive mechanical ventilation (IMV) had the highest mortality risk (adjusted OR [aOR] = 7.4; 95% CI, 3.8-14.1; p < 0.001), followed by patients > 80 years of age (aOR = 7.3; 95% CI, 3.4-15.4; p < 0.001), and those needing vasopressors (aOR = 5.6; 95% CI, 2.9-10.9; p < 0.001). After adjusting the mortality risk for all patients, having received three vaccine doses (aOR = 0.06; 95% CI, 0.03-0.11; p < 0.001) was the most important protective factor against death. There were progressive benefits of vaccination, reducing the frequency of ICU admissions, use for IMV, and death (respectively, from 44.9%, 39.0% and 39.9% after the first dose to 16.7%, 6.2% and 4.4% after the third dose), as well as significant improvements in survival after each subsequent dose (p < 0.001). CONCLUSIONS: Vaccines were effective in reducing illness severity and death in this cohort of COVID-19 inpatients, and the administration of additional doses conferred them with accumulative vaccine protection.

Risk factors for death and illness severity in vaccinated versus unvaccinated COVID-2019 inpatients: a retrospective cohort study / Fatores de risco para óbito e gravidade da doença em pacientes internados com COVID-19 vacinados e não vacinados: estudo de coorte retrospectivo

ABSTRACT Objective: To determine the clinical profile of COVID-19 inpatients who were vaccinated prior to hospitalization and to compare the risk factors for death and the 28-day survival rate of between those inpatients vaccinated with one, two, or three doses and unvaccinated COVID-19 inpatients. Methods: This was a retrospective observational cohort study involving COVID-19 patients admitted to a referral hospital in the city of Recife, Brazil, between July of 2020 and June of 2022. Results: The sample comprised 1,921 inpatients, 996 of whom (50.8%) were vaccinated prior to hospitalization. After adjusting the mortality risk for vaccinated patients, those undergoing invasive mechanical ventilation (IMV) had the highest mortality risk (adjusted OR [aOR] = 7.4; 95% CI, 3.8-14.1; p < 0.001), followed by patients > 80 years of age (aOR = 7.3; 95% CI, 3.4-15.4; p < 0.001), and those needing vasopressors (aOR = 5.6; 95% CI, 2.9-10.9; p < 0.001). After adjusting the mortality risk for all patients, having received three vaccine doses (aOR = 0.06; 95% CI, 0.03-0.11; p < 0.001) was the most important protective factor against death. There were progressive benefits of vaccination, reducing the frequency of ICU admissions, use for IMV, and death (respectively, from 44.9%, 39.0% and 39.9% after the first dose to 16.7%, 6.2% and 4.4% after the third dose), as well as significant improvements in survival after each subsequent dose (p < 0.001). Conclusions: Vaccines were effective in reducing illness severity and death in this cohort of COVID-19 inpatients, and the administration of additional doses conferred them with accumulative vaccine protection.

RESUMO Objetivo: Traçar o perfil clínico de pacientes internados com COVID-19 que haviam sido vacinados antes da hospitalização e comparar os fatores de risco para óbito e a taxa de sobrevida em 28 dias entre esses internados vacinados com uma, duas ou três doses e pacientes internados com COVID-19 não vacinados. Métodos: Estudo de coorte observacional retrospectivo envolvendo pacientes com COVID-19 internados em um hospital de referência na cidade do Recife (PE) entre julho de 2020 e junho de 2022. Resultados: A amostra foi composta por 1.921 pacientes internados, dos quais 996 (50,8%) haviam sido vacinados antes da hospitalização. Após ajuste do risco de mortalidade para os pacientes vacinados, aqueles submetidos à ventilação mecânica invasiva (VMI) apresentaram o maior risco de mortalidade (OR ajustada [ORa] = 7,4; IC95%: 3,8-14,1; p < 0,001), seguidos pelos pacientes > 80 anos (ORa = 7,3; IC95%: 3,4-15,4; p < 0,001) e aqueles que necessitam de vasopressores (ORa = 5,6; IC95%: 2,9-10,9; p < 0,001). Após ajuste do risco de mortalidade para todos os pacientes, o recebimento de três doses de vacina (ORa = 0,06; IC95%: 0,03-0,11; p < 0,001) foi o fator de proteção mais importante contra o óbito. Houve benefícios progressivos da vacinação, com redução da frequência de internações em UTI, de uso de VMI e de óbitos (de 44,9%, 39,0% e 39,9% após a primeira dose para 16,7%, 6,2% e 4,4% após a terceira dose, respectivamente), bem como melhora significativa na sobrevida após cada dose subsequente (p < 0,001). Conclusões: As vacinas foram efetivas na redução da gravidade da doença e dos óbitos nesta coorte de pacientes internados com COVID-19, e a aplicação de doses adicionais conferiu-lhes proteção vacinal cumulativa.

Women with cancer and COVID-19: an analysis of lethality and clinical aspects in Pernambuco / Mulheres com câncer e COVID-19: uma análise da letalidade e aspectos clínicos em Pernambuco

Abstract Objectives: to analyze the lethality and clinical characteristics in Pernambuco women with neoplasia that were infected by SARS-CoV-2. Methods: a cross-sectional, retrospective study with female patients with neoplasm sin the state of Pernambuco registered and made available by the Secretariat of Planning and Management of the State of Pernambuco (SEPLAG PE). Secondary data from public domain notifications and the independent factors associated with death were analyzed through logistic regression. The value ofp<0.25 was considered significant in the bivariate analysis and for a multivariate analysis, the value ofp<0.05 was considered significant. Results: forty-nine women died. The mean age and standard deviation were 58.75 ± 20.93 years. 55.86% of the patients were 60 years old or more. The overall lethality rate was 72.06% (CI95%=59.8 - 82.2). The most prevalent symptoms were fever (70.59%), cough (58.82%), dyspnea (57.35%) and O2 saturation less than 95% (48.53%). Conclusions: female patients, with cancer and infected by SARS-CoV-2 are particularly susceptible to death, regardless of the presence of comorbidities or age, with peripheral O2 saturation <95% being the only independent factor associated with death in this group.

Resumo Objetivos: analisar a letalidade e características clínicas em mulheres pernambucanas portadoras de neoplasia que apresentaram infecção por SARS-CoV-2. Métodos: estudo de corte transversal, retrospectivo com pacientes do sexo feminino, portadoras de neoplasias no estado de Pernambuco com registros disponibilizados pela Secretaria de Planejamento e Gestão do Estado de Pernambuco. Analisou-se dados secundários de notificações de domínio público e os fatores independentes associados ao óbito através de regressão logística. Foi considerado significativo o valor de p<0,25 na análise bivariada e para a análise multivariada foi considerado significativo o valor de p<0,05. Resultados: quarenta e nove mulheres vieram a óbito. A média da idade e desvio padrão foram 58, 75 ± 20,93 anos. 55,86% das pacientes tinham 60 anos ou mais. A taxa de letalidade global foi de 72,06% (IC95%= 59,8 - 82,2). Os sintomas mais prevalentes foram febre (70,59%), tosse (58,82%), dispneia (57,35%) e saturação de O2 <95% (48,53%). Conclusão: pacientes do sexo feminino, com câncer e infectadas pelo SARS-CoV-2 são particularmente suscetíveis a óbito, independentemente da presença de comorbidades ou da idade, sendo a saturação periférica de O2 <95% o único fator independente associado ao óbito nesse grupo.

Death risk and the importance of clinical features in elderly people with COVID-19 using the Random Forest Algorithm / Previsão de óbito e importância de características clínicas em idosos com COVID-19 utilizando o Algoritmo Random Forest

Abstract Objectives: train a Random Forest (RF) classifier to estimate death risk in elderly people (over 60 years old) diagnosed with COVID-19 in Pernambuco. A "feature" of this classifier, called feature importance, was used to identify the attributes (main risk factors) related to the outcome (cure or death) through gaining information. Methods: data from confirmed cases of COVID-19 was obtained between February 13 and June 19, 2020, in Pernambuco, Brazil. The K-fold Cross Validation algorithm (K=10) assessed RF performance and the importance of clinical features. Results: the RF algorithm correctly classified 78.33% of the elderly people, with AUC of 0.839. Advanced age was the factor representing the highest risk of death. The main comorbidity and symptom were cardiovascular disease and oxygen saturation ≤ 95%, respectively. Conclusion: this study applied the RF classifier to predict risk of death and identified the main clinical features related to this outcome in elderly people with COVID-19 in the state of Pernambuco.

Resumo Objetivos: treinar um classificador do tipo Random Forest (RF) para estimar o risco de óbito em idosos (com mais de 60 anos) diagnosticados com COVID-19 em Pernambuco. Uma "feature" deste classificador, chamada feature_importance, foi usada para identificar os atributos (principais fatores de risco) relacionados com o desfecho final (cura ou óbito) através do ganho de informação. Métodos: dados dos casos confirmados de COVID-19foram obtidos entre os dias 13 de fevereiro e 19 de junho de 2020, em Pernambuco, Brasil. O algoritmo K-fold Cross Validation, com K=10, foi usado para avaliar tanto o desempenho do RF quanto a importância das características clínicas. Resultados: o algoritmo RF classificou corretamente 78,33% dos idosos, com AUC de 0,839. A idade avançada é o fator que representa maior risco de evolução para óbito. Além disso, a principal comorbidade e sintoma também identificados, foram, respectivamente, doença cardiovascular e saturação de oxigênio ≤95%. Conclusão: este trabalho se dedicou à aplicação do classificador RF para previsão de óbito e identificou as principais características clínicas relacionadas com este desfecho em idosos com COVID-19 no estado de Pernambuco.

Developing Machine Learning Algorithms for the Prediction of Early Death in Elderly Cancer Patients: Usability Study.

BACKGROUND: The importance of classifying cancer patients into high- or low-risk groups has led many research teams, from the biomedical and bioinformatics fields, to study the application of machine learning (ML) algorithms. The International Society of Geriatric Oncology recommends the use of the comprehensive geriatric assessment (CGA), a multidisciplinary tool to evaluate health domains, for the follow-up of elderly cancer patients. However, no applications of ML have been proposed using CGA to classify elderly cancer patients. OBJECTIVE: The aim of this study was to propose and develop predictive models, using ML and CGA, to estimate the risk of early death in elderly cancer patients. METHODS: The ability of ML algorithms to predict early mortality in a cohort involving 608 elderly cancer patients was evaluated. The CGA was conducted during admission by a multidisciplinary team and included the following questionnaires: mini-mental state examination (MMSE), geriatric depression scale-short form, international physical activity questionnaire-short form, timed up and go, Katz index of independence in activities of daily living, Charlson comorbidity index, Karnofsky performance scale (KPS), polypharmacy, and mini nutritional assessment-short form (MNA-SF). The 10-fold cross-validation algorithm was used to evaluate all possible combinations of these questionnaires to estimate the risk of early death, considered when occurring within 6 months of diagnosis, in a variety of ML classifiers, including Naive Bayes (NB), decision tree algorithm J48 (J48), and multilayer perceptron (MLP). On each fold of evaluation, tiebreaking is handled by choosing the smallest set of questionnaires. RESULTS: It was possible to select CGA questionnaire subsets with high predictive capacity for early death, which were either statistically similar (NB) or higher (J48 and MLP) when compared with the use of all questionnaires investigated. These results show that CGA questionnaire selection can improve accuracy rates and decrease the time spent to evaluate elderly cancer patients. CONCLUSIONS: A simplified predictive model aiming to estimate the risk of early death in elderly cancer patients is proposed herein, minimally composed by the MNA-SF and KPS. We strongly recommend that these questionnaires be incorporated into regular geriatric assessment of older patients with cancer.

Correlation of spirometry with the six-minute walk test in eutrophic and obese individuals.

OBJECTIVE: To assess the distance covered by both eutrophic individuals and individuals with different grades of obesity and correlate the data obtained with spirometric values. This study is justified by the existing difficulty in assessing the functional capacity in obese individuals, and by the low cost and good specificity of six-minute walk test (6MWT) in predicting reduced capacity for activities of daily living for any individual. METHODS: One hundred fifty-four individuals of both genders were assessed after being divided into two groups: G1, obese individuals (n = 93, BMI ≥ 30 kg/m²) and G2, eutrophic individuals (n = 61, BMI 18.5 to 24.99 kg/m²). The 6MWT was performed using the methodology described by the American Thoracic Society (ATS-2002). Spirometry was performed both before and after the application of a bronchodilator agent (BDA) in accordance with the Guidelines for Pulmonary Function Tests by the Brazilian Society of Pneumology and Phthisiology (SBPT-2002). The statistical analysis, consisting of mean, standard deviation, Pearson's correlation, Student's t test and Spearman's correlation, considered p < 0.05. RESULTS: The 6MWT analysis with spirometry for G1 was positively correlated only with pre- and post-BDA peak expiratory flow rate (PEFR). CONCLUSION: The present study showed a positive correlation between pre- and post-BDA PEFR and the distance covered in the 6MWT in obese subjects, that is, the higher the PEFR, the higher the physico-functional capacity of the individual, and consequently, the greater the distance covered.

Correlação da espirometria com o teste de caminhada de seis minutos em eutróficos e obesos / Correlation of spirometry with the six-minute walk test in eutrophic and obese individuals

OBJETIVO: Avaliar a distância percorrida por indivíduos eutróficos e com diferentes graus de obesidade e correlacionar com parâmetros espirométricos. A justificativa para o estudo se faz pela dificuldade de avaliar a capacidade funcional de obesos, e devido ao baixo custo do teste de caminhada de seis minutos (TC6') e sua boa especificidade em predizer reduzida capacidade de atividades de vida diária para todo e qualquer indivíduo. MÉTODOS: Avaliados 154 indivíduos, de ambos os sexos, divididos em dois grupos: G1 obesos (n = 93, IMC ≥ 30 kg/m²) e G2 eutróficos (n = 61, IMC de 18,5 a 24,99 kg/m²). O TC6' foi realizado com metodologia descrita pela ATS (2002). A espirometria foi realizada antes e após a aplicação do broncodilatador (BD) conforme as Diretrizes para Testes de Função Pulmonar da Sociedade Brasileira de Pneumologia e Tisiologia: SBPT-2002. Análise estatística composta por média, desvio-padrão, correlação de Pearson, Teste t de Student e de Spearman, considerando p < 0,05. RESULTADOS: A análise do TC6' com a espirometria para o G1 apresentou correlação positiva apenas para o pico de fluxo expiratório (PFE) pré- e pós-BD. CONCLUSÃO: O presente estudo apresentou correlação positiva entre o PFE pré- e pós-BD e a distância percorrida no TC6' em obesos, ou seja, quanto maior o PFE, maior a capacidade físico-funcional do indivíduo e consequentemente maior a distância percorrida.

OBJECTIVE: To assess the distance covered by both eutrophic individuals and individuals with different grades of obesity and correlate the data obtained with spirometric values. This study is justified by the existing difficulty in assessing the functional capacity in obese individuals, and by the low cost and good specificity of six-minute walk test (6MWT) in predicting reduced capacity for activities of daily living for any individual. METHODS: One hundred fifty-four individuals of both genders were assessed after being divided into two groups: G1, obese individuals (n = 93, BMI ≥ 30 kg/m²) and G2, eutrophic individuals (n = 61, BMI 18.5 to 24.99 kg/m²). The 6MWT was performed using the methodology described by the American Thoracic Society (ATS-2002). Spirometry was performed both before and after the application of a bronchodilator agent (BDA) in accordance with the Guidelines for Pulmonary Function Tests by the Brazilian Society of Pneumology and Phthisiology (SBPT-2002). The statistical analysis, consisting of mean, standard deviation, Pearson's correlation, Student's t test and Spearman's correlation, considered p < 0.05. RESULTS: The 6MWT analysis with spirometry for G1 was positively correlated only with pre- and post-BDA peak expiratory flow rate (PEFR). CONCLUSION: The present study showed a positive correlation between pre- and post-BDA PEFR and the distance covered in the 6MWT in obese subjects, that is, the higher the PEFR, the higher the physico-functional capacity of the individual, and consequently, the greater the distance covered.

Correlation of respiratory muscle strength with anthropometric variables of normal-weight and obese women.

OBJECTIVE: To correlate anthropometric data and respiratory muscle strength (RMS) of normal-weight and obese women. METHODS: The sample consisted of 103 sedentary women, divided into two groups: 57 obese and 46 normal-weight women. Waist circumference (WC) and hip circumference (HC) were measured to calculate the waist-to-hip ratio (WHR), and maximal respiratory pressures (Pmax) were determined using an analog vacuum manometer to ± 300 cm H2O. Body composition was measured using tetrapolar bioelectrical impedance analysis. Descriptive statistics was used for data analysis, in addition to the Student t test for independent samples, Pearson correlation, and stepwise multiple linear regression analysis. Significance level was set at p ≤ 0.05. RESULTS: The analysis showed significant differences in Pmax of normal-weight women (PImax = -73.04±16.55 cm H2O and PEmax = 79.67±18.89 cm H2O) and obese women (PImax = -85.00±21.69 cm H2O and PEmax = 103.86±20.35 cm H2O). Anthropometric and manometric variables showed no significant correlation in both groups. When analyzing the influence of bioelectrical impedance on RMS, a positive correlation was observed between lean body mass and PImax. CONCLUSION: Bioelectrical impedance and obesity showed a direct correlation with RMS. WC and WHR had no influence on RMS of obese women; however, a relevance to risk factors for associated diseases was observed. We believe that these results are due to an adjustment to excess body weight over the years.

Correlação da força muscular respiratória com variáveis antropométricas de mulheres eutróficas e obesas / Correlation of respiratory muscle strength with anthropometric variables of eutrophic and obese women

OBJETIVO: Correlacionar dados antropométricos e de FMR de mulheres eutróficas e obesas. MÉTODOS: A amostra foi formada por 103 mulheres sedentárias, dividas em dois grupos: 57 obesas e 46 eutróficas. Foram realizadas medidas da circunferência da cintura (CC) e do quadril (CQ) para cálculo da relação cintura/quadril (RC/Q) e coletados as Pressões Respiratórias Máximas (PRM) pela manovacuometria com aparelho analógico de ± 300cmH2O. Para a mensuração da composição corporal, utilizou-se a Bioimpedância Tetrapolar, análise descritiva com o teste T de Student para amostras independentes, correlação de Pearson e regressão linear múltipla com método stepwise. O nível de significância adotado foi p < 0,05. RESULTADOS: A análise demonstrou diferença significativa nas PRM de eutróficas (Pimáx = -73,04±16,55 cm H2O e Pemáx = 79,67±18,89 cm H2O) e de obesas (Pimáx = -85,00±21,69 cm H2O e Pemáx=103,86±20,35 cm H2O). As variáveis da antropometria e da manovacuometria não apresentaram correlação significante nos grupos. Ao analisar a influência da bioimpedância sobre a FMR, observou-se uma correlação positiva da quantidade de massa magra com a Pimáx. CONCLUSÃO: As variavéis da bioimpedância e a obesidade apresentaram uma relação direta com a FMR. As variáveis CC e RC/Q não influenciaram na FMR nas obesas, porém há uma relevância com os fatores de risco para doenças associadas. Acreditamos que esses resultados se devam a uma adaptação ao excesso de peso ao longo dos anos.

OBJECTIVE: To correlate anthropometrical data and RMS of eutrophic and obese women. METHODS: The study group comprised 103 sedentary women, divided into two groups: 57 obese and 46 eutrophic. For measurement of body composition, the Tetrapolar Bioimpedance was used. Measurements of waist and hip circumference were performed to calculate the waist/hip (W/H) ratio, and maximum respiratory pressures (MRP) were collected by analog manovacumeter with ± 300cm H2O. For data evaluation descriptive analysis and the Student's t Test for independent samples were used, as well as the Pearson correlation and multiple linear regression with stepwise method. The level of significance used was p < 0.05. RESULTS: Analysis showed a significant difference in MRPs of eutrophic (MIP = -73.04 ± 16.55cmH2O and MEP = 79.67 ± 18.89cmH2O) and obese (MIP = -85.00 ± 21.69cmH2O and MEP = 103.86 ± 20.35cmH2O). The anthropometry and manovacumetry variables showed no significant correlation in the groups. A positive correlation of the lean mass with the MIP was noted, when analising the bioimpedance influence on the RMS. CONCLUSION: The bioimpedance variables and obesity showed a direct relation with the RMS. The W/H ratio and WC variables had no influence on the obese RMS, however a relevance to the risk factors for associated diseases was found. We believe that these results are due to an adjustment to the excess weight over the years.