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Background: We evaluated in-hospital mortality and outcomes incidence after hospital discharge due to COVID-19 in a Brazilian multicenter cohort. Methods: This prospective multicenter study (RECOVER-SUS, NCT04807699) included COVID-19 patients hospitalized in public tertiary hospitals in Brazil from June 2020 to March 2021. Clinical assessment and blood samples were performed at hospital admission, with post-hospital discharge remote visits. Hospitalized participants were followed-up until March 31, 2021. The outcomes were in-hospital mortality and incidence of rehospitalization or death after hospital discharge. Kaplan-Meier curves and Cox proportional-hazard models were performed. Findings: 1589 participants [54.5% male, age=62 (IQR 50-70) years; BMI=28.4 (IQR,24.9-32.9) Kg/m² and 51.9% with diabetes] were included. A total of 429 individuals [27.0% (95%CI,24.8-29.2)] died during hospitalization (median time 14 (IQR,9-24) days). Older age [vs<40 years; age=60-69 years-aHR=1.89 (95%CI,1.08-3.32); age=70-79 years-aHR=2.52 (95%CI,1.42-4.45); age≥80-aHR=2.90 (95%CI 1.54-5.47)]; noninvasive or mechanical ventilation at admission [vs facial-mask or none; aHR=1.69 (95%CI 1.30-2.19)]; SAPS-III score≥57 [vs<57; aHR=1.47 (95%CI 1.13-1.92)] and SOFA score≥10 [vs <10; aHR=1.51 (95%CI 1.08-2.10)] were independently associated with in-hospital mortality. A total of 65 individuals [6.7% (95%CI 5.3-8.4)] had a rehospitalization or death [rate=323 (95%CI 250-417) per 1000 person-years] in a median time of 52 (range 1-280) days post-hospital discharge. Age ≥ 60 years [vs <60, aHR=2.13 (95%CI 1.15-3.94)] and SAPS-III ≥57 at admission [vs <57, aHR=2.37 (95%CI 1.22-4.59)] were independently associated with rehospitalization or death after hospital discharge. Interpretation: High in-hospital mortality rates due to COVID-19 were observed and elderly people remained at high risk of rehospitalization and death after hospital discharge. Funding: Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Programa INOVA-FIOCRUZ.
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The aim of this study was to analyze the temporal trend of leptospirosis incidence according to rainfall levels in Santa Catarina State between 2005 and 2015. This is an ecological time-series study involving data on leptospirosis incidence and rainfall indexes in Santa Catarina State Health Regions. The distribution of leptospirosis, rainfall indexes, and cases/rainfall ratios, according to seasonality and stratified by Health Regions, were evaluated. There were 5,274 cases, with an average rate of 7.03 cases/100,000 inhabitants per year, varying from 24 to 1,458 cases (Serra Catarinense and Northeast regions, respectively) in Santa Catarina, revealing an increase in the rates of 0.70 cases/100,000 inhabitants in Serra Catarinense and 13.99 cases/100,000 inhabitants in the Northeast. Four regions (Foz do Rio Itajaí, Médio Vale do Itajaí, Grande Florianópolis and Northeast) were responsible for 71.8% of the cases, particularly in the Northeast region (38.5%). The five regions with the highest rates presented greater risk of leptospirosis (RR > 1), ranging from 10.9 to 19.9 more new cases of the disease. The average rainfall volume for Santa Catarina State was 158.69 mm, ranging from 136.44 mm in Laguna to 186.81 mm in the Northeast. The five regions contributed with 32.8% of the rainfall index accumulated in the period. In conclusion, leptospirosis occurred all around Santa Catarina State, differing its temporal trend according to the Health Regions. The aim of this study was to analyze the temporal trend of leptospirosis incidence according to rainfall levels in Santa Catarina State between 2005 and 2015. This is an ecological time-series study involving data on leptospirosis incidence and rainfall indexes in Santa Catarina State Health Regions. The distribution of leptospirosis, rainfall indexes, and cases/rainfall ratios, according to seasonality and stratified by Health Regions, were evaluated. There were 5,274 cases, with an average rate of 7.03 cases/100,000 inhabitants per year, varying from 24 to 1,458 cases (Serra Catarinense and Northeast regions, respectively) in Santa Catarina, revealing an increase in the rates of 0.70 cases/100,000 inhabitants in Serra Catarinense and 13.99 cases/100,000 inhabitants in the Northeast. Four regions (Foz do Rio Itajaí, Médio Vale do Itajaí, Grande Florianópolis and Northeast) were responsible for 71.8% of the cases, particularly in the Northeast region (38.5%). The five regions with the highest rates presented greater risk of leptospirosis (RR > 1), ranging from 10.9 to 19.9 more new cases of the disease. The average rainfall volume for Santa Catarina State was 158.69 mm, ranging from 136.44 mm in Laguna to 186.81 mm in the Northeast. The five regions contributed with 32.8% of the rainfall index accumulated in the period. In conclusion, leptospirosis occurred all around Santa Catarina State, differing its temporal trend according to the Health Regions.
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O objetivo do estudo é analisar a tendência temporal da incidência de leptospirose, de acordo com índices pluviométricos na Região da Grande Florianópolis, conforme sazonalidade - 2005 a 2015. Trata-se de estudo ecológico de séries temporais, com dados de leptospirose, índices pluviométricos e população. Foram analisadas taxas de incidência de leptospirose, excesso relativo da incidência, coeficiente de correlação de Pearson (r), coeficiente angular (ß), a partir do ajuste da regressão linear, com nível de significância de 95%. Apresenta distribuição dos casos de leptospirose, índices pluviométricos e razão casos/índices pluviométricos, estratificados por mês de ocorrência. Foram registrados 1.001 casos de leptospirose, média mensal de 83 casos, com variação de 43, nos meses de agosto, a 146, nos meses de fevereiro. A taxa média de leptospirose foi 8,24/100 mil habitantes. O índice pluviométrico médio foi 154,83 mm, os índices mais baixos ocorreram nos meses de junho, média de 99,48 mm, e, os mais elevados nos meses de janeiro, média de 226,16 mm. Uma correlação positiva entre taxas de leptospirose e níveis pluviométricos, ao longo do período, janeiro a dezembro (r=0,64; p=0,003), aponta para associação temporal positiva entre quantidade de chuva e casos da doença. A doença ocorreu o ano todo e apresentou nítida sazonalidade no período de outubro a março.
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The objective of the study is to analyze the temporal trend of leptospirosis incidence, according to rainfall levels in Santa Catarina, according to seasonality, from 2005 to 2015. This is an ecological study of time series, with date of leptospirosis, rainfall levels and population. The incidence rates of leptospirosis, relative excess of incidence, Pearson's correlation coefficient (r) and an angular coefficient (ß) were analyzed from the linear regression adjustment, with a 5% significance level. Distribution of leptospirosis cases, rainfall levels and cases reason/rainfall levels, stratified by month of occurrence were presented. There were 5,274 cases of leptospirosis, with the monthly average being 439 cases, ranging from 211 in September to 770 in January. The mean rate of leptospirosis was 7.03 per 100,000 habitants. The average rainfall level was 158.68 mm, with the lowest levels occurring in August, average of 124.9 mm, and the highest in January average of 213.20 mm. The positive correlation between leptospirosis rates and rainfall levels, during the period from January to December (r = 0.68, p = 0.023), indicates a positive temporal association between the amount of rainfall and the cases of the disease. The disease occurred all year round and presented a distinct seasonality from October to March.
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Leptospirosis/epidemiología , Lluvia , Estaciones del Año , Brasil/epidemiología , Humanos , IncidenciaRESUMEN
OBJETIVO: Analisar a prevalência e os fatores associados à dislipidemia em pacientes que utilizam a Highly Active Antiretroviral Therapy (HAART). MÉTODOS: Estudo observacional transversal que incluiu 100 pacientes que realizam acompanhamento em ambulatórios de Infectologia de Santa Catarina. Os dados foram obtidos por meio de revisão de prontuários e analisados no programa Statistical Package for Social Science (SPSS), versão 13.0. Utilizou-se o teste qui quadrado de Pearson ou teste exato de Fisher para as variáveis qualitativas. A associação entre as variáveis quantitativas foi avaliada por meio do teste t de Student. O nível de significância estabelecido foi p<0,05. RESULTADOS: Homens corresponderam a 51% e a média de idade foi de 42,90±11,39 anos. A prevalência de dislipidemia foi de 75% nos pacientes que utilizavam HAART e de 85% nos pacientes antes de iniciá-la. O colesterol total médio dos pacientes antes de iniciar HAART encontrou-se em 171,33±37,12, a HDL média em 41,01±14,57 e o LDL médio em 98,05±32,35. Já o colesterol total médio dos pacientes que utilizam HAART ficou em 199,97±42,47 (p<0,01), o HDL médio em 46,93±16,34 (p<0,01) e o LDL médio em 118,88±36,57 (p<0,01). Houve menor média de linfócitos TCD4+ pré-HAART entre pacientes com HDL reduzido (p=0,04) ou qualquer dislipidemia (p=0,01). CONCLUSÃO: Há alta prevalência de dislipidemia em pacientes infectados pelo HIV que utilizam ou não HAART.
OBJECTIVE: To assess the prevalence and factors associated with dyslipidemia in patients using the Highly Active Antiretroviral Therapy (HAART). METHODS: Cross-sectional observational study that included 100 patients who are being followed in infectious diseases clinics of the state of Santa Catarina. Data was obtained through the review of medical records and analyzed using SPSS 13.0 software. Chi-square test or Fisher's exact test were used for qualitative variables. Student's t test was used for the association of quantitative variables.The significance level was p<0.05. RESULTS: Men were 51% and the average age was 42.90±11.39 years. The prevalence of dyslipidemia was 75% in patients using Highly Active Antiretroviral Therapy and 85% before the beginning of therapy. The average total cholesterol of patients before starting Highly Active Antiretroviral Therapy was 171.33±37.12, average highdensity lipoprotein (HDL) was 41.01±14.57 and the average low-density lipoprotein was 98.05±32.35. The average total cholesterol of patients using Highly Active Antiretroviral Therapy remained at 199.97±42.47 (p<0.01), the average high-density lipoprotein at 46.93±16.34 (p<0.01) and the average low-density lipoprotein at 118.88±36.57 (p<0.01). There was a lower averagem of TCD4+ lymphocytes counts pre-Highly Active Antiretroviral Therapy among patients with low high-density lipoprotein (p=0.04) or any dyslipidemia (p=0.01). CONCLUSION: There is high prevalence of dyslipidemia in HIV-infected patients using or not the Highly Active Antiretroviral Therapy.
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Humanos , Masculino , Femenino , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Terapia Antirretroviral Altamente Activa/efectos adversos , Dislipidemias/inducido químicamente , Dislipidemias/diagnósticoRESUMEN
INTRODUCTION: Antiretroviral therapy (ART) has been used to treat large numbers of patients living with human immunodeficiency virus (HIV) infection. Lipid disorders are often observed in these patients, and include elevations in total cholesterol (TC) and triglycerides (TG). METHODS: A cross-sectional study was performed using 333 patient records from the Regional Hospital of São José Doutor Homero de Miranda Gomes (HRSJHMG). The study population consisted of patients with HIV who were under medical follow up, either on or off drug treatment. The data were entered into Excel and exported to SPSS 16.0 for analysis using chi-square testing. We used prevalence ratios as the measure of association. RESULTS: Lipid abnormalities were observed in 78.9% of individuals who received ART. Of the 308 subjects on ART, 59.1%, 41.9%, and 33.1% had TG, TC and low-density lipoprotein (LDL) abnormalities, respectively. The prevalence of LDL changes was 2.57-fold higher in individuals who had been using ART for more than 12 months, compared to those using ART for 6 to 12 months. CONCLUSIONS: HIV patients showed a significant increase in the association between TC and TG levels and the use of ART. In particular, changes in TC, LDL and TG were greater in individuals who had received ART for over more than 12 months.
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Fármacos Anti-VIH/efectos adversos , Dislipidemias/inducido químicamente , Infecciones por VIH/sangre , Adolescente , Adulto , Anciano , Fármacos Anti-VIH/uso terapéutico , Estudios Transversales , Dislipidemias/epidemiología , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Lípidos/sangre , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Adulto JovenRESUMEN
Introduction Antiretroviral therapy (ART) has been used to treat large numbers of patients living with human immunodeficiency virus (HIV) infection. Lipid disorders are often observed in these patients, and include elevations in total cholesterol (TC) and triglycerides (TG). Methods A cross-sectional study was performed using 333 patient records from the Regional Hospital of São José Doutor Homero de Miranda Gomes (HRSJHMG). The study population consisted of patients with HIV who were under medical follow up, either on or off drug treatment. The data were entered into Excel and exported to SPSS 16.0 for analysis using chi-square testing. We used prevalence ratios as the measure of association. Results Lipid abnormalities were observed in 78.9% of individuals who received ART. Of the 308 subjects on ART, 59.1%, 41.9%, and 33.1% had TG, TC and low-density lipoprotein (LDL) abnormalities, respectively. The prevalence of LDL changes was 2.57-fold higher in individuals who had been using ART for more than 12 months, compared to those using ART for 6 to 12 months. Conclusions HIV patients showed a significant increase in the association between TC and TG levels and the use of ART. In particular, changes in TC, LDL and TG were greater in individuals who had received ART for over more than 12 months. .
