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.

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.

Acidithiobacillus sp. applied to sewage sludge bioleaching: perspectives for process optimization through the establishment of optimal operational parameters.

Using Acidithiobacillus sp. during bioleaching assays is a well-known biological approach to solubilizing metals within sewage sludge. However, sludge dewatering has also been reported as a secondary treatment benefit. Based on a literature review, the present work provides perspectives regarding the enhancement of bioleaching outcomes on a laboratory scale by establishing optimal operational parameters. Data from different studies suggest that greater bioleaching efficiency may be achieved using a 10% (v/v) mixed inoculum of Acidithiobacillus thiooxidans and Acidithiobacillus ferrooxidans in a ratio of 4:1, supplemented with ferrous sulfate (FeSO4) and elemental sulfur (S0), and an initial system pH near 6.0. However, operational parameters must be established according to the type of sludge being treated due to differences in their compositions. Bioleaching duration is also an aspect that must be considered since treatments conducted for longer than 48 h increased the concentration of Extracellular Polymeric Substances (EPS), a characteristic associated with reducing dewaterability performance.

Niobium Oxides as Heterogeneous Catalysts for Biginelli Multicomponent Reaction.

This study reports a simple, reusable, and recoverable niobium-based heterogeneous catalysts for Biginelli multicomponent reactions. Different methods of catalysts preparation were investigated. For this purpose, HY-340 (Nb2O5·nH2O) and Nb2O5 were chemically and/or thermally treated and investigated as catalysts for dihydropyrimidinones (DHPMs) production. The catalysts were characterized by scanning electron microscopy, high-resolution transmission electron microscopy, Fourier-transform infrared spectroscopy, X-ray diffraction, temperature-programmed desorption of NH3, adsorption/desorption of N2 at -196 °C, and thermogravimetric and differential thermal analysis. The characterization results showed that niobium oxides have the potential to be used as catalysts because of high crystallinity and large surface area. Among the tested catalysts, Nb2O5 chemically treated (Nb2O5/T) showed the best catalytic performance. In the absence of solvents, 94% yield of DHPMs was achieved. Also, Nb2O5/T can be reused three times without a significant yield decrease. Additionally, a feasible reaction pathway was suggested based on the Knoevenagel mechanism for DHPM synthesis using niobium-based catalysts.