Sociodemographic factors associated with COVID-19 in-hospital mortality in Brazil.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has highlighted inequalities in access to healthcare systems, increasing racial disparities and worsening health outcomes in these populations. This study analysed the association between sociodemographic characteristics and COVID-19 in-hospital mortality in Brazil. STUDY DESIGN: A retrospective analysis was conducted on quantitative reverse transcription polymerase chain reaction-confirmed hospitalised adult patients with COVID-19 with a defined outcome (i.e. hospital discharge or death) in Brazil. Data were retrieved from the national surveillance system database (SIVEP-Gripe) between February 16 and August 8, 2020. METHODS: Clinical characteristics, sociodemographic variables, use of hospital resources and outcomes of hospitalised adult patients with COVID-19, stratified by self-reported race, were investigated. The primary outcome was in-hospital mortality. The association between self-reported race and in-hospital mortality, after adjusting for clinical characteristics and comorbidities, was evaluated using a logistic regression model. RESULTS: During the study period, Brazil had 3,018,397 confirmed COVID-19 cases and 100,648 deaths. The study population included 228,196 COVID-19-positive adult in-hospital patients with a defined outcome; the median age was 61 years, 57% were men, 35% (79,914) self-reported as Black/Brown and 35.4% (80,853) self-reported as White. The total in-hospital mortality was 37% (85,171/228,196). Black/Brown patients showed higher in-hospital mortality than White patients (42% vs 37%, respectively), were admitted less frequently to the intensive care unit (ICU) (32% vs 36%, respectively) and used more invasive mechanical ventilation (21% vs 19%, respectively), especially outside the ICU (17% vs 11%, respectively). Black/Brown race was independently associated with high in-hospital mortality after adjusting for sex, age, level of education, region of residence and comorbidities (odds ratio = 1.15; 95% confidence interval = 1.09-1.22). CONCLUSIONS: Among hospitalised Brazilian adults with COVID-19, Black/Brown patients showed higher in-hospital mortality, less frequently used hospital resources and had potentially more severe conditions than White patients. Racial disparities in health outcomes and access to health care highlight the need to actively implement strategies to reduce inequities caused by the wider health determinants, ultimately leading to a sustainable change in the health system.

Afeitado profundo (super shaving) para la corrección del efecto en trampilla de colgajos nasales / The Super Shaving Technique to Correct the Trapdoor Effect in Nasal Flaps

Introducción y objetivos: El efecto en trampilla o trapdoor es una complicación posible en un colgajo cuando se utiliza especialmente en la zona facial. Consta de una deformidad elevada y abultada, que comienza 3 semanas después de la intervención, y hasta la fecha no existe consenso en su tratamiento. Es por ello que presentamos nuestra experiencia en esta afección, destacando la técnica de afeitado profundo o super shaving para la resolución del efecto en trampilla de colgajos nasales. Materiales y métodos: Estudio retrospectivo y descriptivo de 10 pacientes que desarrollaron un abultamiento posterior a un cierre mediante colgajo en la zona nasal, que fueron resueltos quirúrgicamente a través de la técnica de super shaving y su manejo postoperatorio. Resultados: La edad mediana de los 10 pacientes operados fue 67,7 años, y todos ellos presentaron abultamiento de colgajo de trasposición del área nasal, posterior a una cirugía micrográfica de Mohs o cirugía convencional. El tiempo de aparición de la complicación fue de aproximadamente 5 semanas, y el de cicatrización fue de 4 semanas. Ningún paciente presentó complicaciones mayores en el postoperatorio, y la cicatriz tuvo una incidencia estética baja comparada con el abultamiento. Todos los pacientes refirieron estar muy satisfechos con el resultado estético. Conclusiones: Consideramos que la técnica de super shaving es rápida, efectiva, simple, de bajo costo, se practica de manera ambulatoria, y ofrece resultados estéticamente excelentes para resolver este defecto

Introduction and objectives: The trapdoor effect is a possible complication in flap reconstructions, particularly those involving the face. It consists of a bulging, elevated deformity that appears 3 weeks after the intervention. To date there has been no consensus on how the trapdoor effect should be treated. The aim of this article is to report on our experience with this defect and describe how we use the 'super shaving' technique to resolve the trapdoor effect in nasal flaps. Material and methods: We performed a retrospective, descriptive study of 10 patients who developed a bulging deformity of a nasal flap that was treated surgically with the super shaving technique. We also report on postoperative management. Results: The median age of the 10 patients was 67.7 years and they all developed a bulging transposition flap in the nasal area after conventional or Mohs micrographic surgery. The complication occurred approximately 5 weeks after surgery and healing time was 4 weeks. There were no major postoperative complications and the outcome was of low aesthetic significance compared with the bulging flap. All the patients stated they were very satisfied with the aesthetic outcome. Conclusions: In our opinion, the super shaving technique is a fast, effective, simple, and cheap outpatient procedure that offers excellent aesthetic results

The Super Shaving Technique to Correct the Trapdoor Effect in Nasal Flaps. / Afeitado profundo (super shaving) para la corrección del efecto en trampilla de colgajos nasales.

INTRODUCTION AND OBJECTIVES: The trapdoor effect is a possible complication in flap reconstructions, particularly those involving the face. It consists of a bulging, elevated deformity that appears 3 weeks after the intervention. To date there has been no consensus on how the trapdoor effect should be treated. The aim of this article is to report on our experience with this defect and describe how we use the 'super shaving' technique to resolve the trapdoor effect in nasal flaps. MATERIAL AND METHODS: We performed a retrospective, descriptive study of 10 patients who developed a bulging deformity of a nasal flap that was treated surgically with the super shaving technique. We also report on postoperative management. RESULTS: The median age of the 10 patients was 67.7 years and they all developed a bulging transposition flap in the nasal area after conventional or Mohs micrographic surgery. The complication occurred approximately 5 weeks after surgery and healing time was 4 weeks. There were no major postoperative complications and the outcome was of low aesthetic significance compared with the bulging flap. All the patients stated they were very satisfied with the aesthetic outcome. CONCLUSIONS: In our opinion, the super shaving technique is a fast, effective, simple, and cheap outpatient procedure that offers excellent aesthetic results.

Indicadores biológicos séricos em veado-campeiro ( Ozotoceros bezoarticus bezoarticus, Linnaeus 1758) de vida livre do Pantanal Sul-Mato-Grossense / Serum biological indicators in free-living pampas deer (Ozotoceros bezoarticus bezoarticus, Linnaeus 1758) of the Pantanal Sul-Mato-Grossense

O objetivo com este estudo foi estabelecer os intervalos de referência de diferentes analitos séricos em Ozotoceros bezoarticus bezoarticus de vida livre. Foram coletadas amostras de sangue de 54 fêmeas e 14 machos adultos, capturados no Pantanal de Mato Grosso do Sul. A determinação das concentrações de cálcio total, albumina, colesterol total, creatinina, glicose, fósforo, proteína total, triglicerídeos e ureia séricas e a atividade das enzimas alanina aminotransferase, aspartato aminotransferase, creatina quinase fração MB e fosfatase alcalina foi realizada em equipamento automático. Valores de globulinas, cálcio total e proporções (razões) entre analitos foram realizados por meio de cálculo matemático. Esta é a primeira descrição do intervalo de referência de parâmetros bioquímicos séricos em veado-campeiro de vida livre do Pantanal de Mato Grosso do Sul. O tamanho da amostra e a distribuição dos dados indicam que os valores médios obtidos são representativos e podem ser usados para a monitorização da saúde, do estado nutricional e do diagnóstico de enfermidades nesse estrato populacional.(AU)

The objective of the present study is to establish the reference intervals of different serum analytes in free - living Ozotoceros bezoarticus bezoarticus. Blood samples were drawn from the 54 females and 14 males, adults, captured in the Pantanal of Mato Grosso do Sul. A determination of total calcium, albumin, total cholesterol, creatinine, glucose, phosphorus, total protein, triglycerides, and serum urea concentrations and an activity of the enzymes alanine aminotransferase, aspartate aminotransferase, creatine kinase MB fraction and alkaline phosphatase were performed in automated equipment. Values of globulins, total calcium and proportions among analytes were performed by means of mathematical calculations. This is a first description of the reference parameters for serum biochemistry of free - living pampas deer in the Pantanal of Mato Grosso do Sul. Sample size and distribution of data indicate that the mean values obtained are representative and can be used for a health monitoring, nutritional status, and diagnosis of diseases in this population stratum.(AU)

Impact of a secondary treated bleached Kraft pulp mill effluent in both sexes of goldfish (Carassius auratus L.).

The aim of the present study was to assess the toxic effects of a secondary treated effluent from a modern pulp mill processing Eucalyptus globulus on both sexes of goldfish. The effects in the exposed fish were investigated by measuring biomarkers which have been used to assess the effects of BKME on aquatic biota, with particular emphasis in fish. However, few studies have been focused on effluents from pulp mill plants processing eucalyptus. The relative proportion of cytochrome P450 (CYP1A) and vitellogenin (VTG) induction were analyzed in the livers of males and females goldfish, exposed to different concentrations of a bleached Kraft pulp mill (BKPM) effluent. Somatic indices such as HSI (hepatosomatic index) and GSI (gonadosomatic index) were calculated and a significant reduction was found in males GSI. A significant increase of HSI was recorded for both sexes exposed to 50% BKPM effluent. Exposure to BKPM effluent induced CYP1A synthesis in both sexes and decreased VTG synthesis in females according to the different effluent concentrations suggesting that the secondary treated effluent contained compounds that affect fish negatively. The results suggest that BKPM effluent can cause sex-related biochemical changes in xenobiotic metabolism.

Effects of ECF-Kraft pulp mill effluent treated with fungi (Rhizopus oryzae) on reproductive steroids and liver CYP1A of exposed goldfish (Carassius auratus).

The toxicity of bleached Kraft pulp mill effluents (BKME) is usually attributed to chemical compounds which are produced and released throughout various stages of pulp and paper production. The main objective of the present work was to detect sub-lethal responses of goldfish (Carassius auratus) to secondary treated BKME which was treated with Rhizopus oryzae. A total of 96 carps (C. auratus; 11 +/- 3 g) were exposed to different concentrations of the post-treated effluent (0, 1, 10, 25, 50, and 100%), in 28 days semi-static tests. Several biomarkers were then evaluated to assess the toxicological effects: induction of CYP1A (metabolic processes of organic compounds in liver), change in steroid profiles (11-Ketotestosterone, 17beta-estradiol), histopathology of liver and gonads and somatic indices (GSI, HSI) for endocrine disruption and other physiological disturbances. The most significant results show an induction of CYP1A in both sexes and a decrease of 17beta-estradiol concentrations in females. Histopathological changes such as liver tissue degeneration were observed in fish exposed to 50 and 100% of the BKME. Although the BKME was biologically treated there are some chemical compounds in the effluent that are capable to affect fish physiology, however, a clear evidence for endocrine disruption was not found.

The effectiveness of a biological treatment with Rhizopus oryzae and of a photo-Fenton oxidation in the mitigation of toxicity of a bleached kraft pulp mill effluent.

Huge efforts have been made both in adopting more environmental-friendly bleaching processes, and in developing advanced oxidation processes and more effective biological treatments for the reduction of deleterious impacts of paper mill effluents. Even so, the success of such treatments is frequently reported in terms of chemical parameters without a proper evaluation of the effluent's toxicity mitigation. This is the first study reporting an exhaustive evaluation of the toxicity of a secondary bleached kraft pulp mill effluent, after either tertiary treatment with the soft-rot fungi Rhizopus oryzae or with a photo-Fenton oxidation, using a battery of freshwater species. As it has been reported the photo-Fenton/UV treatment has proved to be the most effective in reducing the colour and the COD (chemical oxygen demand) of the effluent. Nevertheless, extremely low EC(50) values were reported for almost all species, after this tertiary treatment. The treatment with R. oryzae was less effective in terms of colour removal and COD reduction, but proved to be the most promising in reducing toxicity.

Biological treatment of the effluent from a bleached kraft pulp mill using basidiomycete and zygomycete fungi.

Three white-rot fungi (Pleurotus sajor caju, Trametes versicolor and Phanerochaete chrysosporium) and one soft-rot fungi (Rhizopus oryzae) species confirmed their potential for future applications in the biological treatment of effluents derived from the secondary treatment of a bleached kraft pulp mill processing Eucalyptus globulus. Among the four species P. sajor caju and R. oryzae were the most effective in the biodegradation of organic compounds present in the effluent, being responsible for the reduction of relative absorbance (25-46% at 250 nm and 72-74% at 465 nm) and of chemical oxygen demand levels (74 to 81%) after 10 days of incubation. Laccase (Lac), lignin (Lip) and manganese peroxidases (MnP) expression varied among fungal species, where Lac and LiP activities were correlated with the degradation of organic compounds in the effluent treated with P. sajor caju. The first two axes of a principal component analysis explained 88.9% of the total variation among sub-samples treated with the four fungus species, after different incubation periods. All the variables measured contributed positively to the first component except for the MnP enzyme activity which was the only variable contributing negatively to the first component. Absorbances at 465 nm, LiP and Lac enzyme activities were the variables with more weight on the second component. P. sajor caju revealed to be the only species able to perform the biological treatment without promoting an increment in the toxicity of the effluent to the Vibrio fischeri, as it was assessed by the Microtox assay. The opposite was recorded for the treatments with the other three species of fungus. EC(50-5 min) values ranging between 28 and 57% (effluent concentrations) were recorded even after 10 to 13 days of treatment with P. chrysosporium, R. oryzae or with T. versicolor.

Toxicological effects and bioaccumulation in the freshwater clam (Corbicula fluminea) following exposure to trivalent arsenic.

Contamination of aquatic environments by arsenic is a serious worldwide problem. The main objective of this work was to evaluate the response of a freshwater clam (Corbicula fluminea) to arsenic (As III) exposure and infer its potential as a biological indicator of contamination. Metallothioneins (MTs) were used as indicators of metalloid toxicity in combination with an histological and histochemical evaluation. After a period of acclimatization in the laboratory, 50 C. fluminea (0.4 g +/- 0.1) were exposed to different nominal concentrations of arsenic (100, 300, 500, and 1000 microg L(-1)) for 7 days. The concentration of total As III in the water and in the tissues of the organisms was determined by atomic absorption spectrometry, and MTs were quantified through differential pulse polarography. Results suggest that the organisms exposed to the concentrations of 300 and 1000 microg As L(-1) accumulated the highest levels of As III in the tissues (17 +/- 9 and 15 +/- 3 microg g(-1) distilled water, respectively), which was confirmed through histochemical analysis. An apparent induction of MTs was also observed in the organisms exposed to As III, suggesting that C. fluminea possesses some capacity for arsenic regulation. The results suggest that the induction of MTs may be of high interest as a biomarker for arsenic contamination in aquatic environments, and confirms the potential of C. fluminea as a biological indicator.

A characterization of selected endocrine disruptor compounds in a Portuguese wastewater treatment plant.

Anthropogenic compounds that are able to disrupt the endocrine system of wildlife species are a major cause for concern and have led to a demand for new screening methods. The identification and quantification of endocrine disruptor compounds at wastewater treatment plant is of major interest to assess the endocrine activity of wastewater treatment plant discharges into the environment. This study consists of a preliminary survey of concentrations of previously selected endocrine disruptor compounds, undertaken to establish environmental concentrations and to support a biological program assay exposing freshwater fish to them. Selected endocrine disrupting chemicals (APEs, bisphenol A and 17 beta-estradiol) were measured in samples from a wastewater treatment plant located in Lisbon (Portugal), using recent commercial enzyme-linked immunosorbent assay kits and also LC-MS/MS. The results show that the wastewater treatment plant treatment process is efficient on the removal of target endocrine disruptor compounds. However, environmentally significant concentrations are still present in the treated effluent. The results also show that enzyme-linked immunosorbent assay kit is suitable for routine analysis of the selected compounds. The results are also useful since the wastewater treatment plant is located in a Mediterranean region, which results in an effluent with its own characteristics.

Estrogenic effects in crucian carp (Carassius carassius) exposed to treated sewage effluent.

To assess the estrogenicity of a municipal sewage treatment plant, sexually mature crucian carp of both sexes were exposed for 28 days to domestic treated sewage effluent running with a constant flow of water, with tap water and with different concentrations of the sewage effluent (25%, 50% and 100%). Vitellogenin (VTG), gonadosomatic index (GSI), hepatosomatic index (HSI), and histological abnormalities were used to assess the estrogenic potency of the effluent. Results show a significant (P<0.05) increase in VTG levels in all exposed male fish. A significant (P<0.05) reduction in the GSI was only observed in fish exposed to 100% effluent. Morphological changes were detected by histological evaluation, revealing severe effects on the testes. Spermatogenesis was progressively reduced to total inhibition in fish exposed to 100% effluent. One of the most pronounced effects detected was the presence of oocytes in male gonads, observed in 20% of males exposed to 100% sewage effluent.

Comparative study of the estrogenic responses of mirror carp (Cyprinus carpio) exposed to treated municipal sewage effluent (Lisbon) during two periods in different seasons.

To assess the estrogenic potency of the treated domestic sewage effluent from a sewage treatment plant (STP) located in Lisbon (Chelas), 60 mirror carp (Cyprinus carpio) were exposed to different concentrations of the sewage effluent (0%, 25%, 50% and 100%) for two periods of 28 days in two different seasons (winter/spring). Vitellogenin induction in males was used as a biomarker of exposure to xenoestrogens. At the end of the experiment, blood samples were taken for vitellogenin analysis and the fish were sacrificed and dissected. Gonad samples were taken for histological evaluation of the sewage effects. The results showed an increase in vitellogenin induction in exposed fish, both males and females, depending on the different dilutions of the sewage effluent. In comparison with controls, the gonadosomatic index decreased significantly (P < 0.05) in fish exposed to 100% treated effluent. Although statistically not significant, the hepatosomatic index (HSI) was high in all exposed fish. Histological abnormalities in fish gonads were evaluated and related to the different percentages of sewage effluent. Seasonal variations found in estrogenic responses were attributed to weather influences on sewage dilution.

Gender and regional differences in perceived job stress across Europe.

BACKGROUND: Over the last 20 years stress at work has been found to be predictive of several conditions such as coronary heart disease, high blood pressure and non-specific sick leave. The Karasek demand/control/strain concept has been the most widely used in prospective epidemiological studies. OBJECTIVES: To describe distribution in Karasek's demand/control (DC) dimensions as well as prevalence of strain in samples from different parts of Europe grouped into three regions (South, Middle, Sweden), adjusting for occupation. To describe gender differences in Karasek's DC dimensions along with strain prevalence and assess the regional stability of those differences in different occupational groups. DESIGN: The Job stress, Absenteeism and Coronary heart disease in Europe (JACE) study, a Concerted Action (Biomed I) of the European Union, is a multicentre prospective cohort epidemiological study: 38,019 subjects at work aged 35-59 years were surveyed at baseline. Standardised techniques were used for occupation coding (International Standardised Classification of Occupations) and for the DC model (Karasek scale): five items for the psychological demand and nine items for the control or decision latitude dimensions, respectively. RESULTS: A total of 34,972 subjects had a complete data set. There were important regional differences in the Karasek scales and in prevalence of strain even after adjustment for occupational class. Mean demand and control were higher in the Swedish centres when compared to two centres in Milano and Barcelona (Southern region) and values observed in four centres (Ghent, Brussels, Lille and Hoofddorp) in Middle Europe were closer to those observed in the Southern cities than to those obtained in the Swedish cities. Clerks (ISCO 4) and, more specifically, office clerks (ISCO 41) exhibited the smallest regional variation. In a multivariate model, the factor 'region' explained a small fraction of total variance. In the two Southern centres as well as in the four Middle European centres, men perceived marginally less job-demand as compared to women whereas the reverse was observed in the two Swedish centres. Differences were larger for control: men appeared to perceive more control at work than did women. In a multivariate model, gender explained a small fraction whereas occupational level explained a large fraction of the variance. CONCLUSIONS: In this standardised multicentre European study Karasek's DC model showed large gender and occupational differences whereas geographic region explained a small fraction of the total DC variance, notwithstanding large differences in labour market and working conditions as pointed out by the European Commission as recently as 2000.

Detection of an archaic clone of Staphylococcus aureus with low-level resistance to methicillin in a pediatric hospital in Portugal and in international samples: relics of a formerly widely disseminated strain?

Close to half of the 878 methicillin-resistant Staphylococcus aureus (MRSA) strains recovered between 1992 and 1997 from the pediatric hospital in Lisbon were bacteria in which antibiotic resistance was limited to beta-lactam antibiotics. The other half were multidrug resistant. The coexistence of MRSA with such unequal antibiotic resistance profiles prompted us to use molecular typing techniques for the characterization of the MRSA strains. Fifty-three strains chosen randomly were typed by a combination of genotypic methods. Over 90% of the MRSA strains belonged to two clones: the most frequent one, designated the "pediatric clone," was reminiscent of historically "early" MRSA: most isolates of this clone were only resistant to beta-lactam antimicrobials and remained susceptible to macrolides, quinolones, clindamycin, spectinomycin, and tetracycline. They showed heterogeneous and low-level resistance to methicillin (MIC, 1.5 to 6 microg/ml), carried the ClaI-mecA polymorph II, were free of the transposon Tn554, and showed macrorestriction pattern D (clonal type II::NH::D). The second major clone was the internationally spread and multiresistant "Iberian" MRSA with homogeneous and high-level resistance to methicillin (MIC, >200 microg/ml) and clonal type I::E::A. Surprisingly, the multidrug-resistant and highly epidemic Iberian MRSA did not replace the much less resistant pediatric clone during the 6 years of surveillance. The pediatric clone was also identified among contemporary MRSA isolates from Poland, Argentina, The United States, and Colombia, and the overwhelming majority of these were also associated with pediatric settings. We propose that the pediatric MRSA strain represents a formerly widely spread archaic clone which survived in some epidemiological settings with relatively limited antimicrobial pressure.

Atopy and enteroparasites.

UNLABELLED: There are not many studies about the intestinal parasitosis (IP) and atopic asthma (AA) relationship, and these show discordant results, possibly due to different studies design and differences in population selection. On the basis of personal results obtained by an epidemiological inquiry designed to estimate the prevalence of enteroparasitoses in asthmatic children and vice vesa, the aim of this study was to compare the prevalence of IP in AA and in a control group (CG) by a cross sectional study using clinical and laboratorial parameters, applied to 63 children (47 with AA and 16 in CG) aged 6 to 11 years, 37 males and 26 females, Caucasians, with the same socioeconomical conditions, consecutively selected in our Hospital. The results showed: The IP in AA children was 21.3%; the IP in CG was 25%; in the group with AA and IP, 40% of them had symptomology of IP; in the CG with IP, 100% had symptoms. CONCLUSIONS: The IP prevalence in AA was not statistically different from the IP in CG (p > 0.05) More data are needed to clarify the significant differences between the symptomatology rates of IP in asthmatic and non asthmatics; the reduced number of patients with symptoms in AA may reflect modulation of IP in AA and/or different parasite load.