Post-vaccination incidence and side effects of COVID-19 in a cohort of Brazilian healthcare professionals: an internet-based survey.

OBJECTIVE: So far, at least 18 different severe acute respiratory syndrome coronavirus-2 vaccines have been approved. Until October 2022, 12.8 billion doses had been administered all over the world. Vaccination of high-risk groups and healthcare professionals was initially prioritized. This cross-sectional survey aimed to investigate the occurrence of vaccine side effects, as well as the incidence of COVID-19 among vaccinated healthcare professionals. METHODS: A survey was structured and shared with healthcare professionals using a digital platform to collect data between May and June 2021. RESULTS: This study included 6,115 participants. The most prevalent age group was 30-39 years (31.3%), 67.3% were female and 73.2% accounted for physicians, and nearly half worked in frontline care for COVID-19. Approximately, two-thirds of them were vaccinated with CoronaVac, and about 60% reported at least one side effect following the vaccination. Nevertheless, minor reactions were more frequent, such as pain at site of injection, fatigue, and headache. Our data could be used to inform people on the likelihood of side effects of COVID-19 vaccines, particularly CoronaVac, since this is the largest study about vaccine reactions using this vaccine, to our best knowledge. CONCLUSION: The incidence of side effects in Brazilian healthcare professionals was 60%, and the most common side effects included local swelling/pain, fatigue/tiredness, fever, headache, and limb pain.

Risk factors for SARS-CoV-2 infection and epidemiological profile of Brazilian anesthesiologists during the COVID-19 pandemic: cross-sectional study.

INTRODUCTION: The devasting effects of COVID-19 have caused economic and health impacts worldwide. Anesthesiologists were one of the key professionals fighting the pandemic and have been highly exposed at their multiple sites of clinical practice. Thus, the importance of determining the nature of the infection in this population that provides care to SARS-CoV-2 patients. METHOD: We conducted a cross-sectional study administering an online questionnaire to examine the demographic and epidemiological profile of these professionals in Brazil, and to describe the risk factors for viral infection during the pandemic. RESULTS: A total of 1,127 anesthesiologists answered the questionnaire, 55.2% were men, more than 90% with age below 60 years, with infection and reinfection rates of 14.7% and 0.5%, respectively, and 47.2% reported a significant income reduction. The predictors of COVID-19 contamination were practicing in operating rooms (OR = 0.42; 95% CI 0.23-0.78), direct contact with infected patients (OR = 5.74; 95% CI 3.05-11.57), indirect contact with infected patients (OR = 2.43; 95% CI 1.13-5.33), working in a pre-hospital setting (OR = 2.36; 95% CI 1.04-5.03), and presence of immunosuppression, except for cancer (OR = 4.89; 95% CI 1.16-19.01). CONCLUSION: COVID-19 had enormous consequences on Brazilian anesthesiologists regarding sociodemographic aspects and contamination rates (5.57 times higher than in the general population). These are alarming and unprecedented findings for this professional group, as they reveal the considerable risk of infection and its independent predictor variables.

Post-vaccination incidence and side effects of COVID-19 in a cohort of Brazilian healthcare professionals: an internet-based survey

Abstract Objective So far, at least 18 different severe acute respiratory syndrome coronavirus-2 vaccines have been approved. Until October 2022, 12.8 billion doses had been administered all over the world. Vaccination of high-risk groups and healthcare professionals was initially prioritized. This cross-sectional survey aimed to investigate the occurrence of vaccine side effects, as well as the incidence of COVID-19 among vaccinated healthcare professionals. Methods A survey was structured and shared with healthcare professionals using a digital platform to collect data between May and June 2021. Results This study included 6,115 participants. The most prevalent age group was 30-39 years (31.3%), 67.3% were female and 73.2% accounted for physicians, and nearly half worked in frontline care for COVID-19. Approximately, two-thirds of them were vaccinated with CoronaVac, and about 60% reported at least one side effect following the vaccination. Nevertheless, minor reactions were more frequent, such as pain at site of injection, fatigue, and headache. Our data could be used to inform people on the likelihood of side effects of COVID-19 vaccines, particularly CoronaVac, since this is the largest study about vaccine reactions using this vaccine, to our best knowledge. Conclusion The incidence of side effects in Brazilian healthcare professionals was 60%, and the most common side effects included local swelling/pain, fatigue/tiredness, fever, headache, and limb pain.

The role of thromboelastometry in the assessment and treatment of coagulopathy in liver transplant patients / O papel da tromboelastometria na avaliação e no tratamento da coagulopatia em pacientes submetidos ao transplante hepático

ABSTRACT Perioperative monitoring of coagulation is vital to assess bleeding risks, diagnose deficiencies associated with hemorrhage, and guide hemostatic therapy in major surgical procedures, such as liver transplantation. Routine static tests demand long turnaround time and do not assess platelet function; they are determined on plasma at a standard temperature of 37°C; hence these tests are ill-suited for intraoperative use. In contrast, methods which evaluate the viscoelastic properties of whole blood, such as thromboelastogram and rotational thromboelastometry, provide rapid qualitative coagulation assessment and appropriate guidance for transfusion therapy. These are promising tools for the assessment and treatment of hyper- and hypocoagulable states associated with bleeding in liver transplantation. When combined with traditional tests and objective assessment of the surgical field, this information provides ideal guidance for transfusion strategies, with potential improvement of patient outcomes.

RESUMO A monitorização perioperatória da coagulação é fundamental para estimar o risco de sangramento, diagnosticar deficiências causadoras de hemorragia e guiar terapias hemostáticas durante procedimentos cirúrgicos de grande porte, como o transplante hepático. Os testes estáticos, comumente usados na prática clínica, são insatisfatórios no intraoperatório, pois demandam tempo e não avaliam a função plaquetária; são determinados no plasma e realizados em temperatura padrão de 37°C. Os métodos que avaliam as propriedades viscoelásticas do sangue total, como o tromboelastograma e a tromboelastometria rotacional, podem suprir as deficiências dos testes estáticos tradicionais, uma vez que permitem avaliar a coagulação de forma rápida e qualitativa, guiando a terapia transfusional de forma adequada. A tromboelastometria rotacional mostrou-se promissora na avaliação e no tratamento de estados de hipercoagulação e hipocoagulação, associados a sangramento no transplante hepático. Estas informações, combinadas com os testes tradicionais e uma avaliação objetiva do campo cirúrgico, promovem um cenário ótimo para guiar as estratégias transfusionais e potencialmente melhorar o desfecho destes pacientes.

The role of thromboelastometry in the assessment and treatment of coagulopathy in liver transplant patients.

Perioperative monitoring of coagulation is vital to assess bleeding risks, diagnose deficiencies associated with hemorrhage, and guide hemostatic therapy in major surgical procedures, such as liver transplantation. Routine static tests demand long turnaround time and do not assess platelet function; they are determined on plasma at a standard temperature of 37°C; hence these tests are ill-suited for intraoperative use. In contrast, methods which evaluate the viscoelastic properties of whole blood, such as thromboelastogram and rotational thromboelastometry, provide rapid qualitative coagulation assessment and appropriate guidance for transfusion therapy. These are promising tools for the assessment and treatment of hyper- and hypocoagulable states associated with bleeding in liver transplantation. When combined with traditional tests and objective assessment of the surgical field, this information provides ideal guidance for transfusion strategies, with potential improvement of patient outcomes. RESUMO A monitorização perioperatória da coagulação é fundamental para estimar o risco de sangramento, diagnosticar deficiências causadoras de hemorragia e guiar terapias hemostáticas durante procedimentos cirúrgicos de grande porte, como o transplante hepático. Os testes estáticos, comumente usados na prática clínica, são insatisfatórios no intraoperatório, pois demandam tempo e não avaliam a função plaquetária; são determinados no plasma e realizados em temperatura padrão de 37°C. Os métodos que avaliam as propriedades viscoelásticas do sangue total, como o tromboelastograma e a tromboelastometria rotacional, podem suprir as deficiências dos testes estáticos tradicionais, uma vez que permitem avaliar a coagulação de forma rápida e qualitativa, guiando a terapia transfusional de forma adequada. A tromboelastometria rotacional mostrou-se promissora na avaliação e no tratamento de estados de hipercoagulação e hipocoagulação, associados a sangramento no transplante hepático. Estas informações, combinadas com os testes tradicionais e uma avaliação objetiva do campo cirúrgico, promovem um cenário ótimo para guiar as estratégias transfusionais e potencialmente melhorar o desfecho destes pacientes.

Preditores independentes de mortalidade em pacientes politraumatizados: estudo longitudinal, prospectivo, observacional / Independent predictors of mortality in polytrauma patients: a prospective, observational, longitudinal study

O trauma constitui importante problema de saúde pública, com grande impacto sócio-econômico e muitas mortes. Visto que poucos pesquisadores traçam perfil epidemiológico e fatores preditores de óbito de forma integrada e prospectiva, este estudo foi idealizado com o objetivo de identificar preditores independentes de mortalidade em trauma e seu mapeamento populacional, visando melhorar o atendimento a politraumatizados graves. Após aprovação da comissão de ética em pesquisa institucional, estudo longitudinal, prospectivo e observacional foi conduzido entre 2010 e 2013 na região metropolitana da Grande São Paulo/Brasil com vítimas de politrauma grave (Injury Severity Score >15). A coleta de dados clínico-laboratoriais foi realizada em 4 momentos: 1- pré-hospitalar, 2- sala de emergência, 3- após 3 horas da admissão e 4- após 24 hs da admissão. O desfecho principal foi mortalidade em 30 dias. Os dados foram analisados com teste t de Student ou Mann-Whitney, ANOVA não paramétrica, e Equações de Estimação Generalizadas (EEG) para medidas repetidas (p < 0,05). A população total do estudo foi de 334 pacientes, sendo excluídos 124 por não adequação ao protocolo e incluídos 200 indivíduos na análise final. Os preditores independentes de mortalidade encontrados foram: saturação arterial de oxigênio de hemoglobina (OR=0,989; IC 95% 0,982-0,995- p < 0,001), pressão arterial diastólica (OR=0,998; IC 95% 0,995-0,998- p < 0,001), nível sérico de lactato (OR=1,046; IC 95% 1,012-1,082- p < 0,004), pontuação na escala de coma de Glasgow (OR=0,973;IC 95% 0,965-0,982-p < 0,001), quantidade de cristalóides infundidos (OR=1,013; IC 95% 1,000-1,025- p < 0,023 - a cada 1000 ml). Através das análises realizadas neste estudo foi possível concluir que os preditores independentes de mortalidade foram: hipoxemia, hipotensão arterial diastólica, hiperlactatemia, baixa pontuação na escala de coma de Glasgow e aumento de volume de cristalóides infundidos.

Trauma is an important public health problem, with high socioeconomic impact and major adverse clinical outcomes. The epidemiological profile and predictors of death in trauma patients have not been addressed in an integrated and prospective way. Therefore, the present study was designed to identify independent predictors of mortality in trauma patients and their populational mapping to improve the care of severe polytrauma patients. After approval by the ethics in institutional research committee, the present longitudinal, prospective and observational study was conducted between 2010 and 2013 in the metropolitan area of São Paulo/Brazil with victims of severe polytrauma (Injury Severity Score >15). The collection of clinical and laboratory data was performed at 4 different time points: 1, pre-hospital; 2, in the emergency room; 3, at 3 hours after admission; and 4, at 24 hours after admission. The primary outcome was mortality within 30 days. The data were analyzed with Student's t-test or the Mann-Whitney test, nonparametric ANOVA and Generalized Estimating Equations (GEE) for repeated measures (p < 0.05). The total study population consisted of 334 patients. In total, 124 patients were excluded for not fitting the protocol, and 200 individuals were included in the final analysis. The independent predictors of mortality were as follows: arterial hemoglobin oxygen saturation (OR=0.989, 95% CI 0.982-0.995, p < 0.001); diastolic blood pressure (OR=0.998, 95% CI 0.995-0.998, p < 0.001); serum lactate level (OR=1.046, 95% CI 1.012- 1.082, p < 0.004); score on the Glasgow coma scale (OR=0.973, 95% CI 0.965-0.982, p < 0.001); and the amount of infused crystalloid (OR=1.013, 95% CI 1.000-1.025, p < 0.023 - each 1000 ml). Through the analyses performed in this study, it was concluded that the independent predictors of mortality at any given time were as follows: hypoxemia; diastolic arterial hypotension; hyperlactatemia; a low score on the Glasgow coma scale; and...