Higher volume resistance training enhances whole-body muscle hypertrophy in postmenopausal and older females: A secondary analysis of systematic review and meta-analysis of randomized clinical trials.

OBJECTIVE: This study explored the effects of resistance training (RT) volume on muscle hypertrophy in postmenopausal and older females. METHODS: This systematic review searched randomized controlled trials (RCTs) on PubMed/MEDLINE, Scopus, Web of Science, and SciELO. Studies with postmenopausal (age ≥ 45 y) or older females (age ≥ 60 y) that compared RT (whole-body) effects on muscle hypertrophy with a control group (CG) were included. Independently reviewers selected the studies, extracted data, and performed the risk of bias of RCTs (RoB2) and certainty of the evidence (GRADE). Whole-body lean mass, free-fat mass, and skeletal muscle mass measurements were included as muscle hypertrophy outcomes. A random-effects model standardized mean difference (Hedges'g), and 95% confidence interval (95%CI) were used for meta-analysis. RESULTS: Fourteen RCTs (overall RoB2: some concerns, except one study with high risk; GRADE: low evidence) were included. RT groups were divided into low (LVRT, total volume: 445.0 au) and high-volume (HVRT, total volume: 997.3 au). Most exercises performed were arm curl, bench press or chest press, calf raise, leg curl, leg extension, leg press or squat, seated row or lat pulldown, and triceps pushdown. Both groups experienced muscle hypertrophy (HVRT = ∼1.3 kg vs. LVRT = ∼0.9 kg) when compared to CG, although HVRT demonstrated moderate effects size (HVRT = 0.52, 95%CI: 0.27, 0.77) and LVRT demonstrated small effects size (LVRT = 0.34, 95%CI: 0.14, 0.53). CONCLUSIONS: Compared to CG, results suggest that the HVRT protocol elicits superior improvements in muscle hypertrophy outcomes than LVRT in postmenopausal and older females.

Patients hospitalized with active tuberculosis and Covid-19 coinfection: A matched case-control from the Brazilian Covid-19 Registry.

Although control of Covid-19 has improved, the virus continues to cause infections, such as tuberculosis, that is still endemic in many countries, representing a scenario of coinfection. To compare Covid-19 clinical manifestations and outcomes between patients with active tuberculosis infection and matched controls. This is a matched case-control study based on data from the Brazilian Covid-19 Registry, in hospitalized patients aged 18 or over with laboratory confirmed Covid-19 from March 1, 2020, to March 31, 2022. Cases were patients with tuberculosis and controls were Covid-19 patients without tuberculosis. From 13,636 Covid-19, 36 also had active tuberculosis (0.0026%). Pulmonary fibrosis (5.6% vs 0.0%), illicit drug abuse (30.6% vs 3.0%), alcoholism (33.3% vs 11.9%) and smoking (50.0% vs 9.7%) were more common among patients with tuberculosis. They also had a higher frequency of nausea and vomiting (25.0% vs 10.4%). There were no significant differences in in-hospital mortality, mechanical ventilation, need for dialysis and ICU stay. Patients with TB infection presented a higher frequency of pulmonary fibrosis, abuse of illicit drugs, alcoholism, current smoking, symptoms of nausea and vomiting. The outcomes were similar between them.

Clinical characteristics and outcomes in COVID-19 in kidney transplant recipients: a propensity score matched cohort study.

Patients with chronic kidney disease (CKD), especially those on dialysis or who have received a kidney transplant (KT), are considered more vulnerable to severe COVID-19. This susceptibility is attributed to advanced age, a higher frequency of comorbidities, and the chronic immunosuppressed state, which may exacerbate their susceptibility to severe outcomes. Therefore, our study aimed to compare the clinical characteristics and outcomes of COVID-19 in KT patients with those on chronic dialysis and non-CKD patients in a propensity score-matched cohort study. This multicentric retrospective cohort included adult COVID-19 laboratory-confirmed patients admitted from March/2020 to July/2022, from 43 Brazilian hospitals. The primary outcome was in-hospital mortality. Propensity score analysis matched KT recipients with controls - patients on chronic dialysis and those without CKD (within 0.25 standard deviations of the logit of the propensity score) - according to age, sex, number of comorbidities, and admission year. This study included 555 patients: 163 KT, 146 on chronic dialysis, and 249 non-CKD patients (median age 57 years, 55.2% women). With regards to clinical outcomes, chronic dialysis patients had a higher prevalence of acute heart failure, compared to KT recipients, furthermore, both groups presented high in-hospital mortality, 34.0 and 28.1%, for KT and chronic dialysis patients, respectively. When comparing KT and non-CKD patients, the first group had a higher incidence of in-hospital dialysis (26.4% vs. 8.8%, p < 0.001), septic shock (24.1% vs. 12.0%, p = 0.002), and mortality (32.5% vs. 23.3%, p = 0.039), in addition to longer time spent in the intensive care unit (ICU). In this study, chronic dialysis patients presented a higher prevalence of acute heart failure, compared to KT recipients, whereas KT patients had a higher frequency of complications than those without CKD, including septic shock, dialysis during hospitalization, and in-hospital mortality as well as longer time spent in the ICU.

AB2CO risk score for in-hospital mortality of COVID-19 patients admitted to intensive care units.

PURPOSE: To develop a mortality risk score for COVID-19 patients admitted to intensive care units (ICU), and to compare it with other existing scores. MATERIALS AND METHODS: This retrospective observational study included consecutive adult patients with laboratory-confirmed COVID-19 admitted to ICUs of 18 hospitals from nine Brazilian cities, from September 2021 to July 2022. Potential predictors were selected based on the literature review. Generalized Additive Models were used to examine outcomes and predictors. LASSO regression was used to derive the mortality score. RESULTS: From 558 patients, median age was 69 years (IQR 58-78), 56.3 % were men, 19.7 % required mechanical ventilation (MV), and 44.8 % died. The final model comprised six variables: age, pO2/FiO2, respiratory function (respiratory rate or if in MV), chronic obstructive pulmonary disease, and obesity. The AB2CO had an AUROC of 0.781 (95 % CI 0.744 to 0.819), good overall performance (Brier score = 0.191) and an excellent calibration (slope = 1.063, intercept = 0.015, p-value = 0.834). The model was compared with other scores and displayed better discrimination ability than the majority of them. CONCLUSIONS: The AB2CO score is a fast and easy tool to be used upon ICU admission.

Corrigendum: Assessment of risk scores to predict mortality of COVID-19 patients admitted to the intensive care unit.

[This corrects the article DOI: 10.3389/fmed.2023.1130218.].

Propulsive forces and muscle activation during gait: comparisons between premenopausal and postmenopausal midlife women.

OBJECTIVE: The aim of this study was to investigate whether there is a reduction in propulsive force during gait in postmenopausal women compared with premenopausal women. METHODS: Forty-four women (21 premenopausal and 23 postmenopausal women) aged 40 to 55 years were selected. The ability to reach peak propulsive forces was assessed during the step execution test. The test was performed at the usual speed on 2 nonconsecutive days, with two attempts per day, using a force platform. Four temporal parameters were defined and calculated: initiation phase, preparation phase, swing phase, and total time. Peak force (anteroposterior and vertical) and time to reach peak force were obtained in both preparation and swing phases. The rate of force development was defined as peak force divided by time to reach peak force. RESULTS: The postmenopausal women group presented a longer time in the preparation phase (540.6 ± 77 ms vs 482.5 ± 93 ms, P = 0.024) and consequently a longer total time in the step execution test (1,191 ± 106.4 ms vs 1,129 ± 114.3 ms, P = 0.045). There were differences between the groups for the rate of force development in the anteroposterior (postmenopausal women, 142.5 ± 38.1 N/s vs premenopausal women, 174.7 ± 70.5 N/s; P = 0.022) and vertical directions in the preparation phase (postmenopausal women, 102.7 ± 62.3 N/s vs premenopausal women, 145.3 ± 71 N/s; P = 0.012). No significant differences ( P > 0.05) were found in force, time to peak force, and rate of force development during the swing phase. In addition, there were no observed differences in surface electromyography of the medial and lateral gastrocnemius muscles during the preparation phase and swing phase of the step execution test between the two groups. CONCLUSIONS: Postmenopausal women exhibited lower ability to generate propulsive force rapidly (rates of force development) in both the anteroposterior and vertical directions during the preparation phase of gait compared with premenopausal women. This indicates that postmenopausal women experience a reduction in propulsive force during gait.

Clinical characteristics and outcomes of COVID-19 patients with preexisting dementia: a large multicenter propensity-matched Brazilian cohort study.

BACKGROUND: Although dementia has emerged as an important risk factor for severe SARS-CoV-2 infection, results on COVID-19-related complications and mortality are not consistent. We examined the clinical presentations and outcomes of COVID-19 in a multicentre cohort of in-hospital patients, comparing those with and without dementia. METHODS: This retrospective observational study comprises COVID-19 laboratory-confirmed patients aged ≥ 60 years admitted to 38 hospitals from 19 cities in Brazil. Data were obtained from electronic hospital records. A propensity score analysis was used to match patients with and without dementia (up to 3:1) according to age, sex, comorbidities, year, and hospital of admission. Our primary outcome was in-hospital mortality. We also assessed admission to the intensive care unit (ICU), invasive mechanical ventilation (IMV), kidney replacement therapy (KRT), sepsis, nosocomial infection, and thromboembolic events. RESULTS: Among 1,556 patients included in the study, 405 (4.5%) had a diagnosis of dementia and 1,151 were matched controls. When compared to matched controls, patients with dementia had a lower frequency of dyspnoea, cough, myalgia, headache, ageusia, and anosmia; and higher frequency of fever and delirium. They also had a lower frequency of ICU admission (32.7% vs. 47.1%, p < 0.001) and shorter ICU length of stay (7 vs. 9 days, p < 0.026), and a lower frequency of sepsis (17% vs. 24%, p = 0.005), KRT (6.4% vs. 13%, p < 0.001), and IVM (4.6% vs. 9.8%, p = 0.002). There were no differences in hospital mortality between groups. CONCLUSION: Clinical manifestations of COVID-19 differ between older inpatients with and without dementia. We observed that dementia alone could not explain the higher short-term mortality following severe COVID-19. Therefore, clinicians should consider other risk factors such as acute morbidity severity and baseline frailty when evaluating the prognosis of older adults with dementia hospitalised with COVID-19.

A nationwide survey of Antimicrobial Stewardship in Pediatric Intensive Care Unit: implementation notes from the Brazilian underground.

A multicenter diagnostic study was conducted to investigate the implementation of an Antimicrobial Stewardship Program in Brazilian Pediatric Intensive Care Units. The analysis unveiled the main implementation impediments of the Antimicrobial Stewardship Program such as the lack of professionals and resources available to the program.

Facial soft tissue changes and volumetric analysis of upper airways in patients undergoing surgically assisted rapid maxillary expansion using a transpalatal distractor.

OBJECTIVE: To verify changes in facial soft tissue using the RadiANT-DICOM-viewer and Dolphin Imaging software, through linear measurements of tomographic points in a 3D reconstruction of the face and volumetric evaluation with three-dimensional measurements of the upper airways of patients with transverse maxillary discrepancy undergoing Surgically Assisted Rapid Maxillary Expansion (SARME). METHODS: Retrospective, transverse, and descriptive study, through the analysis of computed tomography scans of the face of patients with transverse maxillary discrepancy, treated from July 2019 to December 2022. The sample consisted of 15 patients of both sexes, aged 21-42 years old, who underwent surgically assisted rapid maxillary expansion using the transpalatal distractor. Analysis was performed through linear, angular, and three-dimensional measurements in millimeters, in the preoperative and late four-month postoperative period, in frontal 3D tomographic images of the face, in the region of the width of the nose and alar base and also angular measurement in the lateral tomography for the angle nasolabial and upper airways of rhinopharynx, oropharynx and hypopharynx. RESULTS: There was an increase in nasal width with an average of 1.3467mm and an increase in the alar base with an average of 1.7333mm. A significant difference was found in the pre- and postoperative assessments of the measurements of nasal width, alar base and nasolabial angle, as well as the upper airways in all their extension. The results favour a better understanding of the professional and the patient regarding the diagnosis and management of patients with transverse maxillary width discrepancies. CONCLUSION: Although our study shows an increase in soft tissues after SARME, no aesthetic changes are observed clinically, and all patients report significant respiratory improvement. SARME may therefore contribute to the improvement of professionals working in the field of oral and maxillofacial surgery and orthodontics. LEVEL OF EVIDENCE: Level 4.

Assessing the robustness of muscle strength and physical performance measures in women older than 40 years: a test-retest reliability study.

OBJECTIVES: This study investigated the test-retest reliability and minimal detectable change (MDC) of muscle strength and physical performance tests in women older than 40 years. METHODS: A total of 113 women, aged 58 ± 11 years (82% postmenopausal women), with a body mass index of 28.5 ± 5.8 kg/m 2 , participated in this study. One-repetition maximum (1RM) tests were conducted for seven strength exercises: 45° leg press, bench press, leg extension, pec deck, wide-grip lateral pull-down, leg curl, and seated cable row, with a retest after 48 hours. Timed Up and Go (TUG), 6-minute walk, and 30-second sit-to-stand tests were performed on the same day and retested after 72 hours. The tests and retests were administered by the same evaluators. Relative reliability (consistency of participant rank between test-retest) was assessed using the intraclass correlation coefficient for consistency and agreement, and absolute reliability (precision of score) was assessed using the MDC based on the standard error of prediction. RESULTS: The 1RM and performance tests exhibited excellent reliability: 45° leg press (consistency, 0.99; agreement, 0.98), bench press (consistency, 0.96; agreement, 0.96), leg extension (consistency, 0.93; agreement, 0.91), pec deck (consistency, 0.90; agreement, 0.88), wide-grip lateral pull-down (consistency, 0.91; agreement, 0.89), leg curl (consistency, 0.84; agreement, 0.83), seated cable row (consistency, 0.92; agreement, 0.94), TUG (consistency, 0.87; agreement, 0.87), 6-minute walk (consistency, 0.96; agreement, 0.95), and 30-second sit to stand (consistency, 0.85; agreement, 0.80). These tests showed meaningful MDC values, particularly for the 1RM test performed on the machine and the 30-second sit-to-stand test: 45° leg press, 22.2 kg (15%); bench press, 4.9 kg (19%); leg extension, 9.2 kg (35%); pec deck, 8.8 kg (44%); wide-grip lateral pull-down, 9.4 kg (31%); leg curl, 9.2 kg (51%); seated cable row, 11.4 kg (29%); TUG, 1.4 seconds (20%); 6-minute walk, 50.9 m (10%); and 30-second sit to stand, 4.6 reps (30%). CONCLUSIONS: Although the muscle strength and physical performance tests demonstrate excellent relative reliability in women older than 40 years, they exhibit low absolute reliability, particularly the 1RM test performed on the machine and the 30-second sit-to-stand test. Therefore, although these tests show good consistency in the positioning of women within the group after repeated measures, their precision measure is relatively low (high fluctuation). Changes in these tests that are smaller than the MDC may not indicate real changes in women at middle age and older.

Effect of resistance training volume on body adiposity, metabolic risk, and inflammation in postmenopausal and older females: Systematic review and meta-analysis of randomized controlled trials.

PURPOSE: This meta-analytical study aimed to explore the effects of resistance training (RT) volume on body adiposity, metabolic risk, and inflammation in postmenopausal and older females. METHODS: A systematic search was performed for randomized controlled trials in PubMed, Scopus, Web of Science, and SciELO. Randomized controlled trials with postmenopausal and older females that compared RT effects on body adiposity, metabolic risk, and inflammation with a control group (CG) were included. Independent reviewers selected the studies, extracted the data, and performed the risk of bias and certainty of the evidence (Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)) evaluations. Total body and abdominal adiposity, blood lipids, glucose, and C-reactive protein were included for meta-analysis. A random-effects model, standardized mean difference (Hedges' g), and 95% confidence interval (95%CI) were used for meta-analysis. RESULTS: Twenty randomized controlled trials (overall risk of bias: some concerns; GRADE: low to very low) with overweight/obese postmenopausal and older females were included. RT groups were divided into low-volume RT (LVRT, ∼44 sets/week) and high-volume RT (HVRT, ∼77 sets/week). Both RT groups presented improved body adiposity, metabolic risk, and inflammation when compared to CG. However, HVRT demonstrated higher effect sizes than LVRT for glucose (HVRT = -1.19; 95%CI: -1.63 to -0.74; LVRT = -0.78; 95%CI:-1.15 to -0.41) and C-reactive protein (HVRT = -1.00; 95%CI: -1.32 to -0.67; LVRT = -0.34; 95%CI, -0.63 to -0.04)) when compared to CG. CONCLUSION: Compared to CG, HVRT protocols elicit greater improvements in metabolic risk and inflammation outcomes than LVRT in overweight/obese postmenopausal and older females.

Assessment of the ABC2-SPH risk score to predict invasive mechanical ventilation in COVID-19 patients and comparison to other scores.

Background: Predicting the need for invasive mechanical ventilation (IMV) is important for the allocation of human and technological resources, improvement of surveillance, and use of effective therapeutic measures. This study aimed (i) to assess whether the ABC2-SPH score is able to predict the receipt of IMV in COVID-19 patients; (ii) to compare its performance with other existing scores; (iii) to perform score recalibration, and to assess whether recalibration improved prediction. Methods: Retrospective observational cohort, which included adult laboratory-confirmed COVID-19 patients admitted in 32 hospitals, from 14 Brazilian cities. This study was conducted in two stages: (i) for the assessment of the ABC2-SPH score and comparison with other available scores, patients hospitalized from July 31, 2020, to March 31, 2022, were included; (ii) for ABC2-SPH score recalibration and also comparison with other existing scores, patients admitted from January 1, 2021, to March 31, 2022, were enrolled. For both steps, the area under the receiving operator characteristic score (AUROC) was calculated for all scores, while a calibration plot was assessed only for the ABC2-SPH score. Comparisons between ABC2-SPH and the other scores followed the Delong Test recommendations. Logistic recalibration methods were used to improve results and adapt to the studied sample. Results: Overall, 9,350 patients were included in the study, the median age was 58.5 (IQR 47.0-69.0) years old, and 45.4% were women. Of those, 33.5% were admitted to the ICU, 25.2% received IMV, and 17.8% died. The ABC2-SPH score showed a significantly greater discriminatory capacity, than the CURB-65, STSS, and SUM scores, with potentialized results when we consider only patients younger than 80 years old (AUROC 0.714 [95% CI 0.698-0.731]). Thus, after the ABC2-SPH score recalibration, we observed improvements in calibration (slope = 1.135, intercept = 0.242) and overall performance (Brier score = 0.127). Conclusion: The ABC2-SPHr risk score demonstrated a good performance to predict the need for mechanical ventilation in COVID-19 hospitalized patients under 80 years of age.

Does cross-education minimize the loss of muscle force and power and sEMG amplitude during short-term detraining in older women who are recreationally engaged in resistance training?

This study aimed to investigate whether 4 weeks of unilateral resistance training (RT) could attenuate the decline in muscle function in the contralateral limb of older women recreationally engaged in RT compared to control group (CTL). Twenty-four participants completed a 10-week RT before the cross-education (CR-Edu) phase and subsequent detraining. Afterward, participants were randomized into two groups: CTL (n = 8 women, n = 16 legs) who underwent 4 weeks of detraining without any training, and CR-Edu (n = 16 women, n = 16 legs) who performed 4 weeks of unilateral RT. Muscle force, power, and surface electromyography were measured unilaterally before and after the 4-week period, using five repetitions conducted at 40% and 60% of the 1RM. The results showed a reduction in muscle force at both 40% and 60% of 1RM, as well as a decrease in power at 60% of 1RM (P-time < 0.05) without significant differences between the two groups (P interaction > 0.05). There was a decline in power at 60% of 1RM (P-time < 0.05) but no significant change at 40% of 1RM (P-time > 0.05), and again, no significant differences were observed between the groups (P-interaction > 0.05). The surface electromyography of vastus lateralis decreased only in the CTL group (P-interaction < 0.05). Older women recreationally engaged in RT who perform in unilateral leg extension compared to a brief period of detraining seem not to retain muscle force and power, and sEMG amplitude of their homologous and contralateral limb.

Temporal validation of the MMCD score to predict kidney replacement therapy and in-hospital mortality in COVID-19 patients.

BACKGROUND: Acute kidney injury has been described as a common complication in patients hospitalized with COVID-19, which may lead to the need for kidney replacement therapy (KRT) in its most severe forms. Our group developed and validated the MMCD score in Brazilian COVID-19 patients to predict KRT, which showed excellent performance using data from 2020. This study aimed to validate the MMCD score in a large cohort of patients hospitalized with COVID-19 in a different pandemic phase and assess its performance to predict in-hospital mortality. METHODS: This study is part of the "Brazilian COVID-19 Registry", a retrospective observational cohort of consecutive patients hospitalized for laboratory-confirmed COVID-19 in 25 Brazilian hospitals between March 2021 and August 2022. The primary outcome was KRT during hospitalization and the secondary was in-hospital mortality. We also searched literature for other prediction models for KRT, to assess the results in our database. Performance was assessed using area under the receiving operator characteristic curve (AUROC) and the Brier score. RESULTS: A total of 9422 patients were included, 53.8% were men, with a median age of 59 (IQR 48-70) years old. The incidence of KRT was 8.8% and in-hospital mortality was 18.1%. The MMCD score had excellent discrimination and overall performance to predict KRT (AUROC: 0.916 [95% CI 0.909-0.924]; Brier score = 0.057). Despite the excellent discrimination and overall performance (AUROC: 0.922 [95% CI 0.914-0.929]; Brier score = 0.100), the calibration was not satisfactory concerning in-hospital mortality. A random forest model was applied in the database, with inferior performance to predict KRT requirement (AUROC: 0.71 [95% CI 0.69-0.73]). CONCLUSION: The MMCD score is not appropriate for in-hospital mortality but demonstrates an excellent predictive ability to predict KRT in COVID-19 patients. The instrument is low cost, objective, fast and accurate, and can contribute to supporting clinical decisions in the efficient allocation of assistance resources in patients with COVID-19.

Clinical and sociodemographic aspects of cases of severe acute respiratory syndrome in southern Brazil / Aspectos clínicos e sociodemográficos dos casos de Síndrome Respiratória Aguda Grave no sul do Brasil / Aspectos clínicos y sociodemográficos de casos de Síndrome Respiratorio Agudo Severo en el sur de Brasil

Background and objectives: to compare the clinical and sociodemographic aspects of individuals with SARS reported in the countryside of Rio Grande do Sul in 2020 and 2021. Methods: a cross-sectional study, from March 2020 to October 2021. Clinical and sociodemographic variables of individuals with SARS symptoms were analyzed, compared through descriptive, univariate analyses, according to the year of reporting. Results: a total of 4,710 cases of SARS were reported; 53.4% were SARS related to COVID-19 in 2020 and 87.5% in 2021 (p<0.001). Comparing 2020 and 2021, the sociodemographic profile changed in terms of age group, skin color and education (p<0.001). Regarding clinical aspects, there was a reduction in prevalence of pre-existing health conditions, except obesity, changes in reported signs and symptoms and reduction in hospital and Intensive Care Unit admissions. Conclusion: the changes in the profile may reflect the effect of the different variants and the start of immunization for SARS-CoV-2.(AU)

Justificativa e objetivos: comparar, entre os anos de 2020 e 2021, os aspectos clínicos e sociodemográficos dos indivíduos com Síndrome Respiratória Aguda Grave (SRAG) notificados em uma região de saúde do interior do Rio Grande do Sul. Métodos: estudo transversal descritivo, realizado de março de 2020 a outubro de 2021. Foram analisadas variáveis clínicas e sociodemográficas de indivíduos com sintomas de SRAG, comparadas através de análises descritivas, univariadas, conforme o ano de notificação. Resultados: foram notificados 4.710 casos com SRAG; 53,4% foram SRAG relacionados à COVID-19 em 2020 e, 87,5%, em 2021 (p<0,001). Comparando os anos 2020 e 2021, o perfil sociodemográfico modificou quanto faixa etária, cor da pele e escolaridade (p<0,001). Quanto aos aspectos clínicos, houve redução da prevalência de condições de saúde preexistente, exceto obesidade, alterações nos sinais e sintomas relatados e diminuição de internações hospitalares e na Unidade de Terapia Intensiva. Conclusão: as mudanças no perfil podem refletir o efeito das diferentes variantes e o início da imunização para SARS-CoV-2.(AU)

Justificación y objetivos: comparar los aspectos clínicos y sociodemográficos de individuos con SARS notificados en el interior de Rio Grande do Sul en los años 2020 y 2021. Métodos: estudio descriptivo transversal, realizado de marzo de 2020 a octubre de 2021. Se analizaron variables clínicas y sociodemográficas de individuos con síntomas de SARS, comparadas mediante análisis descriptivos univariados, según el año de notificación. Resultados: se notificaron 4.710 casos de SARS; el 53,4% fueron SARS relacionados con COVID-19 en 2020 y el 87,5% en 2021 (p<0,001). Comparando los años 2020 y 2021, el perfil sociodemográfico cambió en cuanto a grupo de edad, color de piel y escolaridad (p<0,001). En cuanto a los aspectos clínicos, hubo reducción en la prevalencia de condiciones de salud preexistentes, excepto obesidad, cambios en los signos y síntomas reportados y reducción en los ingresos hospitalarios y en la Unidad de Cuidados Intensivos. Conclusión: los cambios en el perfil pueden reflejar el efecto de las diferentes variantes y el inicio de la inmunización para el SARS-CoV-2.(AU)

Pharmacoeconomic and antimicrobial stewardship analysis in waste management: Beyond switching drug administration route.

BACKGROUND: The aim of this study was to evaluate the impact of switch therapy of antimicrobials on cost reduction (pharmacoeconomic analysis) and hospital waste generation by switching from intravenous to oral therapy. This is a cross-sectional, observational, and retrospective study. METHODS: Data from 2019, 2020, and 2021, provided by the clinical pharmacy service of a teaching hospital in the interior of Rio Grande do Sul, were analyzed. The variables analyzed were intravenous and oral antimicrobials, frequency, duration of use, and total treatment time according to the institutional protocols. An estimate of the amount of waste not generated from the change of administration route was calculated by weighing the kits using a precision balance in grams. RESULTS: During the analyzed period, 275 switch therapy of antimicrobials were performed, resulting in US$ 55,256.00 of savings. The main antimicrobial classes that underwent changes were cephalosporins (25.1%), penicillins (22.55%), and quinolones (17.45%). Changing from intravenous to oral therapy avoided the generation of 170,631 g of waste, including needles, syringes, infusion bags, equipment, reconstituted solution bottles, and medication. CONCLUSIONS: The change from intravenous to the oral route of antimicrobials is safe for the patient, economically effective, and significantly reduces waste generation.