Association between lung involvement, risk factors and outcomes in COVID-19 patients treated at a reference hospital in Paraíba / Associação entre comprometimento pulmonar, fatores de risco e desfechos em pacientes com covid-19 atendidos em hospital de referência na Paraíba

Objetivo: Avaliar a associação entre o grau de comprometimento pulmonar (CP) na TC de tórax dos pacientes com COVID-19 com fatores de risco e desfechos. Métodos: Estudo observacional e retrospectivo com 284 pacientes com COVID-19. Avaliou-se idade, sexo, quadro clínico, saturação na admissão, fatores de risco, tempo de sinto-mas, porcentagem de CP, tempo de internação em enfermaria, UTI e de IOT, e óbito. Foram divididos três grupos conforme o grau de CP. Resultados: 167 pacientes possuíam comprometimento <25%; 80, 25-50%; e 37, >50%. O grupo com maior comprometimento pulmonar possuía maior idade, mais homens e maior presença de tosse, dispneia e alguma comorbidade. Também apresentou menor saturação à admissão, maior necessidade de IOT, in-ternação em enfermaria ou UTI e maior mortalidade. O CP, IOT e idade foram fatores preditores de mortalidade.Conclusões: O grau de CP aparenta estar significativamente associado a alguns parâmetros clínicos, necessidade de internação, intubação e óbito (AU)

Objective: To assess the association between the degree of lung involvement (LI) on chest CT scans of COVID-19 patients, risk factors and outcomes. Methods: Observational and retrospective study of 284 COVID-19 patients. Age, sex, clinical presentation, oxygen saturation on admission, risk factors, time after symptom onset, percentage of LI, length of stay in ward and ICU, duration of ETI, and death were assessed. 3 groups were created according to the LI. Results: 167 patients had an involvement of <25%; 80, 25-50%; and 37, >50%. The group with gre-ater LI was older, had more males and a higher incidence of cough, dyspnea and some comorbidity. Moreover, the group with greater LI had lower saturation on admission, more ETI, more admissions to the ward or ICU, and higher mortality. LI, ETI and age were predictors of mortality. Conclusion: The degree of LI appears to be significantly associated with some clinical parameters, need for hospitalization, intubation, and death (AU)

First-attempt intubation success and complications in patients with COVID-19 undergoing emergency intubation.

Objectives: To evaluate the first-attempt success rates and complications of endotracheal intubation of coronavirus disease 2019 (COVID-19) patients by emergency physicians. Methods: This prospective observational study was conducted from March 24, 2020 through May 28, 2020 at the emergency department (ED) of an urban, academic trauma center. We enrolled patients consecutively admitted to the ED with suspected or confirmed COVID-19 submitted to endotracheal intubation. No patients were excluded. The primary outcome was first-attempt intubation success, defined as successful endotracheal tube placement with the first device passed (endotracheal tube) during the first laryngoscope insertion confirmed with capnography. Secondary outcomes included the following complications: hypotension, hypoxemia, aspiration, and esophageal intubation. Results: A total of 112 patients with confirmed or suspected COVID-19 were enrolled. Median age was 61 years and 61 patients (54%) were men. The primary outcome, first-attempt intubation success, was achieved in 82% of patients. Among the 20 patients who were not intubated on the first attempt, 75% were intubated on the second attempt and 20% on the third attempt; cricothyrotomy was performed in 1 patient. Forty-eight (42%) patients were hypotensive and required norepinephrine immediately post-intubation. Fifty-eight (52%) experienced peri-intubation hypoxemia, and 2 patients (2%) had cardiac arrest. There were no cases of failed intubation resulting in death up to 24 hours after the procedure. Conclusion: Emergency physicians achieve high success rates when intubating COVID19 patients, although complications are frequent. However, these findings should be considered provisional until their generalizability is assessed in their institutions and setting.

Impact analysis of COVID-19 pandemic on the electricity demand, frequency control and electromechanical oscillation modes of the Brazilian Interconnected Power System using low voltage WAMS data

COVID-19 pandemic presented unique features among the range of threats encountered over the last century. Its impact echoes throughout the world affecting societies and their patterns of behavior, hence affecting the usage of electricity and the operation of power systems. This paper provides an analysis of the impact of COVID-19 Pandemic on the electricity demand, frequency control and electromechanical oscillation modes of the Brazilian Interconnected Power System (BIPS), taking into account public data disclosed by the Brazilian Independent System Operator (BISO) and data acquired through the MedFasee Project, the Brazilian low voltage wide area monitoring system (WAMS) leaded by the Federal University of Santa Catarina. Main results indicate that the BISO has been successful on controlling the system frequency and the main electromechanical interarea modes, despite the occurrence of a significant demand reduction in the BIPS in a certain period of time due to the COVID-19 pandemic. The total time of operation in underfrequency or overfrequency registered during the months with most demand reduction is at most 20% lower than the maximum time registered in the other months studied. The damping of the modes observed in the months with demand reduction has not reached values lower than 10% and the frequencies of oscillation have varied in a range of 0.05Hz, in agreement to what has been observed in other months.

"H" is not for hydroxychloroquine-"H" is for heparin: lack of efficacy of hydroxychloroquine and the role of heparin in COVID-19-preliminary data of a prospective and interventional study from Brazil.

BACKGROUND: COVID-19 pandemic is the major public health problem in the world actually. It's associated with high morbidity and mortality. To date, no therapeutic measure has a curative potential. Hydroxychloroquine (HCQ) is a drug with immunomodulatory properties that has demonstrated antiviral efficacy in in vitro experiments, with conflicting results in in vivo studies. METHODS: A single-center, prospective and interventional study, that evaluates the impact on mortality of the HCQ use in 154 patients hospitalized with COVID-19 in a Brazilian public hospital. The study also aims to determine prognostic factors that predict mortality, ICU admission and endotracheal intubation in this population. RESULTS: 154 patients diagnosed with COVID-19 confirmed by RT-PCR and hospitalized were included. There was a male predominance (87/154, 56.5%), median age 60 years and 88% (136/154) had comorbidities. Among these, 76% (117/154) were admitted to the ICU and 29.2% (45/154) experienced EOT. The OMR was 51.3% (79/154). There was no difference in mortality between patients treated with HCQ (N = 95) and non-HCQ (N = 59) (44.1% × 55.8%, p = 0.758). In univariate analysis, age ≥ 60 years (HR 3.62, p < 0.001), need for mechanical ventilation (HR 2.17, p = 0.001), ≥ 2 comorbidities (HR 1.83, p = 0.049), SAH (HR: 1.56, p = 0.054) were predictors of mortality, as well as no use of prophylactic or therapeutic heparin (HR 3.60, p = 0.02). Multivariate analysis identified admission to the ICU (HR 8.98, p = 0.002) and advanced age (HR 3.37, p < 0.01) as independent predictors of mortality, although, use of heparin (HR 0.25, p = 0.001) was independently associated with a favorable outcome. CONCLUSION: This study confirmed the absence of a benefit associated with the use of HCQ in Brazilian patients hospitalized with COVID-19. However, prophylactic or therapeutic heparin was an independent predictor for reducing mortality in this population.

COVID-19: comments on official social network of the Ministry of Health about action Brazil Count on Me.

OBJECTIVE: To unveil the content of comments in official posts calling from the Ministry of Helth, calling for health professionals to confront COVID-19. METHOD: Qualitative study, carried out with 2823 comments, obtained from the virtual access to the Ministry of Health's social networks on Facebook, Instagram and Twitter. For textual corpus processing, used or software Interface R analyzes Multidimensional Texts and Questionnaires and performs a multivariate analysis by Descending Hierarchical Classification. RESULTS: Five categories were included: "difficulties in the training stages", "aspects involved in the summons", "working conditions without facing the pandemic", "mandatory capacity x possible summons", "visibility and valorization of dentistry in combating the pandemic" COVID-19". CONCLUSION: Comments contemplated professionals or access to training, remuneration and working conditions, mandatory training, possibility of calling for action on the front line without fighting COVID-19 and claiming greater appreciation of dentistry.

SARS-CoV-2 in Human Sewage and River Water from a Remote and Vulnerable Area as a Surveillance Tool in Brazil.

In the present study, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was monitored in environmental samples from rural and vulnerable areas (a presidio, worker accommodation units, and river waters upstream and downstream of a rural community) from Minas Gerais State region, Southern Brazil, in August 2020. The sampling was performed prior to official declaration of the coronavirus disease (COVID-19) cases in those sites. SARS-CoV-2 RNA was detected in the presidio and workers accommodation units (3.0 × 104 virus genome copies (GC)/mL and 4.3 × 104 GC/mL of sewage, respectively). While SARS-CoV-2 was not detected in the river water upstream of the rural community, SARS-CoV-2 RNA was detected in downstream river waters (1.1 × 102 SARS-CoV-2 GC/mL). The results obtained in this study highlight the utility of SARS-CoV-2 monitoring in wastewater and human sewage as a non-invasive early warning tool to support health surveillance in vulnerable and remote areas, particularly in development countries.

Outcomes and Prognostic Factors in a Large Cohort of Hospitalized Cancer Patients With COVID-19.

PURPOSE: Patients with cancer are at increased risk for unfavorable outcomes from COVID-19. Knowledge about the outcome determinants of severe acute respiratory syndrome coronavirus 2 infection in this population is essential for risk stratification and definition of appropriate management. Our objective was to evaluate prognostic factors for all-cause mortality in patients diagnosed with both cancer and COVID-19. METHODS: All consecutive patients with cancer hospitalized at our institution with COVID-19 were included. Electronic medical records were reviewed for clinical and laboratory characteristics potentially associated with outcomes. RESULTS: Five hundred seventy-six consecutive patients with cancer and COVID-19 were included in the present study. An overall in-hospital mortality rate of 49.3% was demonstrated. Clinical factors associated with increased risk of death because of COVID-19 were age over 65 years, Eastern Cooperative Oncology Group performance status > 0 zero, best supportive care, primary lung cancer, and the presence of lung metastases. Laboratory findings associated with a higher risk of unfavorable outcomes were neutrophilia, lymphopenia, and elevated levels of D-dimer, creatinine, C-reactive protein, or AST. CONCLUSION: A high mortality rate in patients with cancer who were diagnosed with COVID-19 was demonstrated in the present study, emphasizing the need for close surveillance in this group of patients, especially in those with unfavorable prognostic characteristics.

How to manage lymphoid malignancies during novel 2019 coronavirus (CoVid-19) outbreak: a Brazilian task force recommendation

ABSTRACT: The novel Coronavirus (CoVid-19) outbreak is now consider a world pandemic, affecting more than 1,300,000 people worldwide. Cancer patients are in risk for severe disease, including a higher risk of intensive care unit (ICU) admission, need for invasive ventilation or death. Management of patients with lymphoid malignancies can be challenging during the outbreak, due to need of multiple hospital visits and admissions, immunosuppression and need for chemotherapy, radiotherapy and stem cell transplantation. In this article, we will focus on the practical management of patients with lymphoid malignancies during the COVID-19 pandemic, focusing on minimizing the risk for patients.

Estudos experimentais sobre COVID-19: panorama da produção científica mundial

Resumo Objetivo Descrever o panorama mundial da produção de estudos experimentais relacionados à COVID-19. Métodos Estudo descritivo, realizado em abril de 2020, a partir de busca pelos registros de ensaios clínicos, nos portais Clinical Trials e Registros Brasileiros de Ensaios Clínicos. A análise estatística foi descritiva. Resultados Dos 645 ensaios clínicos da amostra, houve predominância de 199 (30,9%) oriundos da Europa, 213 (33%) realizados por instituições hospitalares, 482 (74,7%) com objetivo direcionado ao tratamento. Quanto às intervenções pesquisadas, 394 (61,1%) foram sobre medicamentos;70 (10,8%) investigaram intervenções biológicas;45 (7,0%), intervenções com sangue e derivados;40 (6,2%), intervenções comportamentais;38 (5,9%), intervenções com equipamentos;31(4,8%), intervenções assistenciais/procedimentais;18 (2,8%), intervenções para diagnóstico e nove (1,4%), intervenções de suplementação dietética. Observou-se que, em 515 (79,8%) a população estudada foi composta por adultos e idosos, 635 (98,4%) investigaram ambos os sexos, o delineamento de 480 (74,4%) incluiu randomização, de 482 (74,7%) alocação paralela dos participantes e 373 (57,8%) não possuíu o cegamento. Conclusão Os estudos experimentais sobre a COVID-19 foram oriundos da Europa, realizados por hospitais, sobre o tratamento em adultos e idosos, com randomização, mas sem cegamento. Os achados podem direcionar a realização de estudos, para contemplarem as lacunas identificadas. Resumen Objetivo Describir el panorama mundial de la producción de estudios experimentales relacionados con la COVID-19. Métodos Estudio descriptivo, realizado en abril de 2020, a partir de la búsqueda de registros de ensayos clínicos en los portales Clinical Trials y Registros Brasileiros de Ensaios Clínicos. El análisis estadístico fue descriptivo. Resultados De los 645 ensayos clínicos de la muestra, hubo predominancia de 199 (30,9 %) oriundos de Europa, 213 (33 %) realizados por instituciones hospitalarias, 482 (74,7 %) con objetivo orientado al tratamiento. Respecto a las intervenciones investigadas, 394 (61,1 %) fueron sobre medicamentos;70 (10,8 %) investigaron intervenciones biológicas;45 (7,0 %), intervenciones con sangre y derivados;40 (6,2 %), intervenciones de comportamiento;38 (5,9 %), intervenciones con equipos;31 (4,8 %), intervenciones asistenciales/procedimentales;18 (2,8 %), intervenciones para diagnóstico, y 9 (1,4 %), intervenciones de suplementos dietéticos. Se observó que en 515 ensayos (79,8 %) la población estudiada fue compuesta por adultos y ancianos, en 635 (98,4 %) se investigaron ambos sexos, el diseño de 480 (74,4 %) incluyó aleatorización, de 482 (74,7 %) asignación paralela de los participantes y 373 (57,8 %) no poseían cegamiento. Conclusión Los estudios experimentales sobre la COVID-19 fueron oriundos de Europa, realizados por hospitales, sobre el tratamiento en adultos y ancianos, con aleatorización, pero sin cegamiento. Los resultados pueden orientar la realización de estudios que contemplen los vacíos identificados. Objective To describe the world panorama of the production of experimental studies on COVID-19. Methods Descriptive study conducted in April 2020, based on a search for clinical trial records on the Clinical Trials and Brazilian Clinical Trials Records portals. The statistical analysis was descriptive. Results Of the 645 clinical trials in the sample, there was a predominance of 199 (30.9%) from Europe, 213 (33%) performed by hospital institutions, 482 (74.7%) with the objective aimed at the treatment. As for interventions surveyed, 394 (61.1%) were on drugs;70 (10.8%) investigated biological interventions;45 (7.0%) interventions with blood and blood products;40 (6.2%), behavioral interventions;38 (5.9%), interventions with equipment;31 (4.8%), care/procedural interventions;18 (2.8%), diagnostic interventions and nine (1.4%) dietary supplementation interventions. The studied population was composed of adult and elderly subjects in 515 (79.8%) studies, 635 (98.4%) investigated both sexes, the design of 480 (74.4%) included randomization, of 482 (74.7%) parallel allocation of participants and 373 (57.8%) did not have blinding. Conclusion The experimental studies on COVID-19 originated from Europe, were conducted by hospitals, on treatment in adult and elderly subjects, with randomization but without blinding. The findings may direct the performance of studies addressing the identified gaps.

Experimental studies on COVID-19: overview of the world scientific production

Resumo Objetivo Descrever o panorama mundial da produção de estudos experimentais relacionados à COVID-19. Métodos Estudo descritivo, realizado em abril de 2020, a partir de busca pelos registros de ensaios clínicos, nos portais Clinical Trials e Registros Brasileiros de Ensaios Clínicos. A análise estatística foi descritiva. Resultados Dos 645 ensaios clínicos da amostra, houve predominância de 199 (30,9%) oriundos da Europa, 213 (33%) realizados por instituições hospitalares, 482 (74,7%) com objetivo direcionado ao tratamento. Quanto às intervenções pesquisadas, 394 (61,1%) foram sobre medicamentos;70 (10,8%) investigaram intervenções biológicas;45 (7,0%), intervenções com sangue e derivados;40 (6,2%), intervenções comportamentais;38 (5,9%), intervenções com equipamentos;31(4,8%), intervenções assistenciais/procedimentais;18 (2,8%), intervenções para diagnóstico e nove (1,4%), intervenções de suplementação dietética. Observou-se que, em 515 (79,8%) a população estudada foi composta por adultos e idosos, 635 (98,4%) investigaram ambos os sexos, o delineamento de 480 (74,4%) incluiu randomização, de 482 (74,7%) alocação paralela dos participantes e 373 (57,8%) não possuíu o cegamento. Conclusão Os estudos experimentais sobre a COVID-19 foram oriundos da Europa, realizados por hospitais, sobre o tratamento em adultos e idosos, com randomização, mas sem cegamento. Os achados podem direcionar a realização de estudos, para contemplarem as lacunas identificadas. Resumen Objetivo Describir el panorama mundial de la producción de estudios experimentales relacionados con la COVID-19. Métodos Estudio descriptivo, realizado en abril de 2020, a partir de la búsqueda de registros de ensayos clínicos en los portales Clinical Trials y Registros Brasileiros de Ensaios Clínicos. El análisis estadístico fue descriptivo. Resultados De los 645 ensayos clínicos de la muestra, hubo predominancia de 199 (30,9 %) oriundos de Europa, 213 (33 %) realizados por instituciones hospitalarias, 482 (74,7 %) con objetivo orientado al tratamiento. Respecto a las intervenciones investigadas, 394 (61,1 %) fueron sobre medicamentos;70 (10,8 %) investigaron intervenciones biológicas;45 (7,0 %), intervenciones con sangre y derivados;40 (6,2 %), intervenciones de comportamiento;38 (5,9 %), intervenciones con equipos;31 (4,8 %), intervenciones asistenciales/procedimentales;18 (2,8 %), intervenciones para diagnóstico, y 9 (1,4 %), intervenciones de suplementos dietéticos. Se observó que en 515 ensayos (79,8 %) la población estudiada fue compuesta por adultos y ancianos, en 635 (98,4 %) se investigaron ambos sexos, el diseño de 480 (74,4 %) incluyó aleatorización, de 482 (74,7 %) asignación paralela de los participantes y 373 (57,8 %) no poseían cegamiento. Conclusión Los estudios experimentales sobre la COVID-19 fueron oriundos de Europa, realizados por hospitales, sobre el tratamiento en adultos y ancianos, con aleatorización, pero sin cegamiento. Los resultados pueden orientar la realización de estudios que contemplen los vacíos identificados. Objective To describe the world panorama of the production of experimental studies on COVID-19. Methods Descriptive study conducted in April 2020, based on a search for clinical trial records on the Clinical Trials and Brazilian Clinical Trials Records portals. The statistical analysis was descriptive. Results Of the 645 clinical trials in the sample, there was a predominance of 199 (30.9%) from Europe, 213 (33%) performed by hospital institutions, 482 (74.7%) with the objective aimed at the treatment. As for interventions surveyed, 394 (61.1%) were on drugs;70 (10.8%) investigated biological interventions;45 (7.0%) interventions with blood and blood products;40 (6.2%), behavioral interventions;38 (5.9%), interventions with equipment;31 (4.8%), care/procedural interventions;18 (2.8%), diagnostic interventions and nine (1.4%) dietary supplementation interventions. The studied population was composed of adult and elderly subjects in 515 (79.8%) studies, 635 (98.4%) investigated both sexes, the design of 480 (74.4%) included randomization, of 482 (74.7%) parallel allocation of participants and 373 (57.8%) did not have blinding. Conclusion The experimental studies on COVID-19 originated from Europe, were conducted by hospitals, on treatment in adult and elderly subjects, with randomization but without blinding. The findings may direct the performance of studies addressing the identified gaps.

Cancer and Cardiovascular Diseases during the COVID-19 Pandemic. / Câncer e Doenças Cardiovasculares na Pandemia de COVID-19.

The challenges that the COVID-19 pandemic cretead to the healthcare system have made it necessary to adapt routines and services, with the objectives of controlling the spread of the virus and preserving health. Safe and correct management of patients in risks groups, such as elderly patients, patients with cardiovascular diseases, and patients with cancer, has become even more important. Thus, cardio-oncology has gained a new dimension, with the aim of adapting to patients' needs during the pandemic by restructuring the system of care in a manner that offers quality and safety in healthcare.

O desafio imposto ao sistema de saúde pela pandemia da COVID-19 faz com que haja uma necessidade de readequações de rotinas e serviços de saúde, com os objetivos de controlar a disseminação do vírus e preservar a saúde. Torna-se ainda mais importante o manejo seguro e correto dos pacientes dos grupos de risco, como os pacientes idosos, os portadores de doenças cardiovasculares e os pacientes com câncer. Dessa forma, a cardio-oncologia ganha novo dimensionamento, no intuito de se adequar às necessidades dos pacientes diante de uma pandemia, reestruturando o sistema de atendimento de forma a oferecer qualidade e segurança na assistência à saúde.

How to manage lymphoid malignancies during novel 2019 coronavirus (CoVid-19) outbreak: a Brazilian task force recommendation.

The novel Coronavirus (CoVid-19) outbreak is now consider a world pandemic, affecting more than 1,300,000 people worldwide. Cancer patients are in risk for severe disease, including a higher risk of intensive care unit (ICU) admission, need for invasive ventilation or death. Management of patients with lymphoid malignancies can be challenging during the outbreak, due to need of multiple hospital visits and admissions, immunosuppression and need for chemotherapy, radiotherapy and stem cell transplantation. In this article, we will focus on the practical management of patients with lymphoid malignancies during the COVID-19 pandemic, focusing on minimizing the risk for patients.

Experimental studies on COVID-19: overview of the world scientific production Estudios experimentales sobre COVID-19: panorama de la producción científica mundial

Abstract Objective To describe the world panorama of the production of experimental studies on COVID-19. Methods Descriptive study conducted in April 2020, based on a search for clinical trial records on the Clinical Trials and Brazilian Clinical Trials Records portals. The statistical analysis was descriptive. Results Of the 645 clinical trials in the sample, there was a predominance of 199 (30.9%) from Europe, 213 (33%) performed by hospital institutions, 482 (74.7%) with the objective aimed at the treatment. As for interventions surveyed, 394 (61.1%) were on drugs;70 (10.8%) investigated biological interventions;45 (7.0%) interventions with blood and blood products;40 (6.2%), behavioral interventions;38 (5.9%), interventions with equipment;31 (4.8%), care/procedural interventions;18 (2.8%), diagnostic interventions and nine (1.4%) dietary supplementation interventions. The studied population was composed of adult and elderly subjects in 515 (79.8%) studies, 635 (98.4%) investigated both sexes, the design of 480 (74.4%) included randomization, of 482 (74.7%) parallel allocation of participants and 373 (57.8%) did not have blinding. Conclusion The experimental studies on COVID-19 originated from Europe, were conducted by hospitals, on treatment in adult and elderly subjects, with randomization but without blinding. The findings may direct the performance of studies addressing the identified gaps.

Information about COVID-19 for deaf people: an analysis of Youtube videos in Brazilian sign language.

OBJECTIVE: to analyze YouTube videos with information about COVID-19 in Brazilian sign language. METHODS: a cross-sectional study conducted with 402 videos from the YouTube sharing platform. Chi-square, Fisher's exact, Mann-Whitney and Spearman's correlation tests were used. RESULTS: the videos mainly covered COVID-19 prevention (20.6%). There was a positive correlation between video length and number of views (p<0.001). The length of more than 20 minutes was associated with narration only in BSL (p=0.37) and in BSL with audio (p<0.001), while videos with less than 20 minutes were associated with simultaneous narration in BSL, audio and subtitles. Those with narration only in BSL had a similar number of views to those narrated with subtitles and/or audio (p=0.998). CONCLUSION: the videos were mostly short and included COVID-19 prevention. The longer the video, the greater the number of views. Regardless the presentation of narrations, the videos had a similar number of views.