Successful pandemic management through computer science: a case study of a financial corporation with workers on premises.

Background: In November 2019, an infectious agent that caused a severe acute respiratory illness was first detected in China. Its rapid spread resulted in a global lockdown with negative economic impacts. In this regard, we expose the solutions proposed by a multinational financial institution that maintained their workers on premises, so this methodology can be applied to possible future health crisis. Objectives: To ensure a secure workplace for the personnel on premises employing biomedical prevention measures and computational tools. Methods: Professionals were subjected to recurrent COVID-19 diagnostic tests during the pandemic. The sanitary team implemented an individual following to all personnel and introduced the information in databases. The data collected were used for clustering algorithms, decision trees, and networking diagrams to predict outbreaks in the workplace. Individualized control panels assisted the decision-making process to increase, maintain, or relax restrictive measures. Results: 55,789 diagnostic tests were performed. A positive correlation was observed between the cumulative incidence reported by Madrid's Ministry of Health and the headcount. No correlation was observed for occupational infections, representing 1.9% of the total positives. An overall 1.7% of the cases continued testing positive for COVID-19 after 14 days of quarantine. Conclusion: Based on a combined approach of medical and computational science tools, we propose a management model that can be extended to other industries that can be applied to possible future health crises. This work shows that this model resulted in a safe workplace with a low probability of infection among workers during the pandemic.

Proteomic signatures for perioperative oxygen delivery in skin after major elective surgery: mechanistic sub-study of a randomised controlled trial.

BACKGROUND: Maintaining adequate oxygen delivery (DO2) after major surgery is associated with minimising organ dysfunction. Skin is particularly vulnerable to reduced DO2. We tested the hypothesis that reduced perioperative DO2 fuels inflammation in metabolically compromised skin after major surgery. METHODS: Participants undergoing elective oesophagectomy were randomised immediately after surgery to standard of care or haemodynamic therapy to achieve their individualised preoperative DO2. Abdominal punch skin biopsies were snap-frozen before and 48 h after surgery. On-line two-dimensional liquid chromatography and ultra-high-definition label-free mass spectrometry was used to characterise the skin proteome. The primary outcome was proteomic changes compared between normal (≥preoperative value before induction of anaesthesia) and low DO2 (

Acquired loss of cardiac vagal activity is associated with myocardial injury in patients undergoing noncardiac surgery: prospective observational mechanistic cohort study.

BACKGROUND: Myocardial injury is more frequent after noncardiac surgery in patients with preoperative cardiac vagal dysfunction, as quantified by delayed heart rate (HR) recovery after cessation of cardiopulmonary exercise testing. We hypothesised that serial and dynamic measures of cardiac vagal activity are also associated with myocardial injury after noncardiac surgery. METHODS: Serial autonomic measurements were made before and after surgery in patients undergoing elective noncardiac surgery. Cardiac vagal activity was quantified by HR variability and HR recovery after orthostatic challenge (supine to sitting). Revised cardiac risk index (RCRI) was calculated for each patient. The primary outcome was myocardial injury (high-sensitivity troponin ≥15 ng L-1) within 48 h of surgery, masked to investigators. The exposure of interest was cardiac vagal activity (high-frequency power spectral analysis [HFLn]) and HR recovery 90 s from peak HR after the orthostatic challenge. RESULTS: Myocardial injury occurred in 48/189 (25%) patients, in whom 41/48 (85%) RCRI was <2. In patients with myocardial injury, vagal activity (HFLn) declined from 5.15 (95% confidence interval [CI]: 4.58-5.72) before surgery to 4.33 (95% CI: 3.76-4.90; P<0.001) 24 h after surgery. In patients who remained free of myocardial injury, HFLn did not change (4.95 [95% CI: 4.64-5.26] before surgery vs 4.76 [95% CI: 4.44-5.08] after surgery). Before and after surgery, the orthostatic HR recovery was slower in patients with myocardial injury (5 beats min-1 [95% CI: 3-7]), compared with HR recovery in patients who remained free of myocardial injury (10 beats min-1 [95% CI: 7-12]; P=0.02). CONCLUSIONS: Serial HR measures indicating loss of cardiac vagal activity are associated with perioperative myocardial injury in lower-risk patients undergoing noncardiac surgery.

Nervous form of listeriosis in buffaloes / Listeriose nervosa em búfalos

ABSTRACT: Listeriosis is a disease that affects several animal species, including humans, and has three different forms of presentation: encephalic, reproductive, or septicemic. The nervous form is caused mainly by the bacterium Listeria monocytogenes. In Brazil, this disease has already been described in sheep, goats, and cattle. There are no reports of the disease in buffaloes in Brazil and worldwide. The objective of this study was to describe an outbreak of listeric meningoencephalitis in buffaloes in the state of Pará, Brazil. The outbreak occurred in a property located in the municipality of Bujaru, in the eastern Amazon, from May to July 2016. In a herd of 47 buffaloes, three animals (Cases 1, 2 and 3), aged <40 days, presented a neurological condition with locomotion difficulty characterized by paralysis of the four limbs, hypoesthesia, lateral recumbency, and death. Morbidity was 6.38% and lethality was 100%. At necropsy, no significant macroscopic lesions were found. Samples of the central nervous system were collected, fixed in 10% buffered formalin, and routinely processed for histopathological analysis. The main microscopic changes observed were unilateral microabscesses in the brainstem composed predominantly of mononuclear cells, with fewer polymorphonuclear cells, and perivascular cuffs composed mostly of mononuclear cells and few neutrophils. Samples of Cases 1 and 2 revealed Gram-positive bacteria in the areas of necrosis by the Gram's stain technique. Samples of Case 1 were positive in immunohistochemistry for L. monocytogenes. Diagnosis of the nervous form of listeriosis was based on epidemiological data, clinical profile, and immunostaining for Listeria monocytogenes. Results showed that listeriosis should be considered in the differential diagnosis in buffaloes with nervous signs.

RESUMO: A listeriose é uma doença que afeta várias espécies animais, incluindo o homem, e possui três formas diferentes de apresentação: nervosa, abortiva ou septicêmica. A forma nervosa é causada principalmente pela bactéria Listeria monocytogenes. No Brasil a doença já foi descrita em bovinos, ovinos e caprinos, mas não foram encontrados relatos desta doença em búfalos no Brasil e no mundo. O objetivo deste trabalho foi descrever um surto de listeriose nervosa em búfalos no estado do Pará, Brasil. O surto ocorreu de maio a julho de 2016, em uma propriedade localizada no município de Bujaru, na Amazônia Oriental. Três bubalinos de um total de 47 animais (Casos 1, 2 e 3), menores de 40 dias, apresentaram um quadro clínico neurológico caracterizado por dificuldade de locomoção, paralisia dos quatro membros, diminuição da sensibilidade cutânea, decúbito lateral e morte. A morbidade foi de 6,38% e a letalidade de 100%. Na necropsia não foram encontradas lesões macroscópicas significativas. Amostras do sistema nervoso central foram coletadas e fixadas em formalina tamponada a 10% e processadas rotineiramente para análise histopatológica. As principais alterações microscópicas observadas foram microabscessos unilaterais no tronco encefálico, compostos predominantemente por células mononucleares, com menor número de polimorfonucleares, e manguitos perivasculares compostos predominantemente por células mononucleares e poucos neutrófilos. Amostras dos Casos 1 e 2 revelaram bactérias Gram positivas nas áreas de necrose na técnica de Gram. Amostras do Caso 1 resultaram positivas na imuno-histoquímica para L. monocytogenes. O diagnóstico da forma nervosa da listeriose foi baseado nos dados epidemiológicos, no quadro clínico patológico e na imunomarcação para Listeria monocytogenes. Os resultados demostram que a listeriose deve ser considerada no diagnóstico diferencial em bubalinos com sinais nervosos.

Cuantificación de vitamina d: de la investigación a la práctica clínica / Quantification of vitamin d: from research to clinical practice

Las formas biológicamente activas de la vitamina D se han convertido en elementos de gran relevancia en la práctica clínica y la investigación, por lo tanto, su análisis se ha incrementado en años recientes. La vitamina D tiene un papel esencial en la regulación del metabolismo del calcio y fósforo; adicionalmente, esta vitamina es considerada un posible factor preventivo para diversas enfermedades crónicas como la diabetes mellitus tipo 2, algunos tipos de cáncer, cardiovasculares, autoinmunes, enfermedad pulmonar obstructiva crónica y la pre-eclampsia. Debido al posible papel en estas enfermedades y a los pocos estudios comparativos que se han realizado entre éstas y los niveles de vitamina D, los investigadores y clínicos están interesados en usar técnicas confiables y específicas que permitan determinar las concentraciones de vitamina D en el plasma. Sin embargo, no se ha establecido cuál es el mejor biomarcador que refleja la suficiencia de vitamina D y su función, ni tampoco cuál es la mejor técnica para su adecuada cuantificación. El objetivo de esta revisión es describir brevemente el metabolismo de la vitamina D y los retos que existen para su adecuada cuantificación con fines de investigación traslacional.

The analysis of the biologically active forms of vitamin D has increased in the last decades, becoming a relevant tool in the clinical practice and investigation. Vitamin D plays an essential role in regulating the metabolism of calcium and phosphorous. In addition, this vitamin is considered a potential preventive factor in a wide range of chronical diseases such as cardiovascular and autoimmune diseases, different kinds of cancer, type 2 diabetes, chronical obstructive pulmonary disease, and pre-eclampsia. Due to the possible role that vitamin D has in these diseases and the few existing comparative studies which have been conducted between these diseases and the vitamin D levels, clinicians and researchers are interested in using reliable and specific techniques to quantify the concentrations of vitamin D in plasma. Nevertheless, in the scientific literature reviewed have not been established which is the best biomarker that indicates the sufficiency and function of vitamin D nor which is the most appropriate technique for adequate quantification. The goal of this review is to briefly describe the metabolism of vitamin D and the current challenges for its proper quantification and use in translational research.

Reemerging of natural infection by Trypanosoma evansi in horses in Arari, Marajó Island, Brazil / Reemergência da infecção natural por Trypanosoma evansi em cavalos, na região do Arari, Ilha do Marajó, Brazil

ABSTRACT: Two outbreaks of trypanosomiasis by Trypanosoma evansi in horses in the municipality of Chaves, Marajó Island, Pará State, Brazil are reported. The first outbreak occurred in April 2011 in a farm with 147 horses; of these, 47 (31.97%) got sick, and 40 (27.21%) died. The second outbreak occurred in May 2012 and involved nine properties. Of a total of 679 horses, 209 (30.07%) got sick, and 183 (26.97%) died. The main clinical signs observed in these horses were weight loss, abdominal edema, toe dragging, and pelvic muscle atrophy. Necropsy was performed in two horses, one from each outbreak. Macroscopic alterations were not seen in the horse from the first outbreak; however, the horse from the second outbreak exhibited emaciation, pallor and icterus, as well as enlarged spleen with prominent white pulp at cut surface. Histopathology of the central nervous system of both animals revealed mild to severe, diffuse lymphoplasmacytic encephalitis, with presence of Mott cells. Immunohistochemistry for T. evansi revealed structures similar to intralesional trypomastigote forms. Between November and December of 2013, an epidemiological survey was carried out in the municipalities of Cachoeira do Arari, Santa Cruz do Arari, Salvaterra, Soure, and Chaves. Only Santa Cruz do Arari and Chaves had reported cases of the disease. Blood samples were collected from 243 horses for detection of T. evansi DNA by polymerase chain reaction (PCR) and 20 were positive.

RESUMO: São relatados dois surtos de tripanossomíase por Trypanosoma evansi , em cavalos no município de Chaves, Ilha do Marajó, Pará, Brasil. O primeiro surto ocorreu em abril de 2011 em uma fazenda com 147 cavalos, em que 47 (31,97%) adoeceram e 40 (27,21%) morreram. O segundo ocorreu em maio de 2012 e envolveu nove propriedades. De um total de 679 cavalos, 209 (30,07%) adoeceram e 183 (26,97%) morreram. Os principais sinais clínicos observados foram perda de peso, edema abdominal, emboletamento dos membros e atrofia da musculatura da região pélvica e membros posteriores. A necropsia foi realizada em dois cavalos, um de cada surto. O equino do primeiro surto não apresentou lesões macroscópicas, enquanto o segundo, do segundo surto, apresentava emagrecimento, palidez e icterícia, aumento do baço com protrusão da polpa branca ao corte. O sistema nervoso central de ambos os animais revelou uma leve à severa encefalite linfoplasmocitária, difusa, com presença de células de Mott. A imunohistoquímica para T. evansi revelou estruturas similares a formas tripomastigotas nas lesões. Entre novembro e dezembro de 2013, um levantamento epidemiológico foi realizado nos municípios de Cachoeira do Arari, Santa Cruz do Arari, Salvaterra, Soure e Chaves. Somente Santa Cruz do Arari e Chaves relataram casos da doença. Foram coletadas amostras de sangue de 243 equinos e realizada a reação em cadeia de polimerase (PCR) para a detecção do DNA de T. evansi das quais 20 foram positivas.

A non-randomized multicentre trial of human immune plasma for treatment of hantavirus cardiopulmonary syndrome caused by Andes virus.

BACKGROUND: In Chile, Andes virus (ANDV) is the sole aetiological agent of hantavirus cardiopulmonary syndrome (HCPS) with mean annual incidence of 55 cases, 32% case fatality rate (CFR) and no specific treatment. Neutralizing antibody (NAb) titres at hospital admission correlate inversely with HCPS severity. We designed an open trial to explore safety and efficacy and evaluate pharmacokinetics of immune plasma as a treatment strategy for this disease. METHODS: We performed plasmapheresis on donors at least 6 months after HCPS and measured NAb titres through a focus-reduction neutralization test. Subjects admitted to 10 study sites with suspected/confirmed HCPS were eligible for treatment with immune plasma by intravenous infusion at an ANDV NAb dose of 5,000 U/kg. HCPS was confirmed through immunoglobulin M serology or reverse transcriptase-PCR. The main outcome was mortality within 30 days. RESULTS: From 2008-2012, we enrolled and treated 32 cases and confirmed HCPS in 29. CFR of hantavirus plasma-treated cases was 4/29 (14%); CFR of non-treated cases in the same period in Chile was 63/199 (32%; P=0.049, OR=0.35, CI=0.12, 0.99); CFR of non-treated cases at the same study sites between 2005-2012 was 18/66 (27%; (P=0.15, OR=0.43, CI=0.14, 1.34) and CFR in a previous methylprednisolone treatment study was 20/60 (33%; P=0.052, OR=0.32, CI=0.10, 1.00). We detected no serious adverse events associated to plasma infusion. Plasma NAb titres reached in recipients were variable and viral load remained stable. CONCLUSIONS: Human ANDV immune plasma infusion appears safe for HCPS. We observed a decrease in CFR in treated cases with borderline significance that will require further studies for confirmation.

Individualised oxygen delivery targeted haemodynamic therapy in high-risk surgical patients: a multicentre, randomised, double-blind, controlled, mechanistic trial.

BACKGROUND: Morbidity after major surgery is associated with low oxygen delivery. Haemodynamic therapy aimed at increasing oxygen delivery in an effort to reduce oxygen debt, tissue injury, and morbidity, is controversial. The most appropriate target for this strategy is unclear and might have several off-target effects, including loss of neural (parasympathetic)-mediated cellular protection. We hypothesised that individualised oxygen delivery targeted haemodynamic therapy (goal-directed therapy) in high-risk surgical patients would reduce postoperative morbidity, while secondarily addressing whether goal-directed therapy affected parasympathetic function. METHODS: In this multicentre, randomised, double-blind, controlled trial, adult patients undergoing major elective surgery were allocated by computer-generated randomisation to a postoperative protocol (fluid, with and without dobutamine) targeted to achieve their individual preoperative oxygen delivery value (goal-directed therapy) or standardised care (control). Patients and staff were masked to the intervention. The primary outcome was absolute risk reduction (ARR) in morbidity (defined by Clavien-Dindo grade II or more) on postoperative day 2. We also assessed a secondary outcome focused on parasympathetic function, using time-domain heart rate variability measures. Analyses were done on an intention-to-treat basis. The trial was registered with Controlled Clinical Trials (number ISRCTN76894700). FINDINGS: We enrolled 204 patients between May 20, 2010, and Feb 12, 2014. Intention-to-treat analysis of the 187 (92%) patients who completed the trial intervention period showed that early morbidity was similar between goal-directed therapy (44 [46%] of 95 patients) and control groups (49 [53%] of 92 patients) (ARR -7%, 95% CI -22 to 7; p=0·30). Prespecified secondary analysis showed that 123 (66%) of 187 patients achieved preoperative oxygen delivery (irrespective of intervention). These patients sustained less morbidity (ARR 19%, 95% CI 3-34; p=0·016), including less infectious complications. Goal-directed therapy reduced parasympathetic activity postoperatively (relative risk 1·33, 95% CI 1·01-1·74). INTERPRETATION: Achievement of preoperative oxygen delivery values in the postoperative phase was associated with less morbidity, but this was not affected by the use of an oxygen delivery targeted strategy. Reduced parasympathetic activity after goal-directed therapy was associated with the failure of this intervention to reduce postoperative morbidity. FUNDING: Academy of Medical Sciences and Health Foundation Clinician Scientist Award.

Clasificación de pacientes de atención ambulatoria en un centro hospitalario traumatológico / Classification of outpatients in a traumatologic hospital center

En salud es prioritario conocer el tipo de paciente, sus necesidades, tipo de dependencia y riesgo del estado de salud para poder definir claramente qué carencias se deben cubrir mayoritariamente y qué tipo de personal se requiere. Para esto se propuso identificar el perfil de atención de cada unidad según la clasificación de pacientes en área ambulatoria del Hospital del Trabajador de Santiago (HTS). Se elaboró un instrumento de clasificación de pacientes ambulatorios según sus dependencias y riesgos, también se clasificaron las intervenciones de enfermería. El sistema fue aplicado durante 7 meses en la unidades de atención ambulatoria de los servicios de policlínico, centro médico y servicio de urgencia, Se detectó que el tipo de paciente más frecuente en el HTS fue el de bajo riesgo y autosuficiencia (C3) 59,6 por ciento al igual que en el policlínico y centro médico. Los requerimientos de Enfermería, son vitales en la atención directa de los pacientes de riesgo alto/mediano y de dependencia total (A1, B1), no así para los demás tipos de pacientes, que muestran variabilidad en sus necesidades. Para el caso de los pacientes C3 la dependencia es casi nula, con respecto a ese servicio

Linfoma no Hodgkin y trasplante autólogo de médula ósea y/o células progenitoras periféricas, reseña general y análisis de resultados de 13 años en la Unidad de Trasplante de Médula Ósea del Hospital Británico / Non Hodgkin lymphoma and autologous bone marrow and/or peripheral stem cells transplantation: general overview and analysis of results of 13 years at the Bone Marrow Transplantation Unit of the British Hospital

La infusión de células progenitoras previamente criopreservadas para la recuperación de la mielopoyesis permite el uso de altas dosis de quimioterapia o radioterapia en el tratamiento de los linfomas no Hodgkin. Entre mayo de 1987 y junio de 2000, 36 pacientes fueron trasplantados por linfoma no Hodgkin en el Hospital Británico. 21 de sexo masculino y 15 de sexo femenino con una media de 40,6 años de edad. La histología demostró 5 linfomas de bajo grado, 2 linfomas de bajo grado con transformación a alto grado, 17 linfomas de grado intermedio, 7 linfomas de alto grado de malignidad, 4 linfomas linfoblásticos y 1 linfoma tipo Burkitt. La sobrevida global fué de 89 por ciento con una sobrevida libre de enfermedad de 71 por ciento durante un seguimiento promedio de 30 meses. La mortalidad relacionada al tratamiento fue de 2,77 por ciento. La mejor evolución fue observada entre los pacientes con linfomas de alto grado trasplantados en primer remisión