Covid-19 in Brazil: A sad scenario.

The main contribution of this article is to report general statistics about COVID-19 in Brazil, based on analysis of accumulated series of confirmed cases, deaths and lethality rates, in addition to presenting graphs of moving averages for states and municipalities. The data show that the pandemic in Brazil has grown rapidly since February 25th (date of the first reported case). Furthermore, the lethality rate of COVID-19 in Brazil is greater than in many other Latin American countries (Chile, Argentina, Uruguay and Paraguay). However, the number of new confirmed cases in Brazil has little statistical relevance because only a small part of the population has been tested. In relation to Brazilian municipalities, we highlight the 10 states with the highest lethality rates, ranked from highest to lowest. Also, predictions about the increaseor decrease innew cases and deaths for states and capital cities are presented. These results can help managers and researchers to better guide their decisions regarding COVID-19.

Impact of Gas Flow and Humidity on Trans-Nasal Aerosol Deposition via Nasal Cannula in Adults: A Randomized Cross-Over Study.

BACKGROUND: Trans-nasal pulmonary aerosol delivery using high flow nasal cannula (HFNC) devices is described with the administration of high gas flows exceeding patient inspiratory flow (HF) and with lower flows (LF). The aim of this pilot clinical trial was to compare deposition and distribution of radiolabeled aerosol via nasal cannula in healthy adults across three rates of gas flow delivered with active heated humidification, and to further identify the impact of aerosol administration without heated humidity. METHODS: Twenty-three (23) healthy adults (16F) were randomized to receive aerosol with active heated humidification or unheated oxygen at gas flows of 10 L/min (n = 8), 30 L/min (n = 7), or 50 L/min (n = 8). Diethylenetriaminepentaacetic acid labeled with 1 millicurie (37 MBq) of Technetium-99m (DTPA-Tc99m) was mixed with NaCl to a fill volume of 1 mL, and administered via mesh nebulizer placed at the inlet of the humidifier. Radioactivity counts were performed using a gamma camera and the regions of interest (ROIs) were delimited with counts from the lungs, upper airways, stomach, nebulizer, circuit, and expiratory filter. A mass balance was calculated and each compartment was expressed as a percentage of the total. RESULTS: Lung deposition (mean ± SD) with heated humidified gas was greater at 10 L/min than 30 L/min or 50 L/min (17.2 ± 6.8%, 5.71 ± 2.04%, and 3.46 ± 1.24%, respectively; p = 0.0001). Using unheated carrier gas, a lung dose of aerosol was similar to the active heated humidification condition at 10 L/min, but greater at 30 and 50 L/min (p = 0.011). Administered gas flow and lung deposition were negatively correlated (r = -0.880, p < 0.001). CONCLUSIONS: Both flow and active heated humidity inversely impact aerosol delivery through HFNC. Nevertheless, aerosol administration across the range of commonly used flows can provide measurable levels of lung deposition in healthy adult subjects (NCT02519465).

Radioaerosol Pulmonary Deposition Using Mesh and Jet Nebulizers During Noninvasive Ventilation in Healthy Subjects.

BACKGROUND: In vivo deposition studies of aerosol administration during noninvasive ventilation (NIV) are scarce in the literature. The aim of this study was to compare radioaerosol pulmonary index and radioaerosol mass balance in the different compartments (pulmonary and extrapulmonary) of radio-tagged aerosol administered using vibrating mesh nebulizers and conventional jet nebulizers during NIV. METHODS: This was a crossover clinical trial involving 10 healthy subjects (mean age of 33.7 ± 10.0 y) randomly assigned to both treatment arms of this study: group 1 (NIV + vibrating mesh nebulizer, n = 10) and group 2 (NIV + jet nebulizer, n = 10). All subjects inhaled 3 mL of technetium-99m diethylenetriaminepentaacetic acid (25 mCi) and 0.9% saline solution via vibrating mesh and jet nebulizers during NIV through a face mask secured with straps while receiving positive inspiratory and expiratory pressures of 12 and 5 cm H2O, respectively. Scintigraphy was performed to count radioaerosol particles deposited in the regions of interest to determine radioaerosol mass balance from the lungs, upper airways, stomach, nebulizer, ventilator circuit, inspiratory and expiratory filters, and mask as a percentage. RESULTS: Vibrating mesh nebulizers deposited 972,013 ± 214,459 counts versus jet nebulizer with 386,025 ± 130,363 counts (P = .005). In a determination of mass balance, vibrating mesh nebulizers showed a higher deposition of inhaled radioaerosol compared with jet nebulizers (23.1 ± 5.8% vs 6.1 ± 2.5%, P = .005) and a higher proportion of radioaerosol deposited into the lungs (5.5 ± 0.9% versus 1.5 ± 0.6%, respectively, P = .005). The residual drug volume was lower with vibrating mesh nebulizers (5.1 ± 1.5%) compared with jet nebulizers (41.3 ± 4.2%, P = .005). CONCLUSIONS: During NIV in healthy subjects, vibrating mesh nebulizers delivered > 2-fold more radiolabeled drug into the respiratory tract compared with conventional jet nebulizers. Additional studies are recommended in subjects with asthma, COPD, bronchiectasis, and cystic fibrosis to better understand differences in both aerosol delivery and response. (ClinicalTrials.gov registration NCT01889524.).

Ventricular synchrony in patients with dilated cardiomyopathy and normal individuals: assessment by radionuclide ventriculography.

OBJECTIVE: To establish the parameters of intra- and interventricular synchrony in normal individuals and to compare them with patients with dilated cardiomyopathy with and without conduction disorders shown in the electrocardiogram (ECG) examination. METHODS: Three groups of patients were included in this study: 18 individuals (G1) with no cardiomyopathy and with a normal ECG (52+/-12 years, 29% male); 50 patients with dilated cardiomyopathy and severe left ventricular dysfunction, with 20 patients (G2) presenting QRS <120 ms (51+/-10 years, 75% male) and 30 patients (G3) with QRS >120 ms (57+/-12 years, 60% male). All patients underwent RV. Evaluation of left intraventricular dyssynchrony was carried out with the measurement of the phase histogram width and interventricular dyssynchrony was evaluated by the difference of the mean phase angle between the right and left ventricles (RLDif). RESULTS: Left ventricle ejection fractions (LVEF)s were: 62 +/- 6% (G1), 27 +/- 7% (G2) and 22 +/- 8% (G3) and right ventricle ejection fractions were: 46 +/- 5% (G1), 41 +/- 6%(G2) and 38 +/- 8% (G3). Evaluation of the phase histogram width was: 89 +/- 18 ms (G1), 203 +/- 54 ms (G2) and 312 +/- 130 ms (G3), p<0.0001. The measurement of RLDif was: 14 +/- 11 ms (G1), 39 +/- 40 ms (G2) and 87 +/- 49 ms (G3); comparing G1 vs. G2 and G1 vs. G3, p<0.0001 and G2 vs. G3, p=0.0007. CONCLUSION: The parameters analyzed discriminate the three groups of patients according to the ventricular synchrony degree. Patients with dilated cardiomyopathy and with no branch block in ECG (QRS <120 ms) may present dyssynchrony, but at a lower degree than patients with widened QRS.

Sincronia ventricular em portadores de miocardiopatia dilatada e indivíduos normais: avaliação através da ventriculografia radioisotópica / Ventricular synchrony in patients with dilated cardiomyopathy and normal individuals: assessment by radionuclide ventriculography

OBJETIVO: Estabelecer parâmetros de sincronia intra- e interventricular em indivíduos normais e compará-los aos de pacientes com miocardiopatia dilatada com e sem distúrbios de condução ao eletrocardiograma (ECG). MÉTODOS: Três grupos de pacientes foram incluídos no estudo: 18 indivíduos (G1) sem cardiopatia e com ECG normal (52+/-12 anos, 29 por cento masculinos); 50 portadores de miocardiopatia dilatada e disfunção ventricular esquerda grave, sendo 20 pacientes (G2) com QRS < 120 ms (51+/-10 anos, 75 por cento masculinos) e 30 pacientes (G3) com QRS > 120 ms (57+/-12 anos, 60 por cento masculinos). Todos foram submetidos à ventriculografia radioisotópica (VR). Para avaliar dissincronia intraventricular esquerda foi estudada a largura do histograma de fase e para avaliar dissincronia interventricular foi medida a diferença da média do ângulo de fase entre o ventrículo direito e o esquerdo (DifDE). RESULTADOS: As frações de ejeção do ventrículo esquerdo (FEVE)s foram: 62±6 por cento (G1), 27±6 por cento (G2) e 22±7 por cento (G3) e do VD foram: 46 ± 4 por cento (G1), 38±9 por cento(G2) e 37±9 por cento (G3). A avaliação da largura do histograma de fase foi de: 89±18 ms (G1), 203±54 ms (G2) e 312±130 ms (G3), p<0,0001. A medida da difVDVE foi de: 14±11 ms (G1), 39±40 ms (G2) e 87±49 ms (G3); quando se compararam G1 x G2 e G1 x G3, p<0,0001 e G2 x G3, p=0,0007. CONCLUSÃO: Os parâmetros analisados discriminam os três grupos de pacientes de acordo com o grau de sincronia ventricular. Pacientes com miocardiopatia dilatada e sem bloqueio de ramo ao ECG (QRS < 120 ms) podem apresentar dissincronia, porém em menor grau que os pacientes com QRS alargado.

OBJECTIVE: To establish the parameters of intra- and interventricular synchrony in normal individuals and to compare them with patients with dilated cardiomyopathy with and without conduction disorders shown in the electrocardiogram (ECG) examination. METHODS: Three groups of patients were included in this study: 18 individuals (G1) with no cardiomyopathy and with a normal ECG (52±12 years, 29 percent male); 50 patients with dilated cardiomyopathy and severe left ventricular dysfunction, with 20 patients (G2) presenting QRS <120ms (51±10 years, 75 percent male) and 30 patients (G3) with QRS >120ms (57±12 years, 60 percent male). All patients underwent RV. Evaluation of left intraventricular dyssynchrony was carried out with the measurement of the phase histogram width and interventricular dyssynchrony was evaluated by the difference of the mean phase angle between the right and left ventricles (RLDif). RESULTS: Left ventricle ejection fractions (LVEF)s were: 62 ± 6 percent (G1), 27 ± 7 percent (G2) and 22 ± 8 percent (G3) and right ventricle ejection fractions were: 46 ± 5 percent (G1), 41 ± 6 percent(G2) and 38 ± 8 percent (G3). Evaluation of the phase histogram width was: 89 ± 18 ms (G1), 203 ± 54 ms (G2) and 312 ± 130 ms (G3), p<0.0001. The measurement of RLDif was: 14 ± 11 ms (G1), 39 ± 40 ms (G2) and 87 ± 49 ms (G3); comparing G1 vs. G2 and G1 vs. G3, p<0.0001 and G2 vs. G3, p=0.0007. CONCLUSION: The parameters analyzed discriminate the three groups of patients according to the ventricular synchrony degree. Patients with dilated cardiomyopathy and withno branch block in ECG (QRS <120 ms) may present dyssynchrony, but at a lower degree than patients with widened QRS.