Cohort study of hospitalized patients with COVID-19 at Brazilian tertiary-care hospital: Occurrence of adverse events and mortality.

INTRODUCTION: Patients hospitalized with COVID-19 are often submitted to invasive procedures and they are at risk for hospital-associated adverse events. OBJECTIVES: To evaluate the epidemiological and clinical aspects of patients hospitalized with COVID-19; the occurrence of adverse events and the risk factors for mortality. METHOD: Cohort study that included adult patients hospitalized with a diagnosis of SARSCoV-2 infection, at the tertiary University Hospital of UNICAMP from March 2020 to March 2021. Patients were identified through the hospital epidemiological surveillance system and followed until discharge or death. Descriptive, comparative, and logistic regression analysis was performed. RESULTS: 650 adult patients were included. The main adverse events identified were nosocomial infections (31.5%), renal failure (33.8%), thromboembolic and vascular events (12.6%). Mortality was higher among those with bloodstream infections (30.2% vs. 8.6%; p < 0.0001), ventilator-associated pneumonia (VAP, 52.5% vs. 12.3%; p < 0.0001), catheter associated urinary infection (27.3% vs. 7.2%; p < 0.0001); thromboembolic and vascular events (23.0% vs. 9.9%; p < 0.0001) and renal failure (81.3% vs. 20.9%; p < 0.0001). Klebsiella pneumoniae (15.6%), Pseudomonas aeruginosa (14.4%), Enterococcus faecalis (8.6%) were the most isolated bacteria. Logistic regression analysis identified age, (RR = 1.03; 95% CI 1.02 to 1.05); ICU admission (RR = 3.06; 95% CI 1.59 to 5.87), vasoactive drug use (RR = 3.1; 95% CI 1.79 to 4.82); renal failure (RR = 7.76; 95% CI 4.54 to 13.26); and VAP (RR = 2.2; 95% CI 1.23 to 3.96), independently associated with mortality. CONCLUSION: adverse events have an important impact on the evolution of patients with COVID-19, reinforcing the need for optimized prevention and control measures as an essential part of care for these patients.

Oximetry at admission as a predictor of tomographic and functional impairment after 3-6 months in hospitalized patients with COVID-19.

OBJECTIVE: To investigate characteristics that may be associated with radiologic and functional findings following discharge in patients with severe coronavirus disease 2019 (COVID-19). METHODS: This single-center, prospective, observational cohort study comprised patients aged >18 years who were hospitalized with COVID-19 pneumonia, between May and October 2020. After 3 to 6 months of discharge, patients were clinically evaluated and underwent spirometry, a 6-minute walk test (6MWT), and chest computed tomography (CT). Statistical analysis was performed using association and correlation tests. RESULTS: A total of 134 patients were included (25/114 [22%] were admitted with severe hypoxemia). On the follow-up chest CT, 29/92 (32%) had no abnormalities, regardless of the severity of the initial involvement, and the mean 6MWT distance was 447 m. Patients with desaturation on admission had an increased risk of remaining CT abnormalities: patients with SpO2 between 88 and 92% had a 4.0-fold risk, and those with SpO2 < 88% had a 6.2-fold risk. The group with SpO2 < 88% also walked shorter distances than patients with SpO2 between 88 and 92%. CONCLUSION: Initial hypoxemia was found to be a good predictor of persistent radiological abnormalities in follow-up and was associated with low performance in 6MWT.

An analysis of student numbers per class and educational performance in the Brazilian context.

The relationship between class size and school performance has always been ambiguous and the current literature has found no direct connection between them, especially in the Brazilian context. Therefore, this study aimed to verify whether the number of students per class influences school performance. We used Microdata from the Prova Brazil of 2017. Using the propensity score matching statistical model, with the nearest neighbor matching estimator, we grouped the classes into clusters by similarity. The metric used to group the clusters was the Euclidean distance. We attempted to verify adherence to the normal distribution of data using the Kolmogorov Smirnov test and tested the null hypothesis of the medians using the Wilcoxon test. All the statistical analysis were performed using SPSS Statistic version 20. The results showed that the number of students per class has little influence on performance and, when the influence exists, larger classes perform better.

Cohort study of hospitalized patients with COVID-19 at Brazilian tertiary-care hospital: Occurrence of adverse events and mortality

ABSTRACT Introduction: Patients hospitalized with COVID-19 are often submitted to invasive procedures and they are at risk for hospital-associated adverse events. Objectives: To evaluate the epidemiological and clinical aspects of patients hospitalized with COVID-19; the occurrence of adverse events and the risk factors for mortality. Method: Cohort study that included adult patients hospitalized with a diagnosis of SAR-SCoV-2 infection, at the tertiary University Hospital of UNICAMP from March 2020 to March 2021. Patients were identified through the hospital epidemiological surveillance system and followed until discharge or death. Descriptive, comparative, and logistic regression analysis was performed. Results: 650 adult patients were included. The main adverse events identified were nosocomial infections (31.5%), renal failure (33.8%), thromboembolic and vascular events (12.6%). Mortality was higher among those with bloodstream infections (30.2% vs. 8.6%; p < 0.0001), ventilator-associated pneumonia (VAP, 52.5% vs. 12.3%; p < 0.0001), catheter associated urinary infection (27.3% vs. 7.2%; p < 0.0001); thromboembolic and vascular events (23.0% vs. 9.9%; p < 0.0001) and renal failure (81.3% vs. 20.9%; p < 0.0001). Klebsiella pneumoniae (15.6%), Pseudomonas aeruginosa (14.4%), Enterococcus faecalis (8.6%) were the most isolated bacteria. Logistic regression analysis identified age, (RR = 1.03; 95% CI 1.02 to 1.05); ICU admission (RR = 3.06; 95% CI 1.59 to 5.87), vasoactive drug use (RR = 3.1; 95% CI 1.79 to 4.82); renal failure (RR = 7.76; 95% CI 4.54 to 13.26); and VAP (RR = 2.2; 95% CI 1.23 to 3.96), independently associated with mortality. Conclusion: adverse events have an important impact on the evolution of patients with COVID-19, reinforcing the need for optimized prevention and control measures as an essential part of care for these patients.

Combining dynamic Monte Carlo with machine learning to study nanoparticle translocation.

Resistive pulse sensing (RPS) measurements of nanoparticle translocation have the ability to provide information on single-particle level characteristics, such as diameter or mobility, as well as ensemble averages. However, interpreting these measurements is complex and requires an understanding of nanoparticle dynamics in confined spaces as well as the ways in which nanoparticles disrupt ion transport while inside a nanopore. Here, we combine Dynamic Monte Carlo (DMC) simulations with Machine Learning (ML) and Poisson-Nernst-Planck calculations to simultaneously simulate nanoparticle dynamics and ion transport during hundreds of independent particle translocations as a function of nanoparticle size, electrophoretic mobility, and nanopore length. The use of DMC simulations allowed us to explicitly investigate the effects of Brownian motion and nanoparticle/nanopore characteristics on the amplitude and duration of translocation signals. Simulation results were verified with experimental RPS measurements and found to be in quantitative agreement.

Pectus excavatum e assimetrias mamárias: correção com mamoplastia de aumento / Pectus excavatum and breast asymmetry: correction with breast augmentation

Introdução: O pectus excavatum é definido com uma depressão aproximando o esterno e as cartilagens costais à coluna vertebral. Existem diversas teorias em relação à etiologia; a mais aceita consiste no crescimento exagerado das cartilagens costais, causando um deslocamento posterior do esterno e consequente depressão. Dentre as formas de tratamento, encontra-se a correção das assimetrias mamárias utilizando próteses mamárias de silicone em pacientes sem sintomas cardiopulmonares, apenas com queixa estética. Métodos: Foram revisados os registros em prontuários e registros fotográficos de oito casos de pacientes femininas com diagnóstico de pectus excavatum operadas em um hospital privado na região Sul do Brasil, que procuravam o serviço com queixas estéticas locais, e não apresentavam queixas cardiorrespiratórias. Resultados: Seis casos foram submetidos somente à inclusão de prótese mamária. Uma paciente havia colocado prótese havia 15 anos, sendo essa substituída por novo implante, no mesmo plano. Outra paciente já havia realizado cirurgia de correção de pectus descrito por Nuss, 10 anos antes, vindo a consulta com queixa de hipomastia e assimetria. O tipo anestésico preferido foi a anestesia geral, em cinco dos casos. O plano de inclusão de prótese na quase totalidade dos casos foi o subglandular. Somente uma paciente apresentou complicação (seroma). Conclusões: Evidenciamos, na nossa amostra, que a inclusão de prótese mamária em pacientes com pectus excavatum é capaz de trazer resultados estético harmônicos, atenuando e/ou mascarando o defeito torácico, com resultados estéticos satisfatórios para os pacientes.

Introduction: Pectus excavatum is defined as a depression approaching the sternum and costal cartilages to the spine. Several theories explain its etiology, the most accepted of which is the exaggerated growth of the costal cartilages, which causes a posterior displacement of the sternum and consequent depression. The treatment includes correction of breast asymmetries by using silicone breast implants in patients without cardiopulmonary symptoms, only with esthetic complaints. Methods: We reviewed the medical and photographic records of eight female patients diagnosed as having pectus excavatum, who underwent operation at a private hospital in the southern region of Brazil. These women sought consultation for local esthetic complaints and had no cardiorespiratory complaints. Results: Six patients submitted only for breast prosthesis placement. One patient had a prosthesis implanted 15 years before, which was replaced by a new implant in the same plane. Another patient had undergone pectus repair with Nuss surgery 10 years before, and the patient came to the hospital with a complaint of hypomasty and asymmetry. The preferred anesthesia was general anesthesia in five of the cases. The prosthesis inclusion plane in almost all the cases was subglandular. Only one patient had a complication (seroma). Conclusions: In our sample, the placement of breast prostheses in the patients with pectus excavatum brought harmonic esthetic results, attenuating and/or masking the chest defect, with satisfactory esthetic results for the patients.

Histological study on acute inflammatory reaction to polyurethane-coated silicone implants in rats.

PURPOSE: Evaluating histologically the silicone peri-implant coated by polyurethane inflammation associated to the use of anti-microbial and bacterial contamination. METHODS: It was used 35 Wistar rats. The animals were divided in seven groups: I - Control; II - implant cavity contamination with 10 bacteria/ml; III - implant cavity contamination with 10 bacteria/ml; IV - implant cavity contamination with 10 bacteria/ml; V - identical contamination to group II and implant immersions in anti-microbial solution; VI - identical contamination in group III and implant immersions in the anti-microbial solution; VII - identical contamination of group IV and implant immersions in anti-microbial solution. It was evaluated morphometrically the peri-implant capsules after 30 days of introduction. RESULTS: The factors with more discriminating power were the giants cells of a strange body and the mononuclear. There was no correlation between the bacterial concentrations and the histological alterations. CONCLUSION: 1) The histological standard of the inflammatory reaction around the silicone implant coated with polyurethan is chronic granulomatosis type of a strange body; 2) There isn't correlation between concentration of Staphylococcus epidermidis and histological changes; 3) The use of anti-microbial solution decreased the mononuclear cell reactions, with the increase of giant cells in a strange body.

Histological study on acute inflammatory reaction to polyurethane-coated silicone implants in rats

PURPOSE: Evaluating histologically the silicone peri-implant coated by polyurethane inflammation associated to the use of anti-microbial and bacterial contamination. METHODS: It was used 35 Wistar rats. The animals were divided in seven groups: I - Control; II - implant cavity contamination with10 bacteria/ml; III - implant cavity contamination with 10 bacteria/ml; IV - implant cavity contamination with 10 bacteria/ml; V - identical contamination to group II and implant immersions in anti-microbial solution; VI - identical contamination in group III and implant immersions in the anti-microbial solution; VII - identical contamination of group IV and implant immersions in anti-microbial solution. It was evaluated morphometrically the peri-implant capsules after 30 days of introduction. RESULTS: The factors with more discriminating power were the giants cells of a strange body and the mononuclear. There was no correlation between the bacterial concentrations and the histological alterations. CONCLUSION: 1) The histological standard of the inflammatory reaction around the silicone implant coated with polyurethan is chronic granulomatosis type of a strange body; 2) There isn´t correlation between concentration of Staphylococcus epidermidis and histological changes; 3) The use of anti-microbial solution decreased the mononuclear cell reactions, with the increase of giant cells in a strange body.

OBJETIVO: Avaliar, histologicamente, a reação inflamatória aos implantes de silicone revestidos por poliuretano, com contaminação bacteriana, associada ou não ao uso de antimicrobianos. MÉTODOS: Utilizou-se 35 ratos Wistar. Os animais foram divididos em 7 grupos: I- Controle, II- contaminação da cavidade do implante com 10¹ bactérias/ml, III- contaminação da cavidade do implante com 10³ bactérias/ml, IV- contaminação da cavidade do implante com 10(5) bactérias/ml, V- contaminação idêntica ao grupo II e imersão dos implantes em solução antimicrobiana, VI- contaminação idêntica do grupo III e imersão dos implantes em solução antimicrobiana, VII- contaminação idêntica do grupo IV e imersão dos implantes em solução antimicrobiana. Avaliou-se morfometricamente as cápsulas peri-implantes após 30 dias da introdução. RESULTADOS: Os fatores com maior poder discriminante foram as células gigantes de corpo estranho e os mononucleares. Não houve correlação entre as concentrações bacterianas e as alterações histológicas. CONCLUSÕES: 1) O padrão histológico da reação inflamatória ao redor dos implantes de silicone revestidos com poliuretano é do tipo crônica granulomatosa de corpo estranho; 2) Não há correlação entre a concentração de bactérias Staphylococcus epidermidis e as alterações morfométricas; 3) O uso de solução antimicrobiana diminui a reação de células mononucleares, com aumento de células gigantes de corpo estranho.