Hitac: a hierarchical taxonomic classifier for fungal ITS sequences compatible with QIIME2.

BACKGROUND: Fungi play a key role in several important ecological functions, ranging from organic matter decomposition to symbiotic associations with plants. Moreover, fungi naturally inhabit the human body and can be beneficial when administered as probiotics. In mycology, the internal transcribed spacer (ITS) region was adopted as the universal marker for classifying fungi. Hence, an accurate and robust method for ITS classification is not only desired for the purpose of better diversity estimation, but it can also help us gain a deeper insight into the dynamics of environmental communities and ultimately comprehend whether the abundance of certain species correlate with health and disease. Although many methods have been proposed for taxonomic classification, to the best of our knowledge, none of them fully explore the taxonomic tree hierarchy when building their models. This in turn, leads to lower generalization power and higher risk of committing classification errors. RESULTS: Here we introduce HiTaC, a robust hierarchical machine learning model for accurate ITS classification, which requires a small amount of data for training and can handle imbalanced datasets. HiTaC was thoroughly evaluated with the established TAXXI benchmark and could correctly classify fungal ITS sequences of varying lengths and a range of identity differences between the training and test data. HiTaC outperforms state-of-the-art methods when trained over noisy data, consistently achieving higher F1-score and sensitivity across different taxonomic ranks, improving sensitivity by 6.9 percentage points over top methods in the most noisy dataset available on TAXXI. CONCLUSIONS: HiTaC is publicly available at the Python package index, BIOCONDA and Docker Hub. It is released under the new BSD license, allowing free use in academia and industry. Source code and documentation, which includes installation and usage instructions, are available at https://gitlab.com/dacs-hpi/hitac .

The Urban Toolkit: A Grammar-Based Framework for Urban Visual Analytics.

While cities around the world are looking for smart ways to use new advances in data collection, management, and analysis to address their problems, the complex nature of urban issues and the overwhelming amount of available data have posed significant challenges in translating these efforts into actionable insights. In the past few years, urban visual analytics tools have significantly helped tackle these challenges. When analyzing a feature of interest, an urban expert must transform, integrate, and visualize different thematic (e.g., sunlight access, demographic) and physical (e.g., buildings, street networks) data layers, oftentimes across multiple spatial and temporal scales. However, integrating and analyzing these layers require expertise in different fields, increasing development time and effort. This makes the entire visual data exploration and system implementation difficult for programmers and also sets a high entry barrier for urban experts outside of computer science. With this in mind, in this paper, we present the Urban Toolkit (UTK), a flexible and extensible visualization framework that enables the easy authoring of web-based visualizations through a new high-level grammar specifically built with common urban use cases in mind. In order to facilitate the integration and visualization of different urban data, we also propose the concept of knots to merge thematic and physical urban layers. We evaluate our approach through use cases and a series of interviews with experts and practitioners from different domains, including urban accessibility, urban planning, architecture, and climate science. UTK is available at urbantk.org.

PROWIS: A Visual Approach for Building, Managing, and Analyzing Weather Simulation Ensembles at Runtime.

Weather forecasting is essential for decision-making and is usually performed using numerical modeling. Numerical weather models, in turn, are complex tools that require specialized training and laborious setup and are challenging even for weather experts. Moreover, weather simulations are data-intensive computations and may take hours to days to complete. When the simulation is finished, the experts face challenges analyzing its outputs, a large mass of spatiotemporal and multivariate data. From the simulation setup to the analysis of results, working with weather simulations involves several manual and error-prone steps. The complexity of the problem increases exponentially when the experts must deal with ensembles of simulations, a frequent task in their daily duties. To tackle these challenges, we propose ProWis: an interactive and provenance-oriented system to help weather experts build, manage, and analyze simulation ensembles at runtime. Our system follows a human-in-the-loop approach to enable the exploration of multiple atmospheric variables and weather scenarios. ProWis was built in close collaboration with weather experts, and we demonstrate its effectiveness by presenting two case studies of rainfall events in Brazil.

Clinical Characteristics and Outcomes of Patients with Aneurysmal Subarachnoid Hemorrhage: A Prospective Multicenter Study in a Middle-Income Country.

BACKGROUND: Aneurysmal subarachnoid hemorrhage (SAH) is associated with high mortality and long-term functional impairment. Data on clinical management and functional outcomes from developing countries are scarce. We aimed to define patient profiles and clinical practices and evaluate long-term outcomes after SAH in a middle-income country. METHODS: This was a prospective study including consecutive adult patients admitted with SAH to two reference centers in Brazil from January 2016 to February 2020. The primary outcome was functional status at 6 months using the modified Rankin Scale. Mixed multivariable analysis was performed to determine the relationship between clinical variables and functional outcomes. RESULTS: From 471patients analyzed, the median time from symptom onset to arrival at a study center was 4 days (interquartile range 0-9). Median age was 55 years (interquartile range 46-62) and 353 (75%) patients were women. A total of 426 patients (90%) were transferred from nonspecialized general hospitals, initial computed tomography revealed thick hemorrhage in 73% of patients (modified Fisher score of 3 or 4), and 136 (29%) had poor clinical grade (World Federation of Neurological Surgeons score of 4 or 5). A total of 312 (66%) patients underwent surgical clipping, and 119 (25%) underwent endovascular coiling. Only 34 patients (7%) underwent withdrawal or withholding of life-sustaining therapy during their hospital stay, and in-hospital mortality was 24%. A total of 187 (40%) patients had an unfavorable long-term functional outcome (modified Rankin Scale score of 4 to 6). Factors associated with unfavorable outcome were age (adjusted odds ratio [OR] 1.05, 95% confidence interval [CI] 1.03-1.08), hypertension (adjusted OR 1.81, 95% CI 1.04-3.16), poor clinical grade (adjusted OR 4.92, 95% CI 2.85-8.48), external ventricular drain (adjusted OR 3.8, 95% CI 2.31-6.24), postoperative deterioration (adjusted OR 2.33, 95% CI 1.32-4.13), cerebral infarction (adjusted OR 3.16, 95% CI 1.81-5.52), rebleeding (adjusted OR 2.95, 95% CI 1.13-7.69), and sepsis (adjusted OR 2.68, 95% CI 1.42-5.05). CONCLUSIONS: Our study demonstrated that SAH management in a middle-income country diverges significantly from published cohorts and current guidelines, despite comparable clinical profiles on presentation and admission to high-volume referral centers. Earlier aneurysm occlusion and increased use of endovascular therapy could potentially reduce modifiable in-hospital complications and improve functional outcomes in Brazil.

A Comparison of Spatiotemporal Visualizations for 3D Urban Analytics.

Recent technological innovations have led to an increase in the availability of 3D urban data, such as shadow, noise, solar potential, and earthquake simulations. These spatiotemporal datasets create opportunities for new visualizations to engage experts from different domains to study the dynamic behavior of urban spaces in this under explored dimension. However, designing 3D spatiotemporal urban visualizations is challenging, as it requires visual strategies to support analysis of time-varying data referent to the city geometry. Although different visual strategies have been used in 3D urban visual analytics, the question of how effective these visual designs are at supporting spatiotemporal analysis on building surfaces remains open. To investigate this, in this paper we first contribute a series of analytical tasks elicited after interviews with practitioners from three urban domains. We also contribute a quantitative user study comparing the effectiveness of four representative visual designs used to visualize 3D spatiotemporal urban data: spatial juxtaposition, temporal juxtaposition, linked view, and embedded view. Participants performed a series of tasks that required them to identify extreme values on building surfaces over time. Tasks varied in granularity for both space and time dimensions. Our results demonstrate that participants were more accurate using plot-based visualizations (linked view, embedded view) but faster using color-coded visualizations (spatial juxtaposition, temporal juxtaposition). Our results also show that, with increasing task complexity, plot-based visualizations perform better in preserving efficiency (time, accuracy) compared to color-coded visualizations. Based on our findings, we present a set of takeaways with design recommendations for 3D spatiotemporal urban visualizations for researchers and practitioners. Lastly, we report on a series of interviews with four practitioners, and their feedback and suggestions for further work on the visualizations to support 3D spatiotemporal urban data analysis.

Autonomia do jovem com síndrome de down: concepções de mães e filhos1 / Autonomy of young people with down syndrome: conceptions of mothers and children

RESUMO O objetivo deste artigo foi analisar as concepções de mães e filhos em relação à autonomia de jovens com Síndrome de Down. Nesse sentido, participaram deste estudo 20 mães e 20 jovens com Síndrome de Down. Foi realizado um estudo qualitativo, por meio de entrevistas semiestruturadas, que foram gravadas, transcritas e posteriormente analisadas. Os resultados do estudo mostraram que a perspectiva das mães com relação à autonomia diz respeito à realização das atividades cotidianas em casa, mas, ao sair desse ambiente, eles demonstram medo, não permitindo que os filhos ampliem essa autonomia para outros ambientes. Com relação ao jovem com Síndrome de Down, é possível perceber que, mesmo não entendendo a sua condição genética e o que venha a ser de fato autonomia, eles demonstram o desejo de terem uma vida como qualquer outro jovem, que estuda, namora, trabalha, sai de casa sozinho. Assim sendo, é preciso a implementação de programas voltados à capacitação de profissionais, família e jovens com SD no auxílio à autonomia.

ABSTRACT The objective of this article was to analyze the conceptions of mothers and children in relation to the autonomy of young people with Down Syndrome. In this sense, 20 mothers and 20 young people with Down Syndrome participated in this study. A qualitative study was carried out through semi-structured interviews, which were recorded, transcribed and subsequently analyzed. The results of the study showed that the perspective of mothers regarding autonomy concerns carrying out daily activities at home, but when leaving this environment, they show fear, not allowing their children to extend this autonomy to other environments. With regard to young people with Down Syndrome, it is possible to notice that even though they do not understand their genetic condition and what autonomy actually means, they demonstrate the desire to have a life like any other young person, who studies, dates, works, leaves home alone. Thus, it is necessary to implement programs aimed at training professionals, families and young people with DS in helping autonomy.

A Tale of Two Centers: Visual Exploration of Health Disparities in Cancer Care.

The annual incidence of head and neck cancers (HNC) worldwide is more than 550,000 cases, with around 300,000 deaths each year. However, the incidence rates and disease-characteristics of HNC differ between treatment centers and different populations, due to undetermined reasons, which may or not include socioeconomic factors. The multi-faceted and multi-variate nature of the data in the context of the emerging field of health disparities research makes automated analysis impractical. Hence, we present a visual analysis approach to explore the health disparities in the data of HNC patients from two different cohorts at two cancer care centers. Our approach integrates data from multiple sources, including census data and city data, with custom visual encodings and with a nearest neighbor approach. Our design, created in collaboration with oncology experts, makes it possible to analyze the patients' demographic, disease characteristics, treatments and outcomes, and to make significant comparisons of these two cohorts and of individual patients. We evaluate this approach through two case studies performed with domain experts. The results demonstrate that this visual analysis approach successfully accomplishes the goal of comparing two cohorts in terms of different significant factors, and can provide insights into the main source of health disparities between the two centers.

CovRadar: continuously tracking and filtering SARS-CoV-2 mutations for genomic surveillance.

SUMMARY: The ongoing pandemic caused by SARS-CoV-2 emphasizes the importance of genomic surveillance to understand the evolution of the virus, to monitor the viral population, and plan epidemiological responses. Detailed analysis, easy visualization and intuitive filtering of the latest viral sequences are powerful for this purpose. We present CovRadar, a tool for genomic surveillance of the SARS-CoV-2 Spike protein. CovRadar consists of an analytical pipeline and a web application that enable the analysis and visualization of hundreds of thousand sequences. First, CovRadar extracts the regions of interest using local alignment, then builds a multiple sequence alignment, infers variants and consensus and finally presents the results in an interactive app, making accessing and reporting simple, flexible and fast. AVAILABILITY AND IMPLEMENTATION: CovRadar is freely accessible at https://covradar.net, its open-source code is available at https://gitlab.com/dacs-hpi/covradar. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Near-Fall Detection in Unexpected Slips during Over-Ground Locomotion with Body-Worn Sensors among Older Adults.

Slip-induced falls are a growing health concern for older adults, and near-fall events are associated with an increased risk of falling. To detect older adults at a high risk of slip-related falls, this study aimed to develop models for near-fall event detection based on accelerometry data collected by body-fixed sensors. Thirty-four healthy older adults who experienced 24 laboratory-induced slips were included. The slip outcomes were first identified as loss of balance (LOB) and no LOB (NLOB), and then the kinematic measures were compared between these two outcomes. Next, all the slip trials were split into a training set (90%) and a test set (10%) at sample level. The training set was used to train both machine learning models (n = 2) and deep learning models (n = 2), and the test set was used to evaluate the performance of each model. Our results indicated that the deep learning models showed higher accuracy for both LOB (>64%) and NLOB (>90%) classifications than the machine learning models. Among all the models, the Inception model showed the highest classification accuracy (87.5%) and the largest area under the receiver operating characteristic curve (AUC), indicating that the model is an effective method for near-fall (LOB) detection. Our approach can be helpful in identifying individuals at the risk of slip-related falls before they experience an actual fall.

Critical Assessment of Metagenome Interpretation: the second round of challenges.

Evaluating metagenomic software is key for optimizing metagenome interpretation and focus of the Initiative for the Critical Assessment of Metagenome Interpretation (CAMI). The CAMI II challenge engaged the community to assess methods on realistic and complex datasets with long- and short-read sequences, created computationally from around 1,700 new and known genomes, as well as 600 new plasmids and viruses. Here we analyze 5,002 results by 76 program versions. Substantial improvements were seen in assembly, some due to long-read data. Related strains still were challenging for assembly and genome recovery through binning, as was assembly quality for the latter. Profilers markedly matured, with taxon profilers and binners excelling at higher bacterial ranks, but underperforming for viruses and Archaea. Clinical pathogen detection results revealed a need to improve reproducibility. Runtime and memory usage analyses identified efficient programs, including top performers with other metrics. The results identify challenges and guide researchers in selecting methods for analyses.

Comparative genomics of Bordetella pertussis and prediction of new vaccines and drug targets.

Pertussis is a highly contagious respiratory disease caused by Bordetella pertussis, a Gram-negative bacterium described over a century ago. Despite broad vaccine coverage and treatment options, the disease is remerging as a public health problem especially in infants and older children. Recent data indicate re-emergence of the disease is related to bacterial resistance to immune defences and decreased vaccine effectiveness, which obviously suggests the need of new effective vaccines and drugs. In an attempt to contribute with solutions to this great challenge, bioinformatics tools were used to genetically comprehend the species of these bacteria and predict new vaccines and drug targets. In fact, approaches were used to analysis genomic plasticity, gene synteny and species similarities between the 20 genomes of Bordetella pertussis already available. Furthermore, it was conducted reverse vaccinology and docking analysis to identify proteins with potential to become vaccine and drug targets, respectively. The analyses showed the 20 genomes belongs to a homogeneous group that has preserved most of the genes over time. Besides that, were found genomics islands and good proteins to be candidates for vaccine and drugs. Taken together, these results suggests new possibilities that may be useful to develop new vaccines and drugs that will help the prevention and treatment strategies of pertussis disease caused by these Bordetella strains. Communicated by Ramaswamy H. Sarma.

Pan-genomic analyses of 47 complete genomes of the Rickettsia genus and prediction of new vaccine targets and virulence factors of the species.

The genus Rickettsia belongs to the Proteobacteria phylum and these bacteria infect animals and humans causing a range of diseases worldwide. The genus is divided into 4 groups and despite the public health threat and the knowledge accumulated so far, the mandatory intracellular bacteria behaviour and limitation for in vitro culture makes it difficult to create new vaccines and drug targets to these bacteria. In an attempt to overcome these limitations, pan-genomic approaches has used 47 genomes of the genus Rickettsia, in order to describe species similarities and genomics islands. Moreover, we conducted reverse vaccinology and docking analysis aiming the identification of proteins that have great potential to become vaccine and drug targets. We found out that the bacteria of the four Rickettsia groups have a high similarity with each other, with about 90 to 100% of identity. A pathogenicity island and a resistance island were predicted. In addition, 8 proteins were also predicted as strong candidates for vaccine and 9 as candidates for drug targets. The prediction of the proteins leads us to believe in a possibility of prospecting potential drugs or creating a polyvalent vaccine, which could reach most strains of this large group of bacteria.Communicated by Ramaswamy H. Sarma.

UrbanRama: Navigating Cities in Virtual Reality.

Exploring large virtual environments, such as cities, is a central task in several domains, such as gaming and urban planning. VR systems can greatly help this task by providing an immersive experience; however, a common issue with viewing and navigating a city in the traditional sense is that users can either obtain a local or a global view, but not both at the same time, requiring them to continuously switch between perspectives, losing context and distracting them from their analysis. In this article, our goal is to allow users to navigate to points of interest without changing perspectives. To accomplish this, we design an intuitive navigation interface that takes advantage of the strong sense of spatial presence provided by VR. We supplement this interface with a perspective that warps the environment, called UrbanRama, based on a cylindrical projection, providing a mix of local and global views. The design of this interface was performed as an iterative process in collaboration with architects and urban planners. We conducted a qualitative and a quantitative pilot user study to evaluate UrbanRama and the results indicate the effectiveness of our system in reducing perspective changes, while ensuring that the warping doesn't affect distance and orientation perception.

Titanium Allergy Caused by Dental Implants: A Systematic Literature Review and Case Report.

(1) Background: Hypersensitivity reactions to metals may arise in predisposed patients chronically exposed to metallic materials, including dental implants made of titanium alloys. The purpose of this article was to systematically review titanium allergy manifestations in patients treated with dental implants and report a clinical case; (2) Methods: A systematic electronic search was performed for articles published in the English language until July 2021. The following eligibility criteria were adopted: (1) Population: individuals undergoing titanium and/or titanium alloy implant-supported rehabilitations; (2) Exposure: peri-implant soft tissue reactions attributable to implant insertion; (3) Outcome: evidence of titanium allergy, diagnostic methods, and forms of resolution; (3) Results: The included studies, in summary, presented evidence that titanium should not be considered an inert material, being able to trigger allergic reactions, and may be responsible for implant failure. A 55-year-old male patient received 3 implants in the posterior region of the left mandible and presented an epulis-like lesion developed from the peri-implant mucosa. The immunohistochemical analysis of the biopsy specimen confirmed the initial diagnosis of allergic reaction to titanium; (4) Conclusions: Although the evidence is weak, and titanium allergy has a low incidence, hypersensitivity reactions should not be underestimated. A rapid and conclusive diagnosis is mandatory to prevent further complications.

Characterization of the first vaginal Lactobacillus crispatus genomes isolated in Brazil.

BACKGROUND: Lactobacillus crispatus is the dominant species in the vaginal microbiota associated with health and considered a homeostasis biomarker. Interestingly, some strains are even used as probiotics. However, the genetic mechanisms of L. crispatus involved in the control of the vaginal microbiome and protection against bacterial vaginosis (BV) are not entirely known. To further investigate these mechanisms, we sequenced and characterized the first four L. crispatus genomes from vaginal samples from Brazilian women and used genome-wide association study (GWAS) and comparative analyses to identify genetic mechanisms involved in healthy or BV conditions and selective pressures acting in the vaginal microbiome. METHODS: The four genomes were sequenced, assembled using ten different strategies and automatically annotated. The functional characterization was performed by bioinformatics tools comparing with known probiotic strains. Moreover, it was selected one representative strain (L. crispatus CRI4) for in vitro detection of phages by electron microscopy. Evolutionary analysis, including phylogeny, GWAS and positive selection were performed using 46 public genomes strains representing health and BV conditions. RESULTS: Genes involved in probiotic effects such as lactic acid production, hydrogen peroxide, bacteriocins, and adhesin were identified. Three hemolysins and putrescine production were predicted, although these features are also present in other probiotic strains. The four genomes presented no plasmids, but 14 known families insertion sequences and several prophages were detected. However, none of the mobile genetic elements contained antimicrobial resistance genes. The genomes harbor a CRISPR-Cas subtype II-A system that is probably inactivated due to fragmentation of the genes csn2 and cas9. No genomic feature was associated with a health condition, perhaps due to its multifactorial characteristic. Five genes were identified as under positive selection, but the selective pressure remains to be discovered. In conclusion, the Brazilian strains investigated in this study present potential protective properties, although in vitro and in vivo studies are required to confirm their efficacy and safety to be considered for human use.

Impacto do déficit de investimentos para o tratamento da doença de chagas no Brasil: revisão narrativa / Impact of the investment deficit for the treatment of chagas disease in Brazil: narrative review / Impacto del déficit de inversión para el tratamiento de la enfermedad de Chagas en Brasil: revisión narrativa

Objetivo: discutir sobre o impacto do déficit de investimentos para o tratamento da Doença de Chagas no Brasil. Método: trata-se de uma revisão narrativa da literatura realizada nas seguintes bases de dados: SCIELO, LILACS, BIREME e MEDLINE. A amostra final foi composta por 27 artigos científicos publicados entre o período de 2000 a 2020. Resultados: o Brasil é um dos países com maior prevalência de pacientes portadores da doença, porém pouco se avançou em pesquisas nessa área, de modo a repercutir em um baixo incentivo e investimento dos governantes e da indústria farmacêutica para a Doença de Chagas, tendo em vista a doença ser de progressão lenta e o diagnóstico e o tratamento serem tardios. Conclusão: fica evidente a falta de investimento e políticas públicas que possibilitem o diagnóstico e o tratamento precoce da doença tendo como conseqüência um déficit na qualidade de vida dos pacientes.(AU)

Objective: to discuss the impact of the investment deficit for the treatment of Chagas Disease in Brazil. Method: This is a narrative review of the literature conducted in the following databases: SCIELO, LILACS, BIREME and MEDLINE. The final sample consisted of 27 scientific articles published between 2000 and 2020. Results: Brazil is one of the countries with the highest prevalence of patients with the disease, but little progress has been made in research in this area, so as to have a low incentive and investment from governments and the pharmaceutical industry for Chagas Disease, in view of the disease being of slow progression and the diagnosis and treatment are late. Conclusion: it is evident the lack of investment and public policies that make possible the diagnosis and early treatment of the disease with the consequence of a deficit in the quality of life of the patients.(AU)

Objetivo: discutir el impacto del déficit de inversión para el tratamiento de la enfermedad de Chagas en Brasil. Método: se trata de una revisión narrativa de la literatura realizada en las siguientes bases de datos: SCIELO, LILACS, BIREME y MEDLINE. La muestra final consistió en 27 artículos científicos publicados entre 2000 y 2020. Resultados: el Brasil es uno de los países con mayor prevalencia de pacientes con la enfermedad, pero se ha avanzado poco en la investigación en esta área, para tener un bajo incentivo e inversión de los gobiernos y de la industria farmacéutica para la enfermedad de Chagas, considerando que la enfermedad es de progresión lenta y el diagnóstico y tratamiento son tardíos. Conclusión: es evidente la falta de inversión y de políticas públicas que permitan el diagnóstico y tratamiento precoz de la enfermedad con el consiguiente déficit en la calidad de vida de los pacientes.(AU)

Sobrecarga de trabalho em cuidadores de idosos frágeis: revisão integrativa / Overload of work of caregivers of fragile elderly: integrating review / Sobrecarga laboral en cuidadores de ancianos frágiles: una revisión integradora

Objective: to analyze the work overload and its consequences in the caregiver of fragile elderly. Method: it is a descriptive, exploratory study, based on an integrative review, performed in the online databases of the Virtual Health Library: LILACS and SCIELO. The study sample consisted of 14 articles published between 2009 and 2019. A form was used as a data collection tool. Results: the studies emphasize the biopsychosocial burden of labor fatigue, forged in a repetitive daily routine, often for years, with overload of activity in their daily lives, dealing not only with an overload in activities, but also a threat to their health. Conclusion: the care of the family caregiver requires special attention in order to prevent aggravation to his or her health, and the care of dependent elderly people is stressful and entails risk to the physical and mental health of the caregiver.(AU)

Objetivo: analizar la sobrecarga de trabajo y sus consecuencias en el cuidador de ancianos frágiles. Método: Se trata de un estudio descriptivo y exploratorio, basado en una revisión integradora, realizada en las bases de datos online de la Biblioteca Virtual de Salud: LILACS y SCIELO. La muestra del estudio consistió en 14 artículos publicados entre 2009 y 2019. Se utilizó un formulario como herramienta de recogida de datos. Resultados: los estudios destacan la carga biopsicosocial de la fatiga laboral, forjada en una rutina diaria repetitiva, a menudo durante años, con sobrecarga de actividad en su vida cotidiana, enfrentándose no sólo a una sobrecarga en las actividades, sino también a una amenaza para su salud. Conclusión: el cuidado del cuidador familiar requiere una atención especial con el fin de prevenir el agravamiento de su salud, y el cuidado de las personas mayores dependientes es estresante y conlleva un riesgo para la salud física y mental del cuidador. (AU)

Objetivo: analisar a sobrecarga de trabalho e suas conseqüências no cuidador de idosos frágeis. Método: trata-se de um estudo descritivo, exploratório, com base em uma revisão integrativa, realizada nas bases de dados online da Biblioteca Virtual de Saúde, sendo elas: LILACS e SCIELO. A amostra do estudo foi constituída por 14 artigos publicados entre 2009 e 2019. Utilizou-se um formulário como instrumento de coleta de dados. Resultados: os estudos enfatizam o ônus biopsicossocial decorrente do desgastante laboral, forjada numa repetitiva rotina diária incessante, muitas vezes durante anos, com sobrecarga de atividade no seu cotidiano, tratando não só de uma sobrecarga nas atividades, mas também de uma ameaça a sua saúde. Conclusão: a assistência do cuidador familiar requer uma atenção especial tendo em vista a prevenção de agravos a sua saúde, sendo que os cuidados com idosos dependentes são desgastantes e implica risco a saúde física e mental do cuidador. (AU)

Effect of Convalescent Plasma in Critically Ill Patients With COVID-19: An Observational Study.

Background: Convalescent plasma is a potential therapeutic option for critically ill patients with coronavirus disease 19 (COVID-19), yet its efficacy remains to be determined. The aim was to investigate the effects of convalescent plasma (CP) in critically ill patients with COVID-19. Methods: This was a single-center prospective observational study conducted in Rio de Janeiro, Brazil, from March 17th to May 30th, with final follow-up on June 30th. We included 113 laboratory-confirmed COVID-19 patients with respiratory failure. Primary outcomes were time to clinical improvement and survival within 28 days. Secondary outcomes included behavior of biomarkers and viral loads. Kaplan-Meier analyses and Cox proportional-hazards regression using propensity score with inverse-probability weighing were performed. Results: 41 patients received CP and 72 received standard of care (SOC). Median age was 61 years (IQR 48-68), disease duration was 10 days (IQR 6-13), and 86% were mechanically ventilated. At least 29 out of 41CP-recipients had baseline IgG titers ≥ 1:1,080. Clinical improvement within 28 days occurred in 19 (46%) CP-treated patients, as compared to 23 (32%) in the SOC group [adjusted hazard ratio (aHR) 0.91 (0.49-1.69)]. There was no significant change in 28-day mortality (CP 49% vs. SOC 56%; aHR 0.90 [0.52-1.57]). Biomarker assessment revealed reduced inflammatory activity and increased lymphocyte count after CP. Conclusions: In this study, CP was not associated with clinical improvement or increase in 28-day survival. However, our study may have been underpowered and included patients with high IgG titers and life-threatening disease. Clinical Trial Registration: The study protocol was retrospectively registered at the Brazilian Registry of Clinical Trials (ReBEC) with the identification RBR-4vm3yy (http://www.ensaiosclinicos.gov.br).

Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a multicenter cohort study.

PURPOSE: To describe trends in outcomes of cancer patients with unplanned admissions to intensive-care units (ICU) according to cancer type, organ support use, and performance status (PS) over an 8-year period. METHODS: We retrospectively analyzed prospectively collected data from all cancer patients admitted to 92 medical-surgical ICUs from July/2011 to June/2019. We assessed trends in mortality through a Bayesian hierarchical model adjusted for relevant clinical confounders and whether there was a reduction in ICU length-of-stay (LOS) over time using a competing risk model. RESULTS: 32,096 patients (8.7% of all ICU admissions; solid tumors, 90%; hematological malignancies, 10%) were studied. Bed/days use by cancer patients increased up to more than 30% during the period. Overall adjusted mortality decreased by 9.2% [95% credible interval (CI), 13.1-5.6%]. The largest reductions in mortality occurred in patients without need for organ support (9.6%) and in those with need for mechanical ventilation (MV) only (11%). Smallest reductions occurred in patients requiring MV, vasopressors, and dialysis (3.9%) simultaneously. Survival gains over time decreased as PS worsened. Lung cancer patients had the lowest decrease in mortality. Each year was associated with a lower sub-hazard for ICU death [SHR 0.93 (0.91-0.94)] and a higher chance of being discharged alive from the ICU earlier [SHR 1.01 (1-1.01)]. CONCLUSION: Outcomes in critically ill cancer patients improved in the past 8 years, with reductions in both mortality and ICU LOS, suggesting improvements in overall care. However, outcomes remained poor in patients with lung cancer, requiring multiple organ support and compromised PS.