RESUMO
On the basis of a semi-realistic SIR microsimulation for Germany and Poland, we show that the R0 parameter interval for which the COVID-19 epidemic stays overcritical but below the capacity limit of the health care system to reach herd immunity is so narrow that a successful implementation of this strategy is likely to fail, which is in contrast to results obtained from classical differential equation models. Our microsimulation is based on official census data and involves household composition and age distribution as the main population structure variables. Outside household contacts are characterised by an out-reproduction number R* which is the only free parameter of the model. For a subcritical domain we compute the time till extinction and prevalence as a function of the initial number of infected individuals and R*. For the Polish city of Wrocaw we also discuss the combined impact of testing coverage and contact reduction. For both countries we estimate R* for disease progression until 20th of March 2020.
RESUMO
AIM: The usefulness of high-sensitivity troponin T (hs-TnT) as a predictor of perioperative hemodynamic instability is currently unknown. METHODS: A prospective study was conducted on a group of 708 consecutive patients with significant valvular heart disease that underwent elective valve surgery. The primary end point was postoperative hemodynamic instability. The secondary end point was death from all causes in patients with perioperative hemodynamic instability. RESULTS: The postoperative hemodynamic instability occurred in 131 patients. At multivariate analysis hs-TnT measured immediately after surgery and New York Heart Association classes remained independent predictors of the primary end point. Age and hs-TnT measured immediately after surgery were associated with an increased risk of death. CONCLUSION: Elevated postoperative hs-TnT was associated with a higher risk of postoperative hemodynamic instability and death.