Label-Free Plasmonic Biosensor for Rapid, Quantitative, and Highly Sensitive COVID-19 Serology: Implementation and Clinical Validation.

Serological tests are essential for the control and management of COVID-19 pandemic (diagnostics and surveillance, and epidemiological and immunity studies). We introduce a direct serological biosensor assay employing proprietary technology based on plasmonics, which offers rapid (<15 min) identification and quantification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in clinical samples, without signal amplification. The portable plasmonic device employs a custom-designed multiantigen (RBD peptide and N protein) sensor biochip and reaches detection limits in the low ng mL-1 range employing polyclonal antibodies. It has also been implemented employing the WHO-approved anti-SARS-CoV-2 immunoglobulin standard. A clinical validation with COVID-19 positive and negative samples (n = 120) demonstrates its excellent diagnostic sensitivity (99%) and specificity (100%). This positions our biosensor as an accurate and easy-to-use diagnostics tool for rapid and reliable COVID-19 serology to be employed both at laboratory and decentralized settings for the disease management and for the evaluation of immunological status during vaccination or treatment.

Reproducibility of MRI Features of Uterine Leiomyomas: A Study on Interobserver Agreement and Inter-Method Agreement With Surgery.

PURPOSE: To evaluate interobserver agreement in the interpretation of different MRI features of uterine leiomyomas (UL) according to observers' experience, and to assess the inter-method reproducibility (MRI versus surgery) regarding the International Federation of Gynecology and Obstetrics (FIGO) classification. METHODS: Retrospective study including UL patients who underwent MRI and surgical treatment. Four blinded observers (2 vs >10 years of experience) assessed UL regarding dimensions and volume; inner and outer mantles; FIGO classification; vascularization; degeneration; and diffusion-weighted imaging features. Uterine dimensions and volume were calculated. FIGO classification as ascertained by observers was compared to surgical findings. Intraclass correlation coefficient (ICC) estimates were used for interobserver comparison of numerical variables, and kappa statistic for categorical variables. RESULTS: Thirty-five patients (26y-73y) with 61 UL were included in the interobserver analyses, and 31 patients (54 UL) had available data allowing retrospective surgical FIGO classification for assessment of inter-method reproducibility. Both groups of observers had good to excellent agreement in assessing UL (ICC = 0.980-0.994) and uterine volumes (ICC = 0.857-0.914), mantles measurement (ICC = 0.797-0.920), and apparent diffusion coefficient calculation (ICC = 0.787-0.883). There was substantial agreement for both groups regarding FIGO classification (κ = 0.645-0.767). Vascularization, degeneration and restricted diffusion had lower agreement, varying from reasonable to moderate. Inter-method agreement was reasonable (κ = 0.341-0.395). CONCLUSIONS: Interobserver agreement of MRI for UL was higher for quantitative than qualitative features, with a little impact of observers' experience for most features. MRI agreement with surgery was reasonable. Further efforts should be taken to improve interobserver and inter-method reproducibility for MRI in this scenario.

Exacerbations and Changes in Physical Activity and Sedentary Behaviour in Patients with Bronchiectasis after 1 Year.

BACKGROUND: Low physical activity and high sedentary behaviour in patients with bronchiectasis are associated with hospitalisation over one year. However, the factors associated with longitudinal changes in physical activity and sedentary behaviour have not been explored. We aimed to identify clinical and sociodemographic characteristics related to a change in physical activity and sedentary behaviour in patients with bronchiectasis after one year. METHODS: This was a prospective observational study during which physical activity measurements were recorded using a SenseWear Armband for one week at baseline and at one year. At each assessment point, patients were classified as active or inactive (measured as steps per day) and as sedentary or not sedentary (measured as sedentary time). RESULTS: 53 patients with bronchiectasis were analysed, and after one year, 18 (34%) had worse activity and sedentary levels. Specifically, 10 patients became inactive and sedentary. Multivariable analysis showed that the number of exacerbations during the follow-up period was the only outcome independently associated with change to higher inactivity and sedentary behaviour (odds ratio (OR), 2.19; 95% CI, 1.12 to 4.28). CONCLUSIONS: The number of exacerbations in patients with bronchiectasis was associated with changes in physical activity and sedentary behaviour. Exacerbation prevention may appear as a key factor in relation to physical activity and sedentary behaviour in patients with bronchiectasis.

Characteristics and Outcomes in Patients with Ventilator-Associated Pneumonia Who Do or Do Not Develop Acute Respiratory Distress Syndrome. An Observational Study.

Ventilator-associated pneumonia (VAP) is a well-known complication of patients on invasive mechanical ventilation. The main cause of acute respiratory distress syndrome (ARDS) is pneumonia. ARDS can occur in patients with community-acquired or nosocomial pneumonia. Data regarding ARDS incidence, related pathogens, and specific outcomes in patients with VAP is limited. This is a cohort study in which patients with VAP were evaluated in an 800-bed tertiary teaching hospital between 2004 and 2016. Clinical outcomes, microbiological and epidemiological data were assessed among those who developed ARDS and those who did not. Forty-one (13.6%) out of 301 VAP patients developed ARDS. Patients who developed ARDS were younger and presented with higher prevalence of chronic liver disease. Pseudomonas aeruginosa was the most frequently isolated pathogen, but without any difference between groups. Appropriate empirical antibiotic treatment was prescribed to ARDS patients as frequently as to those without ARDS. Ninety-day mortality did not significantly vary among patients with or without ARDS. Additionally, patients with ARDS did not have significantly higher intensive care unit (ICU) and 28-day mortality, ICU, and hospital length of stay, ventilation-free days, and duration of mechanical ventilation. In summary, ARDS deriving from VAP occurs in 13.6% of patients. Although significant differences in clinical outcomes were not observed between both groups, further studies with a higher number of patients are needed due to the possibility of the study being underpowered.

Effect of Combined ß-Lactam/Macrolide Therapy on Mortality According to the Microbial Etiology and Inflammatory Status of Patients With Community-Acquired Pneumonia.

BACKGROUND: Antibiotic combinations that include macrolides have shown lower mortality rates than ß-lactams in monotherapy or combined with fluoroquinolones in patients with community-acquired pneumonia (CAP). However, this effect has not been studied according to the levels of C-reactive protein in CAP with identified microbial cause. In patients with CAP and known microbial cause we aimed to evaluate 30-day mortality of a ß-lactam plus macrolide (BL + M) compared with a fluoroquinolone alone or with a ß-lactam (FQ ± BL). METHODS: We analyzed a prospective observational cohort of patients with CAP admitted to the Hospital Clinic of Barcelona between 1996 and 2016. We included only patients with known microbial cause. RESULTS: Of 1,715 patients (29%) with known etiology, a total of 932 patients (54%) received BL + M. Despite lower crude mortality in the BL + M group in the overall population (BL + M, 5% vs FQ ± BL, 8%; P = .015), after adjustment by a propensity score and baseline characteristics, the combination of BL + M had a protective effect on mortality only in patients with high inflammatory response (C-reactive protein, > 15 mg/dL) and pneumococcal CAP (adjusted OR, 0.28; 95% CI, 0.09-0.93). No benefits on mortality were observed for the population without high inflammatory response and pneumococcal CAP or with other etiologies. CONCLUSIONS: The combination of a ß-lactam with a macrolide was associated with decreased mortality in patients with pneumococcal CAP and in patients with high systemic inflammatory response. When both factors occurred together, BL + M was protective for mortality in the multivariate analysis.

Lymphocytopenia as a Predictor of Mortality in Patients with ICU-Acquired Pneumonia.

BACKGROUND: Intensive care unit-acquired pneumonia (ICU-AP) is a severe complication in patients admitted to the ICU. Lymphocytopenia is a marker of poor prognosis in patients with community-acquired pneumonia, but its impact on ICU-AP prognosis is unknown. We aimed to evaluate whether lymphocytopenia is an independent risk factor for mortality in non-immunocompromised patients with ICU-AP. METHODS: Prospective observational cohort study of patients from six ICUs of an 800-bed tertiary teaching hospital (2005 to 2016). RESULTS: Of the 473 patients included, 277 (59%) had ventilator-associated pneumonia (VAP). Receiver operating characteristic (ROC) analysis of the lymphocyte counts at diagnosis showed that 595 cells/mm3 was the best cut-off for discriminating two groups of patients at risk: lymphocytopenic group (lymphocyte count <595 cells/mm3, 141 patients (30%)) and non-lymphocytopenic group (lymphocyte count ≥595 cells/mm3, 332 patients (70%)). Patients with lymphocytopenia presented more comorbidities and a higher sequential organ failure assessment (SOFA) score at the moment of pneumonia diagnosis. Also, 28-day mortality and 90-day mortality were higher in patients with lymphocytopenia (28-day: 38 (27%) versus 59 (18%), 90-day: 74 (53%) versus 111 (34%)). In the multivariable model, <595 cells/mm3 resulted to be an independent predictor for 90-day mortality (Hazard Ratio 1.41; 95% Confidence Interval 1.02 to 1.94). CONCLUSION: Lymphocytopenia is an independent predictor of 90-day mortality in non-immunocompromised patients with ICU-AP.

Esporte lazer na região dos Campos Gerais: uma análise dos espaços, em foco o município de Telêmaco Borba / Sports and leisure in the Campos Gerais region: an analysis of spaces, focusing on the municipality of Telemaco Borba

O município de Telêmaco Borba/Paraná, situado na região dos Campos Gerais, tem uma população estimada pelo Instituto Brasileiro de Geografia e EstatísticaIBGE (2020) de 79.792 habitantes. A cidade possui informação escassa dos espaços de esporte e lazer, sejam eles públicos ou privados, disponíveis para a população. Para o desenvolvimento da pesquisa, partiu-se do pressuposto que o acesso ao esporte e lazer é direito de todos os cidadãos. Propõe-se, então, apresentar e discutir as principais informações levantadas acerca dos espaços de esporte e lazer de Telêmaco Borba. Com caráter qualitativo, por meio de pesquisa exploratória, foi realizado um levantamento e mapeamento dos espaços de esporte e lazer de Telêmaco Borba. Com essas informações foi criado um portal informativo com essas informações. Observou-se uma relação entre a renda da população e a presença de espaços, assim como uma concentração destes na região central.

The city of Telêmaco Borba/Paraná, located in the region of Campos Gerais, has a population estimated by the Instituto Brasileiro de Geografia e EstatísticaIBGE (2020) (Geography and Statistics Brazilian Institute) of 79,792 people. The city has little information on the spaces of sports and leisure, public or private, available to the population. For the research development, the starting point was that every citizen has the right to sports and leisure access. The purpose is to present and discuss the main information gathered about sports and leisure of Telêmaco Borba. With a qualitative focus, through exploratory research, a gathering and mapping of those spaces was done. An informative website was created based on this information. It was observed that there is a correlation between the presence of those spaces and the income of the population, as well as a concentration of them in the center of the city.

Randomized clinical trial comparing cold knife conization of the cervix with and without lateral hemostatic sutures.

OBJECTIVE: Compare blood loss during cold knife conization of the cervix with and without lateral hemostatic sutures in the cervical branches of the uterine arteries. DESIGN: Randomized clinical trial. SETTING: Hospital de Clínicas de Porto Alegre (HCPA). POPULATION: 102 patients that underwent cold knife conization. METHODS: Women that underwent cold knife conization of the cervix were randomized to undergo the procedure with or without lateral hemostatic sutures. PRIMARY OUTCOME MEASURE: blood loss measured in grams. SECONDARY OUTCOME MEASURES: operative time and postoperative intervention. Only the participants were blinded to group assignment. RESULTS: From March 2009 to August 2012, patients were randomly assigned to one of the study groups. There were no differences in amount of blood loss between patients that underwent the procedure with and without sutures (p = 0.39). Operative time was shorter in the group without suture (p = 0.020). There were no differences in intervention due to bleeding (p = 0.20). Blood loss was greater among menstruating women than for menopausal women (p = 0.011). There were no differences in amount of blood lost between smoking and nonsmoking patients (p = 0.082). CONCLUSIONS: Lateral hemostatic sutures do not affect the amount of intraoperative bleeding or the number of postoperative interventions. Their use is not necessary because they result in longer operative time, have a higher cost due to the use of suture material and pose the risk of ureter lesion in case the sutures are not placed at a lower position in the cervix. ClinicalTrials. gov identifier: NCT02184975.

Análise da tomografia computadorizada no abdome agudo / Analysis of the computed tomography in the acute abdomen

OBJETIVO: Este trabalho visa testar a capacidade da tomografia computadorizada em auxiliar no diagnóstico e na conduta do abdome agudo. MATERIAL E MÉTODO: Este estudo tem um delineamento longitudinal e prospectivo. Foram analisados e acompanhados os pacientes que tiveram diagnóstico de abdome agudo. Obtiveram-se 105 casos de abdome agudo e após a aplicação doscritérios de exclusão foram incluídos no estudo 28 pacientes. Os critérios de exclusão foram: dor de início após 24 horas, instabilidade hemodinâmica e alergia ao meio de contraste. RESULTADOS: A tomografia computadorizada alterou a hipótese diagnóstica dos médicos do pronto-atendimento em 50% dos casos (p < 0,05) e o índice da certeza dos médicos do pronto-atendimento em 85,71% dos casos (p = 0,014). Alterou a conduta em 46,43% dos casos (p > 0,05) quando 78,57% dos pacientes tinham indicação de cirurgia pré-tomografia e 67,86% pós-tomografia (p = 0,0546). O índice de acerto da tomografia computadorizada, quando comparada aos exames anatomopatológicos e diagnóstico final, foi constatado em 82,14% dos casos (p = 0,013). Foi observada diferença de 7,2 dias de internação (p = 0,003) quando comparados grupos com tomografia e a média dos pacientes internados no pronto-atendimento. CONCLUSÃO: A tomografia computadorizada tem boacorrelação com a anatomopatologia e elevada acurácia na determinação da conduta cirúrgica, associada à capacidade de aumentar o índice de certeza dos médicos do pronto-atendimento. Além disso, diminui o tempo de internação e o número de cirurgias, e é custo-efetiva.

INTRODUCTION: This study tends to test the capacity of the computedtomography in assist in the diagnosis and the approach of the acute abdomen. MATERIAL AND METHOD: This is a longitudinal and prospective study, in which were analyzed the patients with the diagnosis of acute abdomen. There were obtained 105 cases of acute abdomen and after the application of the exclusions criteria were included 28 patients in the study. RESULTS: Computed tomography changed the diagnostic hypothesis of the physiciansin 50% of the cases (p < 0.05), and the confidence index in 85.71% of the cases (p = 0.014). Computed tomography also altered the management in 46.43% of the cases (p > 0.05), where 78.57% ofthe patients had surgical indication before computed tomography and 67.86% after computed tomography (p = 0.0546). The index of accurate diagnosis of computed tomography, when compared to the anatomopathologic examination and the final diagnosis, was observed in 82.14% of the cases (p = 0.013). When the analysis was done dividing the patients in surgical and nonsurgical group, were obtained an accuracy of 89.28% (p = 0.0001). The difference of 7.2 days of hospitalization (p = 0.003) was obtained compared with the mean of the acute abdomen without use the computedtomography. CONCLUSION: The computed tomography is correlativewith the anatomopathology and has great accuracy in the surgical indication, associated with the capacity of increase the confident index of the physicians, reduces the hospitalization time, reduces the number of surgeries and is cost-effective.