Quantification of SARS-CoV-2 in wastewater samples from hospitals treating COVID-19 patients during the first wave of the pandemic in Brazil.

The COVID-19 pandemic has caused a global health crisis, and wastewater-based epidemiology (WBE) has emerged as an important tool to assist public health decision-making. Recent studies have shown that the SARS-CoV-2 RNA concentration in wastewater samples is a reliable indicator of the severity of the pandemic for large populations. However, few studies have established a strong correlation between the number of infected people and the viral concentration in wastewater due to variations in viral shedding over time, viral decay, infiltration, and inflow. Herein we present the relationship between the number of COVID-19-positive patients and the viral concentration in wastewater samples from three different hospitals (A, B, and C) in the city of Belo Horizonte, Minas Gerais, Brazil. A positive and strong correlation between wastewater SARS-CoV-2 concentration and the number of confirmed cases was observed for Hospital B for both regions of the N gene (R = 0.89 and 0.77 for N1 and N2, respectively), while samples from Hospitals A and C showed low and moderate correlations, respectively. Even though the effects of viral decay and infiltration were minimized in our study, the variability of viral shedding throughout the infection period and feces dilution due to water usage for different activities in the hospitals could have affected the viral concentrations. These effects were prominent in Hospital A, which had the smallest sewershed population size, and where no correlation between the number of defecations from COVID-19 patients and viral concentration in wastewater was observed. Although we could not determine trends in the number of infected patients through SARS-CoV-2 concentrations in hospitals' wastewater samples, our results suggest that wastewater monitoring can be efficient for the detection of infected individuals at a local level, complementing clinical data.

Long-term monitoring of SARS-CoV-2 RNA in sewage samples from specific public places and STPs to track COVID-19 spread and identify potential hotspots.

Coronavirus pandemic started in March 2020 and since then has caused millions of deaths worldwide. Wastewater-based epidemiology (WBE) can be used as an epidemiological surveillance tool to track SARS-CoV-2 dissemination and provide warning of COVID-19 outbreaks. Considering that there are public places that could be potential hotspots of infected people that may reflect the local epidemiological situation, the presence of SARS-CoV-2 RNA was analyzed by RT-qPCR for approximately 16 months in sewage samples from five public places located in the metropolitan area of Belo Horizonte, MG, Brazil: the sewage treatment plant of Confins International Airport (AIR), the main interstate bus terminal (BUS), an upscale shopping centre (SHC1), a popular shopping centre (SHC2) and a university institute (UNI). The results were compared to those of the influent sewage of the two main sewage treatment plants of Belo Horizonte (STP1 and STP2). Viral monitoring in the STPs proved to be an useful regional surveillance tool, reflecting the trends of COVID-19 cases. However, the viral concentrations in the samples from the selected public places were generally much lower than those of the municipal STPs, which may be due to the behaviour of the non-infected or asymptomatic people, who are likely to visit these places relatively more than the symptomatic infected ones. Among these places, the AIR samples presented the highest viral concentrations and concentration peaks were observed previously to local outbreaks. Therefore, airport sewage monitoring can provide an indication of the regional epidemiological situation. For the other places, particularly the UNI, the results suggested a greater potential to detect the infection and trace cases especially among employees and regular attendees. Taken together, the results indicate that for a regular and permanent sentinel sewage surveillance the sewage from STPs, AIR and UNI could be monitored.

Prevalence and distribution of the main cardiovascular risk factors in Portugal--the AMALIA study.

OBJECTIVES: To assess the self-reported prevalence of the main risk factors for cardiovascular disease in Portugal and their distribution by gender, age-group and region. METHODS: We surveyed 38,893 individuals aged 40 or over, with a distribution by region and age-group proportional to the national population, through a questionnaire applied in the community in a household approach using the random route method, between October 2006 and February 2007. RESULTS: The self-reported prevalence of hypertension was 23.5%, increasing with age in both genders, but slightly higher in women (24.9% vs. 21.8%). The prevalence of hypercholesterolemia, based on respondents' statements, was 19.7%, and higher in women (20.7% vs. 18.6%), with the highest values in the 6th and 7th decades of life (23.9% and 23.6%). The prevalence of diabetes was 8.9%, increasing with age, and slightly higher in women (9.3% vs. 8.5%). The prevalence of smoking was 16.3%, decreasing with age, but always higher in men (25.3% vs. 8.8%). The prevalence of overweight/obesity (BMI equal to or higher than 25/30 kg/m2) was 51.6%, higher in those aged 60-69 (57.1%) and 70-79 years (56%). Most participants (65.3%) declared they never took part in structured physical activity, while 24% claimed to take exercise, on average for 11 years, and 10.6% stated that they no longer exercised. In the Azores, there was a higher prevalence of hypertension, hypercholesterolemia, diabetes and overweight/obesity, while the North and Algarve regions presented the lowest values of these risk factors, although they had higher levels of smoking. CONCLUSIONS: Based on respondents' statements, the AMALIA study found the following prevalences of the six risk factors under investigation, in descending order: sedentarism--76%; overweight/obesity--52%; hypertension--24%; hypercholesterolemia--20%; smoking--16%; and diabetes--9%. Notwithstanding possible under-reporting, the differences in prevalence of these major risk factors by gender and region could influence cardiovascular prevention strategies in Portugal.

Portuguese study of familial dilated cardiomyopathy: the FATIMA study.

Dilated cardiomyopathy (DCM) is a myocardial disease, characterized by ventricular dilatation and impaired systolic function, that in more than 30% of cases has a familial or genetic origin. Given its age-dependent penetrance, DCM frequently manifests in adults by signs or symptoms of heart failure, arrhythmias or sudden death. The predominant mode of inheritance is autosomal dominant, and in these cases mutations are identified in genes coding for cytoskeletal, sarcomeric or nuclear envelope proteins. To date, most studies aimed at molecular diagnosis of DCM have been in selected families, or in larger groups of patients, but screening for mutations in a limited number of genes. Consequently, the epidemiology of mutations in familial DCM remains unknown. There is thus a need for multicenter studies, involving screening for a wide range of mutations in several families and in cases of idiopathic DCM. The present article describes the methodology of a multicenter study, aimed at clinical and molecular characterization of familial DCM patients in the Portuguese population.

Self-reported cerebrovascular and heart diseases and cardiovascular risk factors in Portugal: the AMALIA study.

INTRODUCTION: There is a high prevalence of cardiovascular diseases and associated risk factors in the European population. In order to decrease their incidence, it is necessary to adopt healthy lifestyles and to apply appropriate therapeutic measures. There is therefore a need to inform, to motivate, and to evaluate attitudes and the effectiveness of the measures put into practice. OBJECTIVES: The study's main objective is to determine the prevalence of the main clinical manifestations of ischemic heart and cerebrovascular diseases, as well as cardiovascular risk factors, according to how they are perceived, and to evaluate consumption of health resources (such as hospitalization and medication). Secondary objectives are to characterize work absenteeism and the quality of life of those surveyed. STUDY DESIGN: Cross-sectional study, using a structured questionnaire in a direct interview. POPULATION: 38,000 individuals of both genders, aged 40 years or more. STUDY LOCATION: Randomly selected municipalities in seven Portuguese regions. MEASUREMENTS: The questionnaire covers sociodemographic variables, cardiovascular risk factors and diseases, use of medication and health care services (hospitalizations, medical appointments and diagnostic exams) for the treatment and follow-up of these pathologies, and also quality of life. QUALITY CONTROL: Morbidity data were validated through a pilot study involving 500 individuals from Lisbon, Porto and Leiria. These individuals were requested to fill in the questionnaire, and their blood pressure, total cholesterol level, weight, height, and hip and waist circumference are assessed. CONCLUSIONS: Despite its limitations, which include the evaluation of diseases based on self-reporting, the methodology adopted is justified by the advantage of ease of application, notably the need for fewer resources. A health examination survey-type study of this size would be difficult to implement. The evaluation of patients' perception regarding risk factors, cardiovascular diseases and quality of life may help to define the needs and priorities for cardiovascular disease prevention and treatment, which are essential in order to reduce their incidence.

Acute heart failure--intra-aortic balloon: a forgotten treatment.

Acute heart failure (AHF) is a serious clinical condition associated with high morbidity and mortality. The authors present the case of a 61-year-old man, with a past history of idiopathic dilated cardiomyopathy with heart failure, who came to the emergency room due to acute decompensation. During hospital stay he developed cardiogenic shock and inotropic support was initiated, followed by mechanical circulatory assistance with intra-aortic balloon counterpulsation, as a bridge to heart transplantation. The authors discuss theoretical considerations concerning subtypes and etiology of AHF, and indications for the use of mechanical support and heart transplantation.

Evidence of prolonged disturbances in the haemostatic, hemorheologic and inflammatory profiles in transmural myocardial infarction survivors.

Haemostatic, hemorheologic and inflammatory disturbances have been associated with acute coronary syndromes. Most knowledge is reported in cross sectional studies and are without time dependent evolution of these profiles. The aim of this study was to evaluate, during the first year, the evolution of the haemostatic, hemorheologic and inflammatory profiles determined at hospital discharge in survivors with transmural myocardial infarction (MI). Eighty eight (79 male; 9 female) mean age of 58 +/- 11 years, survivors of a transmural MI were prospectively studied at discharge, 6 months and one year after the event. Haemostatic (protein C, antithrombin III and plasminogen activator inhibitor 1), hemorheologic (blood fluidity and components) and inflammatory profiles (polymorphonuclear elastase and leukocyte count) were determined using standard methodology. The results of the study can be summarized as follows: (1) Protein C decreased (p < 0.05) over time while PAI-1 only varied significantly until 6(th) month. (2) Plasma viscosity and fibrinogen (p < 0.001) decrease over time, while erythrocyte aggregation (p < 0.001) and haematocrit increased. Whole blood viscosity did not vary. (3) Leukocyte decreased (p < 0.001) and elastase did not (4). Those patients with cardiovascular events (n = 7) had higher PAI-1 concentration (p < 0.05) and leukocyte count (p < 0.01), at discharge (5) Left ventricle ejection fraction correlated significantly with plasma viscosity (r = 0.35 p < 0.05). The results of this longitudinal study show dynamic modifications of the haemostatic, hemorheologic and inflammatory profiles during the first year of a transmural myocardial infarction. In addition, there are interrelations between them and the clinical profile that could help to explain the clinical evolution of this group of patients.

[Biohemorheologic factors and cardiovascular events curve in survivors of transmural acute myocardial infarct--24-month follow-up]. / Factores biohemorreológicos e a curva de eventos cardiovasculares em sobreviventes de enfarte agudo do miocárdio transmural--24 meses de seguimento clínico.

INTRODUCTION: Previous reports have shown several biohemorheological disturbances in acute myocardial infarction (AMI), either in the acute phase and after hospital discharge. There is no clearly established relationship between these parameters and the patients' clinical outcome. OBJECTIVE: To evaluate in transmural AMI survivors, a relationship between biohemorheological parameters and the cardiovascular events curve during a 24 month follow-up period. METHODS: Sixty-four consecutive patients (58.0 +/- 12.0, 59 men), transmural AMI survivors (30 anterior and 34 inferior) were included in the study. Clinical follow-up was 24 months (at 6, 12 and 24 months). The following cardiovascular events (CVE) were collected: cardiovascular death, stroke, AMI, unstable angina, embolism. We determined, at hospital discharge, these biohemorheological parameters: plasma viscosity, fibrinogen, PAI-1 inhibitor, leukocyte count, C protein (C Pt), erythrocyte aggregation (EA). For each parameter we determined the 25, 50 and 75 percentiles and other significant cut-off point, grouping patients according to these values. STATISTICS: Group t test, Kaplan-Meier survival curve (with the log rank test), and Cox logistic regression. RESULTS: (1) Patients with CVE (n = 19) during the 24 months of clinical follow-up had at hospital discharge higher leukocyte count (p < 0.001), lower C Pt (p < 0.01) and lower EA (p < 0.05). (2) The higher the percentile of the leukocyte count higher the probability for a CVE. Patients with leukocyte count above the 50 percentile had 6 times more CVE (p < 0.01); (3) The higher the C Pt lower the risk for a CVE. Patients with C PT lower than the 50 percentile had 9 times more risk for a CVE (p < 0.01), and those above the 75 percentile had no CVE (p < 0.01). (4) For the EA we identified a cutoff point (= 14.5), independent of the percentiles values. Patients with EA below 14.5 had six times more CVE. By multivariate analyses, we identified leukocyte count and C Pt as independent risk predictive factors (p < 0.05). CONCLUSION: In this group of transmural MI survivors a relationship was established between some biohemorheological (leukocyte count, C Pt, EA) and the CVE curve during 24 months of clinical follow-up.

Long-term prognostic value of the hemorheological profile in transmural myocardial infarction survivors: 60-month clinical follow-up.

UNLABELLED: Previous reports have shown several hemorheological and hemostatic abnormalities in acute coronary syndrome survivors. Some of these abnormalities were related to cardiovascular events during a 24-month follow-up. The aim of the present work is to evaluate, in transmural myocardial infarction survivors, the long-term (60 months) prognostic value of the biohemorheological profile determined at hospital discharge. Sixty-four patients (59 men), mean age of 58 +/- 12.0 years, transmural myocardial infarction survivors, were prospectively studied for 60 months (32.0 +/- 17 months, median 33 months). The following cardiovascular events (CVE) were analyzed: death, non-fatal infarction, unstable angina, and stroke. Twenty-nine patients had a CVE (nine died). The following parameters were determined at hospital discharge: plasma viscosity, whole blood viscosity, erythrocyte membrane fluidity, erythrocyte aggregation, protein C, plasminogen inhibitor type I (PAI-1), leukocyte count and elastase. The quartiles were determined for each parameter, grouping patients according to these values. STATISTICS: Group-t-test, Kaplan-Meier survival curve (with log rank test), and Cox logistic regression. RESULTS: 1) Leukocyte count (p < 0.01), protein C activity (p < 0.05) and erythrocyte membrane fluidity (p < 0.05) were predictors of the CVE curve; 2) The higher the value of the leukocyte count quartile, the higher the risk for a CVE (p < 0.05). Patients with a leukocyte count above the median had 4 times more risk for a CVE; 3) The lower the protein C activity, the higher the risk for a CVE. Those with protein C activity lower than the lowest quartile had double the risk; 4) The higher the membrane polarization value (membrane rigidity), the higher the risk of a CVE; 5) By multivariate analysis the 3 parameters were independent predictors of a CVE. CONCLUSION: In the present group of transmural myocardial infarction survivors a close relationship was established between hemorheologic, hemostatic and inflammatory factors and the cardiovascular events curve during long-term follow-up.