Characterization of demographic data, clinical signs, comorbidities, and outcomes according to the race in hospitalized individuals with COVID-19 in Brazil: An observational study.

Background: Brazil is a multiracial country with five major official races: White, Black, individuals with multiracial backgrounds, Asian, and Indigenous. Brazil is also one of the epicentres of the Coronavirus Disease (COVID)-19 pandemic. Thus, we evaluated how the races of the Brazilian population contribute to the outcomes in hospitalized individuals with COVID-19, and we also described the clinical profile of the five official Brazilian races. Methods: We performed an epidemiological analysis for the first 67 epidemiological weeks of the COVID-19 pandemic in Brazil (from February 22, 2020, to April 04, 2021) using the data available at OpenDataSUS of the Brazilian Ministry of Health, a data set containing data from Brazilian hospitalized individuals. We evaluated more than 30 characteristics, including demographic data, clinical symptoms, comorbidities, need for intensive care unit and mechanical ventilation, and outcomes. Results: In our data, 585 655 hospitalized individuals with a positive result in SARS-CoV-2 real-time chain reaction (RT-PCR) were included. Of these total, 309 646 (52.9%) identified as White, 31 872 (5.4%) identified as Black, 7108 (1.2%) identified as Asian, 235 108 (40.1%) identified as individuals with multiracial background, and 1921 (0.3%) identified as Indigenous. The multivariate analysis demonstrated that race was significative to predict the death being that Black (OR = 1.43; 95% CI = 1.39-1.48), individuals with multiracial background (OR = 1.36; 95% CI = 1.34-1.38), and Indigenous (OR = 1.91; 95% CI = 1.70-2.15) races were more prone to die compared to the White race. The Asian individuals did not have a higher chance of dying due to SARS-CoV-2 infection compared to White individuals (OR = 0.99; 95% CI = 0.94-1.06). In addition, other characteristics contributed as such as being male (OR = 1.17; 95% CI = 1.16-1.19), age (mainly, +85 years old - OR = 23.02; 95% CI = 20.05-26.42) compared to 1-year-old individuals, living in rural areas (OR = 1.22; 95% CI = 1.18-1.26) or in peri-urban places (OR = 1.25; 95% CI = 1.11-1.40), and the presence of nosocomial infection (OR = 1.91; 95% CI = 1.82-2.01). Among the clinical symptoms, the main predictors were dyspnoea (OR = 1.25; 95% CI = 1.23-1.28), respiratory discomfort (OR = 1.30; 95% CI = 1.28-1.32), oxygen saturation <95% (OR = 1.40; 95% CI = 1.38-1.43). Also, among the comorbidities, the main predictors were the presence of immunosuppressive disorder (OR = 1.44; 95% CI = 1.39-1.49), neurological disorder (OR = 1.21; 95% CI = 1.17-1.25), hepatic disorder (OR = 1.41; 95% CI = 1.34-1.50), diabetes mellitus (OR = 1.40; 95% CI = 1.37-1.42), cardiopathy (OR = 1.13; 95%CI = 1.11-1.14), hematologic disorder (OR = 1.34; 95% CI = 1.24-1.43), Down syndrome (OR = 1.61; 95% CI = 1.43-1.81), renal disease (OR = 1.15; 95% CI = 1.11-1.18), and obesity (OR = 1.18; 95% CI = 1.15-1.21). Individuals on intensive care unit (OR = 2.25; 95% CI = 2.22-2.29) and on invasive (OR = 10.92; 95% CI = 10.66-11.18) or non-invasive (OR = 1.33; 95% CI = 1.30-1.35) mechanical ventilation were more prone to die. Conclusions: Alongside several clinical symptoms and comorbidities, we associated race with an enhanced risk of death in Black individuals, individuals with multiracial backgrounds, and Indigenous peoples.

The Use of Ultrasound as a Tool to Evaluate Pulmonary Disease in Cystic Fibrosis.

BACKGROUND: Lung ultrasound is an examination that allows the assessment of pulmonary involvement by analyzing artifacts. Our primary aim was to correlate our lung ultrasound findings with pulmonary function and the modified Bhalla score in patients with cystic fibrosis. METHODS: Subjects with cystic fibrosis were evaluated based on the results of lung ultrasound, pulmonary function exams (ie, spirometry before and after the use of a bronchodilator and SpO2 ), and the modified Bhalla score. The partial correlation set by age between lung ultrasound, pulmonary function, and modified Bhalla score was carried out. Lung ultrasound was graded according to a new score, ranging from 0 to 36, with a higher score being associated with a greater degree of involvement. We performed Bland-Altman and linear regression analysis to identify bias between lung ultrasound and modified Bhalla score. Alpha = 0.05. RESULTS: 18 subjects with cystic fibrosis were included. In partial correlation controlled by age, we observed significant ultrasound score values with weight (partial correlation = -0.579), body mass index (partial correlation = -0.609), SpO2 (partial correlation = -0.728), FVC% (pre-bronchodilator: partial correlation = -0.538; post-bronchodilator: partial correlation = -0.560), FEV1% (pre-bronchodilator: partial correlation = -0.536; post-bronchodilator: partial correlation = -0.546), and modified Bhalla score (partial correlation = 0.607). We did not identify bias between lung ultrasound and modified Bhalla score measured by z-score. CONCLUSIONS: Lung ultrasound seems to be effective and corroborates with high-resolution computed tomography when evaluated by the modified Bhalla score. At the same time, lung ultrasound had significant correlation with pulmonary function and nutritional status.

Viver com fibrose cística: a visão pessoal do adolescente brasileiro / Living with cystic fibrosis: the personal brazilian adolescent view / Viviendo con la fibrosis quística: una visión personal de la adolescente brasileña

O presente estudo examinou os desafios psicológicos de adolescentes com fibrose cística (FC) no Brasil, por meio de uma entrevista semiestruturada com perguntas abertas : [(i) Como é ter FC para você?; (ii) Você tem necessidades especiais por ter FC?; (iii) Como você vê o seu futuro?] Foi realizada a entrevista com 42 adolescentes com FC. Foi investigado como os adolescentes lidam com a FC, identificado suas necessidades , e como eles vislumbram o futuro. Os resultados mostram que as emoções dos adolescentes incluíam medo da morte, vergonha e raiva. Outras preocupações incluíam a perda da liberdade, ficando com atraso na escola, perda de amigos, da igualdade e aceitação, e as perspectivas futuras. Esses sentimentos e preocupações foram influenciados pela doença. Há poucos estudos que examinaram ajuste dos adolescentes ao convívio com a FC na América do Sul. Assim, buscamos compreender como é viver com uma doença crônica na adolescência; como isso pode contribuir para novas intervenções psicológicas para pacientes e familiares; estimular novas pesquisas, e auxiliar os profissionais de saúde nos cuidados específicos aos adolescentes com FC.

The present study examined the psychological challenges of adolescents with cystic fibrosis (CF) in Brazil. A semi-structured interview with open-ended questions [(i) What is it like for you to have CF?; (ii) Do you have any special needs because you have CF? (iii) How do you envision your future?] was conducted with 42 CF adolescents' patients. We investigated how adolescents faces CF, identified their needs, and how they envision the future. The results show that the adolescents' emotions included fear of death, embarrassment, and anger. Other concerns included the loss of freedom, falling behind at school, a loss of friends, equality and acceptance, and the future perspectives. These feelings and concerns were influenced by the disease and may affect coping with CF. Few studies have examined adolescents' adjustment to living with CF in South America; understanding how to live with CF in adolescence contributes to new psychological interventions for patients and families, stimulate new research, and assist healthcare professionals and others who work and care specific to CF adolescents.

Estudio examinó los retos psicológicos de los adolescentes con fibrosis quística(FQ). Las entrevistas semi-estructuradas con preguntas abiertas [(i) Cómo tienen fibrosis quística para usted? (ii) Tiene necesidad especial de tener la fibrosis quística? (iii) Cómo se imagina su futuro?] se llevó a cabo con 42 adolescentes con FQ. Se investigó cómo los adolescentes tratan FQ, identificas sus necesidades, y cómo ve el futuro. Los resultados muestran que las emociones de los adolescentes incluyen miedo de la muerte, la vergüenza y la ira. Otras preocupaciones incluyen la pérdida de la libertad, quedarse hasta tarde en la escuela, la pérdida de amigos, la igualdad, la aceptación, y las perspectivas futuras. Estos sentimientos y preocupaciones se vieron afectados por la enfermedad. Pocos estudios han examinado el ajuste de los adolescentes que viven con FQ en América del Sur; y comprender sus experiencias pueden conducir al desarrollo de nuevas intervenciones para pacientes y familiares, estimular nuevos profesionales de la investigación y la ayuda de salud en el cuidado de los adolescentes.

TNF-alpha polymorphisms as a potential modifier gene in the cystic fibrosis.

Modifier genes, as the TNF-α gene, can modulate the cystic fibrosis (CF) severity. Thus, -238G>A and -308G>A polymorphisms of TNF-α gene were analyzed as modifiers of CF. In this context, the present study enrolled 49 CF patients (diagnosis performed by sweat test and complete CFTR screening). The -238G>A polymorphism analysis was performed by ARMS-PCR, and -308G>A, by PCR-RFLP. In our data, the -238G>A polymorphism was not associated with clinical variability. The AA genotype for -308G>A polymorphism was a risk factor for early gastrointestinal symptoms (OR=5.98, 95%CI=1.06-49.68) and protection for the first Pseudomonas aeruginosa (OR=0.05, 95%CI=0.0003-0.007). For the first P. aeruginosa, GA genotype was a risk factor (OR=10.2, 95%CI=1.86-84.09); for the same genotype, the diagnosis was made in minor time than the AA genotype (p=0.031). Considering the -308G>A polymorphism alleles, the G allele was a risk factor for early pulmonary symptoms (OR=3.81, 95%CI=1.13-12.97) and P. aeruginosa (OR=66.77, 95%CI=15.18-482.7); however, the same allele showed better transcutaneous oxygen saturation (OR=9.24, 95%CI=1.53-206.1). The A allele was a protective factor for early pulmonary symptoms (OR=12.26, 95%CI=0.08-0.89) and P. aeruginosa (OR=12.15, 95%CI=0002-0007), however, the same allele was a risk factor for worst transcutaneous oxygen saturation (OR=7.01, 95%CI=1.14-157.4). As conclusion, the -308G>A polymorphism of the TNF-α gene was associated with the CF severity.

Características epidemiológicas e genéticas associadas à gravidade da bronquiolite viral aguda pelo vírus sincicial respiratório / Epidemiological and genetic characteristics associated with the severity of acute viral bronchiolitis by respiratory syncytial virus

OBJETIVO: avaliar os fatores epidemiológicos e genéticos associados à gravidade da Bronquiolite Viral Aguda (BVA) pelo Vírus Sincicial Respiratório (VSR). FONTE DOS DADOS: foram utilizados descritores "bronchiolitis", "risk factor", "genetics" e "respiratory syncytial virus" e todas as combinações entre eles, nas bases de dados PubMed, SciELO e Lilacs publicados após o ano de 2000 e que incluíram indivíduos menores de dois anos de idade. SÍNTESE DOS DADOS: foram encontrados 1.259 artigos e lidos seus respectivos resumos. Destes foram selecionados 81 que avaliaram fatores de risco para a gravidade da BVA para leitura na íntegra, e foram incluídos os 60 estudos mais relevantes. Os fatores epidemiológicos associados com a gravidade da BVA pelo VSR foram: prematuridade, tabagismo passivo, baixa idade, ausência de aleitamento materno, doença pulmonar crônica, cardiopatia congênita, sexo masculino, etnia, coinfecção viral, baixo peso na admissão hospitalar, tabagismo materno na gestação, dermatite atópica, ventilação mecânica no período neonatal, antecedente materno de atopia e/ou asma na gestação, estação do nascimento, baixo nível socioeconômico, síndrome de Down, poluição ambiental, morar em altitude acima de 2.500 metros do nível do mar e parto cesariana. Em contrapartida, algumas crianças com BVA grave não apresentam nenhum desses fatores de risco. Neste sentido, estudos recentes têm verificado a influência de fatores genéticos relacionados à gravidade da BVA pelo VSR. Polimorfismos dos genes TLRs, RANTES, JUN, IFNA5, NOS2, CX3CR1, ILs e VDR têm-se mostrado associados com a evolução mais grave da BVA pelo VSR. CONCLUSÃO: a gravidade da BVA pelo VSR é um fenômeno dependente da interação entre variáveis epidemiológicas, ambientais e genéticas em seus diferentes graus de interação.

OBJECTIVE: to assess the epidemiological and genetic factors associated with severity of acute viral bronchiolitis (AVB) by respiratory syncytial virus (RSV). DATA SOURCE: the key words ''bronchiolitis'', ''risk factor'', ''genetics'' and ''respiratory syn-cytial virus'', and all combinations among them were used to perform a search in the PubMed,SciELO, and Lilacs databases, of articles published after the year 2000 that included individualsyounger than 2 years of age. DATA SYNTHESIS: a total of 1,259 articles were found, and their respective summaries were read. Of these, 81 were selected, which assessed risk factors for the severity of AVB, and were read in full; the 60 most relevant studies were included. The epidemiologic factors associated with AVB severity by RSV were prematurity, passive smoking, young age, lack of breastfeeding, chronic lung disease, congenital heart disease, male gender, ethnicity, viral coinfection, low weight at admission, maternal smoking during pregnancy, atopic dermatitis, mechanical ventilation in the neonatal period, maternal history of atopy and/or asthma during pregnancy, season of birth, low socioeconomic status, Down syndrome, environmental pollution, living at an altitude > 2,500 meters above sea level, and cesarean section birth. Conversely, some children with severe AVB did not present any of these risk factors. In this regard, recent studies have verified the influence of genetic factors on the severity of AVB by RSV. Polymorphisms of the TLRs, RANTES, JUN, IFNA5, NOS2, CX3CR1, ILs, and VDR genes have been shown to be associated with more severe evolution of AVB by RSV. CONCLUSION: the severity of AVB by RSV is a phenomenon that depends on the varying degrees of interaction among epidemiological, environmental, and genetic variables.