Cost-consequence analysis of a combined COVID-19/influenza rapid diagnostic test in the Brazilian private healthcare setting

Abstract Combination COVID-19/influenza rapid tests provide a way to quickly and accurately differentiate between the two infections. The goal of this economic evaluation was to assess the cost and health benefits of a combination COVID-19/influenza Rapid Diagnostic Test (RDT) vs. current standard-of-care in the Brazilian private healthcare setting. A dual decision tree model was developed to estimate the impact of rapid differentiation of COVID-19 and influenza in a hypothetical cohort of 1,000 adults with influenza-like illness in an ambulatory healthcare setting. The model compared the use of a combination COVID-19/influenza RDT to Brazil standard diagnostic practice of a COVID-19 RDT and presumptive influenza diagnosis. Different levels of influenza prevalence were modeled with co-infection estimated as a function of the COVID-19 prevalence. Outcomes included accuracy of diagnosis, antiviral prescriptions and healthcare resource use (hospital bed days and ICU occupancy). Depending on influenza prevalence, considering 1,000 patients with influenza-like illness, a combination RDT compared to standard practice was estimated to result in between 88 and 149 fewer missed diagnoses of influenza (including co-infection), 161 to 185 fewer cases of over-diagnosis of influenza; a 24 to 34% reduction in hospital bed days and a 16 to 26% reduction in ICU days. In the base case scenario (20% influenza, 5% COVID-19), the combination RDT was estimated to result in cohort cost savings of $99. Based upon a de novo economic model, this analysis indicates that use of a combination RDT could positively impact influenza antiviral prescriptions and lower healthcare resource use.

Five-year performance analysis of a cystic fibrosis newborn screening program in northeastern Brazil

Abstract Objective: To analyze the performance of the cystic fibrosis (CF) newborn screening (NBS) program over its first five years in a Brazilian northeastern state. Methods: A population-based study using a screening algorithm based on immunoreactive trypsinogen (IRT)/IRT. Data were retrieved from the state referral screening center registry. The program performance was evaluated using descriptive indicators such as the results of an active search, coverage, newborn's age at the time of blood sampling, the time between sample collection and its arrival at the laboratory, and the child's age at diagnosis of disease. Results: The public CF screening program covered 82.6% of the 1,017,576 births that occurred, with an accumulated five-year incidence of 1:20,767 live births. The median (25th-75th) age at diagnosis was 3.5 (2.3-7.3) months. The sampling before 7 days of life for the first IRT (IRT1) increased between 2013 and 2017 from 42.2 to 48.3%. Around 5% of IRT1 samples and 30% of the second samples were collected after 30 days of life. In the first and second stages of screening, 23.6% and 19.9% of the infants, respectively, were lost to follow-up. In both stages of screening, the samples were retained at the health units for a median (25th-75th) of 9.0 (7.0-13.0) days. Conclusions: The coverage by the CF-NBS program was satisfactory as compared to other Brazilian state rates and the percentage of IRT1 samples collected within the first week of life increased progressively. However, time of samples retention at the health units, inappropriate sampling, inherent methodological problems, and loss of follow-up need to improve.

The impact of COVID-19 in medical practice. A review focused on Urology

ABSTRACT COVID-19 pandemic is a rapidly spreading virus that is changing the World and the way doctors are practicing medicine. The huge number of patients searching for medical care and needing intensive care beds led the health care system to a burnout status especially in places where the care system was already overloaded. In this setting, and also due to the absence of a specific treatment for the disease, health authorities had to opt for recommending or imposing social distancing to relieve the health system and reduce deaths. All other medical specialties nondirectly related to the treatment of COVID-19 had to interrupt or strongly reduce their activities in order to give room to seriously ill patients, since no one knows so far the real extent of the virus damage on human body and the consequences of doing non deferrable procedures in this pandemic era. Despite not been a urological disease, the urologist needs to be updated on how to deal with these patients and how to take care of himself and of the medical team he works with. The aim of this article is to review briefly some practical aspects of COVID-19 and its implications in the urological practice in our country.

Effects of Tanreqing Capsule on the negative conversion time of nucleic acid in patients with COVID-19: A retrospective cohort study / 中西医结合学报

OBJECTIVE@#Traditional Chinese medicine plays a significant role in the treatment of the pandemic of coronavirus disease 2019 (COVID-19). Tanreqing Capsule (TRQC) was used in the treatment of COVID-19 patients in the Shanghai Public Health Clinical Center. This study aimed to investigate the clinical efficacy of TRQC in the treatment of COVID-19.@*METHODS@#A retrospective cohort study was conducted on 82 patients who had laboratory-confirmed mild and moderate COVID-19; patients were treated with TRQC in one designated hospital. The treatment and control groups consisted of 25 and 57 cases, respectively. The treatment group was given TRQC orally three times a day, three pills each time, in addition to conventional Western medicine treatments which were also administered to the control group. The clinical efficacy indicators, such as the negative conversion time of pharyngeal swab nucleic acid, the negative conversion time of fecal nucleic acid, the duration of negative conversion of pharyngeal-fecal nucleic acid, and the improvement in the level of immune indicators such as T-cell subsets (CD3, CD4 and CD45) were monitored.@*RESULTS@#COVID-19 patients in the treatment group, compared to the control group, had a shorter negative conversion time of fecal nucleic acid (4 vs. 9 days, P = 0.047) and a shorter interval of negative conversion of pharyngeal-fecal nucleic acid (0 vs. 2 days, P = 0.042). The level of CD3@*CONCLUSION@#Significant reductions in the negative conversion time of fecal nucleic acid and the duration of negative conversion of pharyngeal-fecal nucleic acid were identified in the treatment group as compared to the control group, illustrating the potential therapeutic benefits of using TRQC as a complement to conventional medicine in patients with mild and moderate COVID-19. The underlying mechanism may be related to the improved levels of the immune indicator CD3

Impact of COVID-19 Pandemic on Ibero-American Urology Residents: Perspective of American Confederation of Urology (CAU)

ABSTRACT Introduction: Since World Health Organization (WHO) declared COVID-19 as a global pandemic, urology services have developed strategies to prioritize and not to differ urgent and oncological patient's medical attention, in order to optimize resources and decrease infection probability among staff and patients. This unprecedented situation has generated a decrease in assistance and academic activities in most medical residences. The aim of this manuscript is to evaluate the impact of this health crisis on training programs through a survey addressed to urology medical residents. Materials and Methods: Cross sectional designed study, with multiple-choice non validated survey answered online by residents. Questionnaire was developed through the CAU EDUCACION platform. Results: A total of 148 responses from 18 countries coming from Latin America and Spain answering the survey. Of total, 82% answered that the activity of their urology department was significantly reduced, attending only urgent surgical pathologies, 15 % that, the urology activity has been closed completely and the staff was assigned to COVID-19 patients care, 3% continue with the regular clinic activity. Likewise, 75% stated that their surgical training has been completely affected, 93% receive urological information through tools such as Skype, ZOOM meeting, Cisco Webex, being Webinar modality the most used. Despite technological boom, 65% answered their academic training has been partially or completely affected. Most of the surveyed residents consider that period of residence should be extended to retrieve the educational targets. Conclusion: This unprecedented reality is negatively impacting the heterogeneous residency programs that American Confederation of Urology (CAU) nucleates. It is necessary to continue with technological innovation and allocate time and resources to easily generate accessible tools to favor the training of future urologists.

COVID-19: Measures to prevent hospital contagion. what do urologists need to know?

ABSTRACT A new outbreak of respiratory infection caused by the novel coronavirus in late December 2019 in China caused standards of medical care to change not only for related areas but for the entire healthcare system, and when the WHO declared COVID-19 a pandemic new strategies of patient care had to be defined initially to optimize resources to confront the pandemic and then to protect healthcare personnel. As urologists, we must be involved in these new standards, since without an effective vaccine the risk of contagion is high; thus, the purpose of this review is to have orientation on the measures urologists should take in their everyday clinical practice.

Treatment and research lines for the patient with COVID-19. What do we have and where are we going?

ABSTRACT Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents the most significant global public health crisis of this generation. From the beginning of the pandemic, several publications and on-line resources about different treatment lines have been done, and development effort in response to the COVID-19 pandemic to investigate potential therapies is unprecedented. Unfortunately, until now, there is not enough evidence to recommend any specific anti-COVID19 treatment. Randomized clinical trials and high-quality evidence, even in the middle of a pandemic, are needed. We provide a review of the latest published literature on the therapeutic strategies and current investigational lines for SARS-CoV-2.

Exploring Urological Experience in the COVID-19 Outbreak: American Confederation of Urology (CAU) Survey

ABSTRACT Purpose: To explore the current situation faced by Latin American urology departments during the COVID-19 Outbreak in terms of knowledge, actions, prioritization of urology practices, and implementation of internal clinical management protocols for inpatients and outpatients. Material and Methods: A non-validated, structured, self-administered, electronic survey with 35 closed multiple choice questions was conducted in Spanish, Portuguese, Italian, and English and Deutsch versions from April 1st to April 30th, 2020. The survey was distributed through social networks and the official American Confederation of Urology (CAU) website. It was anonymous, mainly addressed to Latin American urologists and urology residents. It included 35 questions exploring different aspects: 1) Personal Protective Equipment (PPE) and internal management protocols for healthcare providers; 2) Priority surgeries and urological urgencies and 3) Inpatient and outpatient care. Results: Of 864 surveys received, 846 had at least 70% valid responses and were included in the statistical analyses. Surveys corresponded to South America in 62% of the cases, Central America and North America in 29.7%. 12.7% were residents. Regarding to PPE and internal management protocols, 88% confirmed the implementation of specific protocols and 45.4% have not received training to perform a safe clinical practice; only 2.3% reported being infected with COVID-19. 60.9% attended urgent surgeries. The following major uro-oncologic surgeries were reported as high priority: Radical Nephrectomy (RN) 58.4%, and Radical Cystectomy (RC) 57.3%. When we associate the capacity of hospitalization (urologic beds available) and percentage of high-priority surgery performed, we observed that centers with fewer urological beds (10-20) compared to centers with more urological beds (31-40) performed more frequently major urologic cancer surgeries: RN 54.5% vs 60.8% (p=0.0003), RC 53.1% vs 64.9% (p=0.005) respectively. Conclusions: At the time of writing (May 13th 2020) our data represents a snapshot of COVID-19 outbreak in Latin American urological practices. Our findings have practical implications and should be contextualized considering many factors related to patients and urological care: The variability of health care scenarios, institutional capacity, heterogeneity and burden of urologic disease, impact of surgical indications and decision making when prioritizing and scheduling surgeries in times of COVID-19 pandemic.

Emergency Surgery in Urology during the COVID-19 Pandemic

ABSTRACT Proposal: To highlight the indications for emergency surgery during the 2019 Coronavirus pandemic (COVID-19) that support recommendations published in midMarch 2020 by the American Confederation of Urology on its website. Materials and Methods: A bibliographic search was conducted in PubMed and Cochrane Library to perform a non-systematic review, using key words: Urology, Emergency and COVID-19, to determine recommendations for patients that should receive emergency care due to urological pathology. Results: The main recommendations and protocols in the management of different urological emergencies during the COVID-19 pandemic are reviewed and discussed. Conclusions: We are living a new condition with the COVID-19 pandemic, which obliges urologists to conform to the guidelines that appear on a daily basis formulated by multidisciplinary surgical groups to manage urological emergencies. Consequently, in this time of health crisis, we must adapt to the resources available, implementing all biosecurity measures to protect patients and all health personnel who are in charge of patient management.

Implementation and strategies to ensure adequate coordination within a Urology Department during the COVID-19 pandemic

ABSTRACT Purpose: to provide an update on the management of a Urology Department during the COVID-19 outbreak, suggesting strategies to optimize assistance to the patients, to implement telemedicine and triage protocols, to define pathways for hospital access, to reduce risk of contagious inside the hospital and to determine the role of residents during the pandemic. Materials and Methods: In May the 6th 2020 we performed a review of the literature through online search engines (PubMed, Web of Science and Science Direct). We looked at recommendations provided by the EAU and ERUS regarding the management of urological patients during the COVID-19 pandemic. The main aspects of interest were: the definition of deferrable and non-deferrable procedures, Personal Protective Equipment (PPE) and hospital protocols for health care providers, triage, hospitalization and surgery, post-operative care training and residents' activity. A narrative summary of guidelines and current literature for each point of interest was performed. Conclusion: In the actual Covid-19 scenario, while the number of positive patients globally keep on rising, it is fundamental to embrace a new way to deliver healthcare and to overcome challenges of physical distancing and self-isolation. The use of appropriate PPE, definite pathways to access the hospital, the implementation of telemedicine protocols can represent effective strategies to carry on delivering healthcare.

Impact of COVID-19 in Female Urology

ABSTRACT This review discusses the impact of COVID-19 in Female Urology, revises the most important disorders in this field and how their diagnosis and treatment may be modified due to the current pandemic. The text also discusses new options such as telemedicine and what clinical situations within Female Urology should be of utmost importance for the urologist to be careful about. We also discuss how surgeries are being postponed are resumed according to the local scenario.

The Psychosocial Impact of COVID-19 on health care workers

ABSTRACT At the end of 2019, a disease was identified, COVID-19, caused by a new type of easy and fast spreading virus, which led to the beginning of a worldwide pandemic. One of the most exposed groups to the virus and its psychosocial consequences is the healthcare workers, due to their implication in caring for affected people. Health workers are exposed to a fast and unpredictable situation that requires more human resources and materials than usual, however, the lack of means on account to this situation entails an increased probability of suffering different consequences, including the burnout syndrome, to which, generally, this professionals are already vulnerable. In addition, quarantine is added as a measure to prevent the spread of the pandemic, which is another handicap for healthcare workers. Quarantine means these professionals are more likely to suffer the foreseeable psychological consequences in general population, specifically, it has been observed that Post-Traumatic Stress Disorder (PTSD) is more prevalent, because of the stress load of the situation experienced.

Impact of Covid-19 on the urology service in United States: perspectives and strategies to face a pandemic

ABSTRACT Over the course of several weeks following the first diagnosed case of COVID-19 In the U.S., the virus rapidly spread across our communities. It became evident that the pandemic was going to place a severe strain on all components of the U.S. healthcare system, and we needed to adapt our daily practices, training and education. In the present paper we discuss four pillars to face a pandemic: surgical and outpatients service, tele-medicine and tele-education. In the face of unprecedented risks in providing adequate health care to our patients during this current, evolving public health crisis of COVID-19, alternative patient management tools such as telemedicine services, allow clinicians to maintain necessary patient rapport with their healthcare provider when required. As a subspecialty, urology should take full advantage of telehealth and teleeducation at this juncture. As tele-urology and tele-education can obviate the potential drawbacks of "social distancing" as it pertains to healthcare, the platform can also reduce the risk of COVID-19 spread, without compromising quality urological care and educational efforts. Telehealth can bring urologists and their patients together, perhaps closer than ever.

Social media influence in the COVID-19 Pandemic

ABSTRACT Never before in human history has it been possible to communicate so quickly during a pandemic, social media platforms have been a key piece for the dissemination of information; however, there are multiple advantages and disadvantages that must be considered. Responsible use of these tools can help quickly disseminate important new information, relevant new scientific findings, share diagnostic, treatment, and followup protocols, as well as compare different approaches globally, removing geographic boundaries for the first time in history. In order to use these tools in a responsible and useful way, it is recommended to follow some basic guidelines when sharing information on social networks in the COVID-19 era. In this paper, we summarize the most relevant information on the influence, and advantages, and disadvantages of the use of social networks during the COVID-19 pandemic.

SARS-CoV-2 diagnostic testing alternatives for Latin America / Alternativas diagnósticas para SARS-CoV-2 para América Latina

Abstract In the past four months SARS-CoV-2 has reached most countries in the world. Public health strategies based on widespread testing and proper isolation of positive cases have shown to be helpful to reduce local transmission of SARS-CoV-2. Confirmatory tests, that identify viral RNA, and screening serological tests that identify viral antigens or host antibodies against viral proteins are part of the tools that nations can use to fight infectious disease epidemics. Understanding how each test works can provide insights about their test characteristics and how they can be used for different clinical and public health goals. Testing is a key strategy to reduce viral transmission, not only for this epidemic, but also for others to come.

Resumen En los últimos cuatro meses, el virus SARS-CoV-2 ha llegado a la mayoría de países en el mundo. Las estrategias de salud pública basadas en la realización masiva de pruebas diagnósticas y el aislamiento focalizado de casos positivos han demostrado ser útiles para la reducción de la transmisión de SARS-CoV-2. Las pruebas confirmatorias, que identifican el ARN viral, y las pruebas serológicas que identifican antígenos virales o anticuerpos contra las proteínas virales del huésped son herramientas que las naciones pueden usar para combatir las epidemias producidas por agentes infecciosos. El comprender cómo funcionan estas pruebas puede ayudar a entender sus características y cómo pueden ser usadas para diferentes objetivos clínicos y de salud pública. Las pruebas diagnósticas son herramientas clave para reducir la transmisión viral, no solo en esta epidemia, sino para otras por venir.

The Introduction Of Clinical Practice Guideline For The Management Of Suspected Appendicitis In Female Patients May Influence Computed Tomography Usage

Introduction-Concerns about the radiation exposure have led to decrease in use of computed tomography (CT) in appendicitis, with increased reliance on the ultrasound. Females with appendicitis should be risk stratied using the combination of the clinical signs and symptoms, white blood cell count (WBCs), and ultrasound in order to show further evaluation and management.Material and Methods-We prospectively evaluated the clinical guideline in female patients with suspected . Patients were risk-appendicitisstratied based on the history, physical examination ndings, and laboratory results. Imaging was ordered selectively based on the risk category, with ultrasound as initial imaging modality. Computed tomography was ordered if US was indeterminate or negative.Results-One hundred and twenty patients were involved in the study with 49 patients having had appendicectomies for appendicitis while 71 were not diagnosed with apendicititis. CTusage was less in the post guideline implementation. There was not much difference between the sensitivity and the specicity of Ct and USG ndings.Conclusion-We concluded that hospitals with the high CTusage rates for appendicitis may reduce their CTusage to be reliable with national average & clinical practice guidelines.

Performance of diagnostic tests for pulmonary tuberculosis in indigenous populations in Brazil: the contribution of Rapid Molecular Testing / Desempenho de testes para o diagnóstico de tuberculose pulmonar em populações indígenas no Brasil: a contribuição do Teste Rápido Molecular

ABSTRACT Objective: To evaluate the accuracy of rapid molecular testing as a diagnostic tool and estimate the incidence of smear-positive pulmonary tuberculosis among the indigenous population. Methods: This is an epidemiological study based on secondary data. We calculated the incidence of smear-positive pulmonary tuberculosis between January 1st, 2011 and December 31, 2016, and the performance of bacilloscopy and rapid molecular testing in diagnosing pulmonary tuberculosis compared to sputum culture (standard test). Results: We included 4,048 cases of indigenous people with respiratory symptoms who provided sputum samples for analysis. Among them, 3.7%, 6.7%, and 3.7% had positive results for bacilloscopy, sputum culture, and rapid molecular testing, respectively. The mean incidence of pulmonary tuberculosis was 269.3/100 thousand inhabitants. Rapid molecular testing had 93.1% sensitivity and 98.2% specificity, compared to sputum culture. Bacilloscopy showed 55.1% sensitivity and 99.6% specificity. Conclusions: Rapid molecular testing can be useful in remote areas with limited resources and a high incidence of tuberculosis, such as indigenous villages in rural regions of Brazil. In addition, the main advantages of rapid molecular testing are its easy handling, fast results, and the possibility of detecting rifampicin resistance. Together, these attributes enable the early start of treatment, contributing to reduce the transmission in communities recognized as vulnerable to infection and disease.

RESUMO Objetivo: Avaliar a acurácia do teste rápido molecular como ferramenta diagnóstica e estimar a incidência de casos pulmonares positivos entre a população indígena. Métodos: Estudo epidemiológico baseado em dados secundários. Foi calculada a incidência de casos de tuberculose pulmonar positiva entre 1° de janeiro de 2011 e 31 de dezembro de 2016, e o desempenho da baciloscopia e do teste rápido molecular no diagnóstico de tuberculose pulmonar, em comparação à cultura de escarro (teste padrão). Resultados: Foram incluídos 4.048 casos de indígenas considerados sintomáticos respiratórios, que forneceram amostras de escarro para análise. Destes, 3,7%, 6,7% e 3,7% apresentaram resultados positivos para baciloscopia, cultura e teste rápido molecular, respectivamente. A incidência média de tuberculose pulmonar foi de 269,3/100 mil habitantes. A sensibilidade do teste rápido molecular, em relação à cultura, foi 93,1% e a especificidade foi 98,2%. A baciloscopia apresentou sensibilidade 55,1% e especificidade 99,6%. Conclusões: O teste rápido molecular pode ser útil em áreas remotas, com recursos limitados e incidência de tuberculose elevada, como as aldeias indígenas nas áreas rurais do país. Ademais, o teste rápido molecular apresenta como principais vantagens o fácil manuseio, os resultados rápidos e a possibilidade de identificar a resistência à rifampicina. Em conjunto, esses atributos facilitam o início do tratamento precoce, contribuindo para reduzir a transmissão em comunidades reconhecidamente vulneráveis à infecção e à doença.