RESUMO
Background The 4C (Coronavirus Clinical Characterization Consortium) Mortality Score has demonstrated good discrimination in COVID-19 but has not been widely validated in Brazil. The 4C Mortality Score is a clinical tool developed during the COVID-19 pandemic to predict in-hospital mortality for patients admitted with COVID-19. It was derived from a large dataset of hospitalized patients in the United Kingdom and provides a simple yet effective way to stratify patients based on their risk of death. Objective This study aimed to determine the accuracy of the 4C Mortality Score in patients admitted with COVID-19 in a university teaching hospital. Methods The study was observational, longitudinal, and retrospective, conducted in a 180-bed university teaching hospital in Rio de Janeiro, Brazil. We included all patients admitted with COVID-19 and followed them until discharge. The 4C Mortality Score was calculated based on age, sex, Charlson index, respiratory rate, peripheral oxygen saturation (room air), Glasgow Coma Scale, serum urea, and C-reactive protein (CRP) level. The primary outcome was mortality. Results We included 208 participants, with a median age of 63 years. Among them, 111 (53%) were male; 52 (25%) had cardiovascular disease, and 83 (39%) had cancer. Mortality was 39.9%. Independent predictors of mortality were age, hemoglobin, CRP, mechanical ventilation, and the need for vasopressors. The 4C Mortality Score's area under the receiver operating characteristic curve (AUC-ROC) was 89.9%. Conclusion The 4C Mortality Score demonstrated excellent discrimination in a teaching hospital population.
RESUMO
The aim of this study was to assess the oral condition of individuals diagnosed with COVID-19 and its impact on their quality of life. The cross-sectional study participants were patients with or without a diagnosis of COVID-19, on room air, and conscious, admitted to the ICUs and wards of Public Hospital Units in São Luís, Maranhão, Brazil. The data collected included: demographic information, length of stay, comorbidities, and type of diet, obtained from medical records; Oral Health-Related Quality of Life (OHRQoL) [Oral Health Impact Profile (OHIP-14)]questions patients were asked; oral health (measured by the Bedside Oral Exam Scale); oral hygiene status (assessed by the Oral Hygiene Index - Simplified and lingual: degree of lingual coating); and salivary flow. The prevalence of COVID-19 was associated with gender (p = 0.038), with a higher incidence observed in male patients (61.9%). Moreover, there was a correlation between the hospitalization sector (p = 0.037) and the frequency of ICU admissions (53.7%). The prevalence of comorbidities was comparable between the two groups. Relative to oral health, 53% of individuals with confirmed COVID-19 had moderate oral health, while 9% exhibited poor oral health. The prevalence of hyposalivation was higher in the group with a confirmed diagnosis of COVID-19. The quality of life of individuals with confirmed COVID-19 was most significantly impacted by moderate to severe oral health concerns. The most significant alteration in oral health was a reduction in salivary flow, negatively impacting the quality of life of individuals hospitalized for COVID-19 complications.
Assuntos
COVID-19 , Hospitalização , Saúde Bucal , Qualidade de Vida , Humanos , COVID-19/epidemiologia , Masculino , Feminino , Estudos Transversais , Pessoa de Meia-Idade , Brasil/epidemiologia , Saúde Bucal/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Adulto , Idoso , Fatores Sexuais , SARS-CoV-2 , Prevalência , Índice de Higiene Oral , Adulto Jovem , Higiene Bucal/estatística & dados numéricosRESUMO
Ensuring that schools are water, sanitation and hygiene (WASH) friendly requires WASH to be visibly implemented, inclusive and sustainable, engaging the entire school community, including direct and indirect stakeholders (school staff, students and their families). However, students, staff, and parents are often overlooked in the design of WASH solutions. This study aims to contrast different school stakeholders' perspectives on WASH and evaluate the extent to which the Human Right to Water and Sanitation (HRtWS) and its normative contents are being realized in schools within the basic education system, covering students aged 0 to 18. For that purpose, a mixed-method study was conducted involving seven schools located in a small municipality in the southeast region of Brazil. Data collection methods included on-site observations in schools, in-depth interviews with school staff and parents/legal guardians of students, and a one-day art-based research workshop with students around drinking water, sanitation, solid waste management and COVID-19. Several inconsistencies were identified when comparing primary findings with the schools' information previously provided by the Brazilian Government, including differences in the number of schools and levels of education offered, water sources, absence of bathrooms, and waste burning instead of solid waste collection. A clear violation of all the normative contents of the HRtWS was observed, which, in turn, were triggering and exposing students to incidents of violence such as bullying and verbal abuse. There was a misalignment among stakeholders about which interventions implemented amidst the COVID-19 pandemic are still in place. Moreover, discrepancies among school stakeholders' perceptions of WASH suggest insufficient communication among actors. As a result of this research, a list of recommendations formulated by stakeholders and the involvement and alignment of all stakeholders are the first steps in successfully co-creating solutions.
RESUMO
The unprecedented worldwide pandemic caused by COVID-19 has motivated several research groups to develop machine-learning based approaches that aim to automate the diagnosis or screening of COVID-19, in large-scale. The gold standard for COVID-19 detection, quantitative-Real-Time-Polymerase-Chain-Reaction (qRT-PCR), is expensive and time-consuming. Alternatively, haematology-based detections were fast and near-accurate, although those were less explored. The external-validity of the haematology-based COVID-19-predictions on diverse populations are yet to be fully investigated. Here we report external-validity of machine learning-based prediction scores from haematological parameters recorded in different hospitals of Brazil, Italy, and Western Europe (raw sample size, 195554). The XGBoost classifier performed consistently better (out of seven ML classifiers) on all the datasets. The working models include a set of either four or fourteen haematological parameters. The internal performances of the XGBoost models (AUC scores range from 84% to 97%) were superior to ML models reported in the literature for some of these datasets (AUC scores range from 84% to 87%). The meta-validation on the external performances revealed the reliability of the performance (AUC score 86%) along with good accuracy of the probabilistic prediction (Brier score 14%), particularly when the model was trained and tested on fourteen haematological parameters from the same country (Brazil). The external performance was reduced when the model was trained on datasets from Italy and tested on Brazil (AUC score 69%) and Western Europe (AUC score 65%); presumably affected by factors, like, ethnicity, phenotype, immunity, reference ranges, across the populations. The state-of-the-art in the present study is the development of a COVID-19 prediction tool that is reliable and parsimonious, using a fewer number of hematological features, in comparison to the earlier study with meta-validation, based on sufficient sample size (n = 195554). Thus, current models can be applied at other demographic locations, preferably, with prior training of the model on the same population. Availability: https://covipred.bits-hyderabad.ac.in/home; https://github.com/debashreebanerjee/CoviPred.
Assuntos
COVID-19 , Aprendizado de Máquina , SARS-CoV-2 , Humanos , COVID-19/epidemiologia , COVID-19/sangue , COVID-19/diagnóstico , Itália/epidemiologia , Brasil/epidemiologia , Europa (Continente)/epidemiologia , SARS-CoV-2/isolamento & purificação , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Reprodutibilidade dos TestesRESUMO
BACKGROUND: This is a pioneering study on the assessment of a Brazilian municipality entire, comparing alcohol-based hand sanitizer consumption before and during the COVID-19 pandemic. Vilas-Boas et al reported a rise from 24.2mL/PD in 2018 to 46.6 in 2020, being for adult intensive care units the municipality exceeded most of the Brazilian states. However, observed a decline in some hospitals in 2021. OBJECTIVE: Compare alcohol-based hand sanitizer use in intensive care units in a municipality in São Paulo state, before and during the coronavirus pandemic. METHODS: Analytical retrospective study using indirect documentation, with data obtained from a notification spreadsheet for epidemiological indicators of healthcare-associated infection in the state. Data on monthly alcohol-based sanitizer use were collected from the intensive care units of public and private general hospitals of the municipality. Analysis was conducted using descriptive statistics and graphically with run charts. The Mann-Whitney test was applied to compare the median consumption of public and private hospitals, at a 5% significance level. RESULTS: Adult, neonatal and pediatric intensive care units showed median increases in hand sanitizer use of 34.03 to 57.64, 31.53 to 48.66 and 34.38 to 60.35mL/patient-day, respectively. Private hospitals showed greater hand sanitizer use in the adult and pediatric intensive care units compared to public institutions. CONCLUSION: The pandemic contributed to increasing hand sanitizer use in municipal intensive care units, but there is still room for improvement. More effort is needed to ensure that hand sanitizer use remains high.
Assuntos
COVID-19 , Higiene das Mãos , Higienizadores de Mão , Unidades de Terapia Intensiva , Pandemias , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Brasil/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Estudos Retrospectivos , Higiene das Mãos/estatística & dados numéricos , Pandemias/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , SARS-CoV-2 , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/epidemiologia , Desinfecção das Mãos , AdultoRESUMO
BACKGROUND: Magdalon et al. demonstrated that excluding iRAT grades from the final grade calculation of the course negatively impacted student performance and attendance in team-based learning sessions. INTRODUCTION: The COVID-19 pandemic necessitated a shift from in-person to remote learning, including team-based learning activities. Many studies have explored several aspects of team-based learning; however, there is still a lack of knowledge regarding the factors affecting students' attitudes and performance. OBJECTIVE: To evaluate the impact of the COVID-19 pandemic on medical students' performance in individual readiness assurance tests during team-based learning activities, given that their grades were excluded from the final course grades. METHODS: We compared the number of team-based learning applications, student absences, and individual readiness assurance tests grades of medical undergraduate students in three different scenarios: Group 1, in-person individual readiness assurance tests before the pandemic; Group 2, remote individual readiness assurance tests during the lockdown period when their grades were excluded from the final grade calculation; and Group 3, in-person individual readiness assurance tests during the pandemic after lockdown restrictions eased. RESULTS: Remote team-based learning led to significantly lower grades than in-person evaluations. Moreover, the number of students with failing or insufficient grades (below seven) increased during the remote learning period, when their grades were excluded from the final grade calculation, compared to in-person individual readiness assurance tests before the pandemic. Furthermore, absenteeism was higher when the online strategy was applied. CONCLUSION: We observed lower academic performance by medical students during remote team-based learning sessions, likely owing to the exclusion of individual readiness assurance tests grades from the final course grade calculations during the COVID-19 pandemic.
Assuntos
Desempenho Acadêmico , COVID-19 , Educação a Distância , Pandemias , Estudantes de Medicina , Humanos , Estudantes de Medicina/psicologia , Educação a Distância/métodos , Avaliação Educacional/métodos , Educação de Graduação em Medicina/métodos , Masculino , Feminino , SARS-CoV-2 , Brasil , Adulto JovemRESUMO
O Relatório Técnico de Imunização, 2023 apresenta os resultados obtidos em 2023 no contexto da Cooperação Técnica com o Brasil para a área de imunização, em todos os seus componentes operacionais e de gestão. Para o fortalecimento do Programa Nacional de Imunizações, foi ampliada a cooperação com parceiros, tais como sociedades científicas (Sociedade Brasileira de Imunização, Sociedade Brasileira de Pediatria, Sociedade Brasileira de Imunologia, Sociedade Brasileira de Medicina Tropical, entre outras), sociedade civil organizada (Fundação Rotary, Clube Rotary, Instituto Lado a Lado pela Vida, Instituto Questão de Ciência, Grupo Brasileiro de Tumores Ginecológicos etc.) e frentes parlamentares em prol da vacinação, com diversas ações para o fortalecimento da informação, da comunicação e do conhecimento baseado em vacinação. A gestão da imunização está alocada nas cinco prioridades da ECP 2022–2027 com suas respectivas áreas de foco, principalmente em: Proteger e promover a saúde da população, centrada nas pessoas, nas famílias e nas comunidades, especialmente aquelas em situação de vulnerabilidade; Recuperar, melhorar e tornar mais fortes os serviços de saúde e os programas prioritários impactados pela pandemia da Covid-19; e Reforçar a prevenção, a preparação, a resposta oportuna e a recuperação nas emergências e nos desastres, com a participação das comunidades afetadas. As outras duas prioridades intervêm da execução operacional do Programa de Imunizações por meio da Atenção Primária em Saúde para o fortalecimento do conhecimento e da pesquisa, o desenvolvimento da produção de vacinas e a compra mediante o Fundo Rotatório da OPAS, sendo alocadas respectivamente nas estratégias 3 e 4: Contribuir para o desenvolvimento de um SUS mais resiliente, equitativo e eficaz, de acordo com as necessidades de saúde da população; e Impulsionar a pesquisa, a inovação e a geração de conhecimentos científicos e tecnológicos em saúde, incluindo aqueles voltados à pesquisa, ao desenvolvimento e à produção de medicamentos, fitoterápicos e produtos tradicionais em saúde, vacinas, biotecnológicos e tecnologias em saúde.
Assuntos
Imunização , Vacinação , Doenças Preveníveis por Vacina , Cooperação Técnica , BrasilRESUMO
Our aim was to investigate respiratory viruses circulating in animals from the urban Atlantic Forest, which is located in the most densely populated area near Rio de Janeiro in Brazil. This study focused on the detection of Influenza A viruses and diverse coronaviruses, including SARS-CoV-2, in domestic and wild animals, including bats, nonhuman primates, rodents, and marsupials. From August 2020 to September 2022, biological samples were collected from a total of 72 pets, 66 primates, 20 rodents, 36 marsupials, and 390 bats. Samples were tested using RT-PCR for Influenza A and coronaviruses, and positive samples were sequenced. When blood samples were available, they were tested for SARS-CoV-2 antibodies. All terrestrial animals were negative for evidence of infection with SARS-CoV-2 and Influenza A viruses. However, samples from 17 phyllostomid bats, including Great fruit-eating bat (Artibeus lituratus), Silky short-tailed bat (Carollia brevicauda), Seba's short-tailed bat (Carollia perspicillata), Common big-eared bat (Micronycteris microtis), Greater spear-nosed bat (Phyllostomus hastatus), White-lined broad-nosed bat (Platyrrhinus lineatus), Little yellow-shouldered bat (Sturnira lilium), Greater round-eared bat (Tonatia bidens), and Common vampire bat (Desmodus rotundus), were positive for bat coronaviruses classified as Alphacoronavirus. Our study adds new information on the occurrence of coronaviruses in bats and contributes to a long-term program of Influenza surveillance. Developing active surveillance for viruses in wildlife species, as implemented in this study, is crucial for understanding zoonotic risks and preventing future global pandemics.
RESUMO
Objectives: The SARS-CoV-2 JN.1 lineage emerged in late 2023 and quickly replaced the XBB lineages, becoming the predominant Omicron variant worldwide in 2024. We estimate the epidemiologic impact of this SARS-CoV-2 lineage replacement in Brazil and we further assessed the cross-reactive neutralizing antibody (NAb) responses in a cohort of convalescent Brazilian patients infected during 2023. Methods: We analyzed the evolution of SARS-CoV-2 lineages and severe acute respiratory infection (SARI) cases in Brazil between July 2023 and March 2024. We evaluated the cross-reactive NAb responses to the JN.1 variant in a cohort of convalescent Brazilian patients before and after infection with XBB.1* lineages. Results: JN.1 replaced XBB with similar temporal dynamics across all country regions, although its epidemiologic impact varied between locations. The southeastern, southern, and central-western regions experienced a brief XBB wave around October 2023, shortly before the introduction of JN.1, without any immediate upsurge of SARI cases during viral lineage replacement. By contrast, the northeastern and northern regions did not experience an XBB wave in the latter half of 2023 and displayed a rapid surge in SARI cases driven by the emergence of the JN.1. We found that recent XBB infections in the Brazilian population significantly boosted cross-reactive NAb levels against JN.1. Conclusion: The XBB wave observed in the second half of 2023 in some Brazilian states likely acted as a booster for population immunity, providing short-term protection against JN.1 infections and delaying the rise of SARI cases in certain regions of the country.
RESUMO
Background: The angiotensin-converting enzyme 2 (ACE2) and the transmembrane serine protease 2 (TMPRSS2) are central human molecules in the SARS-CoV-2 virus-host interaction. Evidence indicates that ACE1 may influence ACE2 expression. This study aims to determine whether ACE1, ACE2, and TMPRSS2 mRNA expression levels, along with the ACE1 Alu 287 bp polymorphism (rs4646994), contribute to the severity and mortality of COVID-19. Methods: Swabs were collected in two Brazilian cities in 2020: Belo Horizonte (n = 134) and Rio de Janeiro (n = 41). A swab of mild patients in Rio de Janeiro who were not hospitalized (n = 172) was also collected. All analyzed biological material was obtained from residual diagnostic samples in 2020, prior to the emergence of SARS-CoV-2 variants of concern. ACE1, ACE2, TMPRSS2, and B2M (reference gene) expression levels were evaluated in 40 cycles of quantitative PCR. ACE1 Alu 287 bp polymorphism was genotyped using the FastStart Universal SYBR Green Master kit. Results: The median age differed between clinical sites (p = 0.016), but no difference in median days of hospitalization was observed (p = 0.329). Age was associated with severity (p = 0.014) and mortality (p = 0.014) in the Belo Horizonte cohort. No alteration in ACE1, ACE2 and TMPRSS2 expression was associated with severity or mortality. ACE1 polymorphism rs4646994 did not influence the likelihood of either outcome. A meta-analysis including available data from the literature showed significant effects: the D-allele conferred risk (OR = 1.39; 95% CI [1.12-1.72]).
Assuntos
Enzima de Conversão de Angiotensina 2 , COVID-19 , Peptidil Dipeptidase A , SARS-CoV-2 , Serina Endopeptidases , Índice de Gravidade de Doença , Humanos , COVID-19/genética , COVID-19/mortalidade , COVID-19/virologia , Serina Endopeptidases/genética , Serina Endopeptidases/metabolismo , Enzima de Conversão de Angiotensina 2/genética , Enzima de Conversão de Angiotensina 2/metabolismo , Masculino , Feminino , Pessoa de Meia-Idade , Peptidil Dipeptidase A/genética , Brasil/epidemiologia , Idoso , Adulto , Hospitalização/estatística & dados numéricos , Polimorfismo Genético/genéticaRESUMO
Objectives: To investigate the prevalence of nine respiratory viruses and their clinical characteristics in children aged up to 5 years old in the state of Sergipe, Northeast of Brazil in the pre-COVID-19 pandemic period. Methods: Children with suspected influenza virus infection were included in the study. Clinical samples were screened using real-time quantitative polymerase chain reaction for the diagnosis of adenovirus, parainfluenza (PIV)1, PIV2, PIV3, and human metapneumovirus. In addition, data were collected for influenza A viruses (H1N1 and H3N2), influenza B virus, and respiratory syncytial virus. Results: From January 2018 to December 2019, 1081 samples were selected. Of these, 64.1% (n = 693) were positive for at least one of the nine screened respiratory viruses. The most prevalent etiologic agent in the study period was respiratory syncytial virus, detected in 31.8% (344 of 1081) of cases, and the least prevalent was the influenza B virus, detected in 0.6% (six of 1081) of cases. Single infections were found in 85.5% (594 of 693) of the cases, whereas 14.4% (100 of 693) had coinfections. There was no correlation when comparing reported signs and symptoms with real-time quantitative polymerase chain reaction positivity and the type of virus detected. The study highlights the importance of monitoring the etiological agents responsible for respiratory infections in children before the COVID-19 pandemic.
RESUMO
BACKGROUND: Neurological manifestations associated with COVID-19 remain partially described, mainly in low- and middle-income countries where diagnostic tools are limited. To address this, we assembled medical centers in Brazil with the goal of describing neurological syndromes associated with COVID-19 during the first wave of the pandemic. METHODS: From June 1st, 2020 to June 1st, 2021, non-consecutive adult patients with new onset of six neurological syndromes up to 60 days after confirmed COVID-19 were included. Data were compiled from four tertiary centers and compared with general local COVID-19 data, as well as with a previous cohort focused on vascular syndrome. RESULTS: 197 patients were included, presenting with vascular syndromes (81), encephalopathy (68), encephalitis (19), Guillain-Barré syndrome (13), other neuropathies (12), and myelitis (4). The incidence curve of neurocovid mirrored that of COVID-19. Neurological syndromes were present regardless of COVID-19 severity. The median time from COVID-19 to onset of neurological symptoms was 14 days, suggesting a post-infectious immune-mediated mechanism. Patients were 10 times more likely to die (χ2 (1) = 356.55, p < 0.01, OR = 10.89) and 38 times more likely to be hospitalized than other COVID-19 patients (χ2 (1) = 1167.9, p < 0.01, OR = 38.22). Those developing vascular syndromes patients were 3 times more likely to require ICU (χ2 (1) = 37.12, p < 0.01, OR = 3.78) and 4 times more likely to die (χ2 (1) = 58.808, p < 0.01, OR = 4.73) than patients with vascular syndromes due to different etiologies. CONCLUSIONS: Our study corroborates the association of neurological syndromes with COVID-19. The incidence correlated with local waves of COVID-19, and patients with neurocovid exhibited a higher susceptibility to adverse outcomes compared to other COVID-19 patients. Among all neurological syndromes, vascular syndromes were the most common, and their severity surpassed that of vascular syndromes not attributed to COVID-19.
Assuntos
COVID-19 , Doenças do Sistema Nervoso , SARS-CoV-2 , Humanos , COVID-19/complicações , COVID-19/epidemiologia , Brasil/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/virologia , Doenças do Sistema Nervoso/etiologia , Adulto , Idoso , Síndrome de Guillain-Barré/epidemiologia , IncidênciaRESUMO
BACKGROUND: Urban arboviruses pose a significant global burden, particularly in tropical regions like Brazil. São Sebastião, a lower-middle-class urban area just 26 km from the Brazilian capital, is an endemic area for dengue. However, asymptomatic cases may obscure the actual extent of the disease. In this study, we measured the seroprevalence of dengue, Zika virus, and chikungunya, and compared these findings with surveillance data. METHODS: A cross-sectional study was conducted involving 1,535 households. ELISA serological tests were performed to detect IgM and IgG antibodies against dengue, Zika virus, and chikungunya. History of previous exposure to arboviruses, data on age, gender, and education level were collected through a questionnaire. Participants who tested positive for IgM and/or IgG were classified as soropositive. Statistical analyses included tests for normality, associations, mean comparisons, and correlations. Positive serological results were compared with cases captured by local epidemiological surveillance. RESULTS: The study included 1,405 individuals, divided into two groups related to pre-pandemic and pandemic COVID-19 phases. Among participants, 0.7% to 28.8% self-reported history of dengue, Zika, or chikungunya. However, the estimated overall seroprevalence was 64.3% (95% CI: 61.8-66.7) for dengue virus, 51.4% (95% CI: 48.8-53.9) for Zika virus, and 5.4% (95% CI: 4.4-6.7) for chikungunya virus. Multiple arboviruses were noted at 4.0% (95% CI: 3.1-5.1). Advancing age and lower education were associated with higher exposure to arboviruses (p < 0.05). The estimated number of urban arboviral infections was 84 times higher than reported cases. CONCLUSIONS: The large gap between seroprevalence estimates and cases captured by epidemiological surveillance suggests a silent circulation of arboviruses, highlighting the need for comprehensive serological surveys in endemic regions. Addressing these discrepancies is crucial for effective resource allocation and implementation of public health interventions.
Assuntos
Anticorpos Antivirais , Febre de Chikungunya , Dengue , Infecção por Zika virus , Zika virus , Humanos , Estudos Soroepidemiológicos , Brasil/epidemiologia , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/sangue , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/sangue , Febre de Chikungunya/virologia , Masculino , Feminino , Estudos Transversais , Adulto , Pessoa de Meia-Idade , Adolescente , Dengue/epidemiologia , Dengue/sangue , Adulto Jovem , Criança , Zika virus/imunologia , Anticorpos Antivirais/sangue , Pré-Escolar , Vírus Chikungunya/imunologia , Vírus da Dengue/imunologia , Idoso , Imunoglobulina M/sangue , Lactente , Imunoglobulina G/sangue , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Annual estimates of seasonal influenza vaccine effectiveness can guide global risk communication and vaccination strategies to mitigate influenza-associated illness. We aimed to evaluate vaccine effectiveness in countries using the 2023 southern hemisphere influenza vaccine formulation. METHODS: We evaluated end-of-season influenza vaccine effectiveness across eight countries (Argentina, Australia, Brazil, Chile, New Zealand, Paraguay, Thailand, and Uruguay) that used the 2023 southern hemisphere vaccine formulation, with use of a test-negative design. All patients who attended participating hospitals with severe acute respiratory illness were tested by RT-PCR for influenza. We calculated country-specific, network-specific, and pooled vaccine effectiveness against hospitalisation. For countries with sufficient data, we also calculated vaccine effectiveness against intensive care unit (ICU) admission by comparing the odds of vaccination among test-positive cases to that among test-negative controls. We evaluated vaccine effectiveness for groups prioritised for vaccination (young children aged 1-4 years, people aged 5-64 years with underlying health conditions, and older adults aged ≥65 years). FINDINGS: From March 5 to Nov 27, 2023, 31â368 individuals were admitted to hospital with severe acute respiratory infection in the eight included countries. Of these, 12â609 individuals admitted to hospital (6452 [51·2%] female and 6157 [48·8%] male) who met inclusion criteria and had complete data were included in the analysis, including 4388 test-positive cases and 8221 test-negative controls. Pooled vaccine effectiveness against hospitalisation with any influenza virus was 51·9% (95% CI 37·2-66·7), with substantial heterogeneity across countries (I2 74%). Vaccine effectiveness against ICU admission from any influenza virus was 67·7% (44·5-81·2) in Chile and 69·7% (45·3-83·3) in Australia. Vaccine effectiveness estimates against hospitalisation were highest for young children (70·9% [47·5-94·4]) and lowest for older adults (47·7% [24·9-70·5]). INTERPRETATION: Across eight countries, 2023 southern hemisphere vaccines were effective in reducing hospitalisations from influenza illness. Use of common protocols can facilitate data pooling to provide a comprehensive evaluation of vaccine effectiveness across settings. FUNDING: US Centers for Disease Control and Prevention cooperative agreements to the Pan American Health Organization and the Thailand Ministry of Public Health; the Australian Government Department of Health and Aged Care; and the New Zealand Ministry of Health.
Assuntos
Vacinas contra Influenza , Influenza Humana , Humanos , Influenza Humana/prevenção & controle , Influenza Humana/epidemiologia , Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/imunologia , Pessoa de Meia-Idade , Adulto , Adolescente , Idoso , Criança , Pré-Escolar , Masculino , Adulto Jovem , Feminino , Lactente , Eficácia de Vacinas , Chile/epidemiologia , Hospitalização/estatística & dados numéricos , Austrália/epidemiologia , Nova Zelândia/epidemiologia , Argentina/epidemiologia , Tailândia/epidemiologia , Brasil/epidemiologiaRESUMO
Emerging infectious disease agents represent pathogens that may evade current screening protocols while posing significant transfusion transmission risks regionally. This study investigated the prevalence of SARS-CoV-2 and other respiratory viruses among 633 blood donors at the MT-Hemocentro from November 2021 to February 2023. Nucleic acid obtained from nasopharyngeal swabs were tested by RT-qPCR for SARS-CoV-2, RSV, FLU-A, and FLU-B. Serum from positive samples was also tested for nucleic acid. The prevalence of SARS-CoV-2 was 6.48 % (41/633); 2 of the 41 blood donors had SARSCoV-2 detectable in their serum. All positive samples were collected between January 2022 and March 2023, coinciding with the third epidemic wave in Brazil; 97.6 % of these SARS-CoV-2-positive donors were vaccinated with at least two doses. SARS-CoV-2 genomes recovered from six nasopharyngeal samples were classified into BA.1.1.1, BA.1.14.1, BA.2, BA.5.1, BA.5.2.1 sublineages. Phylogeographic analysis across Brazil's five regions revealed that the Northeast acted as the main exporter of Omicron sublineages, while the South and Southeast regions were more frequently importers.
RESUMO
INTRODUCTION: This study compared outcomes of patients with acute limb ischemia (ALI) before, during, and after the COVID-19 pandemic, hypothesizing that poor outcomes observed during the pandemic have not yet been resolved. METHODS: This retrospective, observational, single-center study analyzed ALI patients from 2019 to 2023. RESULTS: Over five years, 298 patients underwent surgery for ALI at our hospital: 35 had COVID-19 (COVID Group), 132 tested negative (Non-COVID Group), 71 were treated before the pandemic (Pre-COVID Group), and 60 after (Post-COVID Group). In 2020, 32% of ALI patients had COVID-19, a percentage that decreased over time. Baseline characteristics shifted, influencing treatment. The Pre-COVID Group had more cardiac disease with embolic ALI and required mainly embolectomy; the COVID Group had worse clinical conditions, undergoing embolectomy or amputation. The Post-COVID Group had more thrombotic ALI, with increased bypass surgery needs. Prolonged ischemia time was a concern during the entire study; 29% of patients presented with Rutherford III ischemia at admission, and 35.2% required major amputations. COVID Group had higher mortality (48.6% vs. 15.5% Pre-COVID, 22.7% Non-COVID, and 28.3% Post-COVID, P=0.003). Additional factors contributing to mortality included older age (OR 1.05 CI 1.02-1.08, P<0.001), prior stroke (OR 2.38, CI 1.07-5.38, P<0.001), COPD (OR 1.88, CI 0.53-6.59, P=0.03), and aorto-iliac ALI (OR 8.72, CI 1.25-22.63, P<0.01). CONCLUSION: Delayed presentations of ALI patients persisted before, during, and after the pandemic, resulting in many cases of irreversible ischemia at admission and increased amputation rates. Mortality rates correlated with COVID-19, older age, COPD, prior stroke, and aorto-iliac involvement.
RESUMO
The PM2.5/PM10 ratio is a metric used to distinguish the primary sources of particulate matter (PM) within a given environment. Higher ratios often indicate significant contributions from anthropogenic sources, while smaller ratios suggest a substantial influence from natural origins. However, various contextual factors can influence this ratio. Our study aimed to investigate the PM2.5/PM10 ratio in four distinct Brazilian cities, each characterized by varying levels of urbanization and primary economic activities. Additionally, we explored meteorological variables that may influence PM behavior across the years and different seasons. Our main finding reveals an association between the spatial distribution of PM and the primary economic activities in the investigated cities, with the highest PM2.5/PM10 ratio observed in the city engaged in coal activities, even though it did not exhibit the highest levels of PM. Conversely, coastal cities showed the lowest ratios. Furthermore, we observed that meteorological conditions also play a significant role in influencing PM behavior, with wind speed and the UV index emerging as the most influential meteorological parameters affecting this ratio. A subtle increase in PM2.5/PM10 ratios was noted in the fourth and fifth years of investigation across all cities, suggesting a potential impact from the restriction measures and the subsequent resumption of activities related to the COVID-19 pandemic in the region. However, these ratios stabilized in the post-pandemic years, returning to patterns similar to those observed pre-pandemic. Moreover, winter consistently exhibited the highest PM2.5/PM10 ratio across all cities, also being the season with the highest levels of both PM10 and PM2.5. Beyond providing important information about PM behavior in the evaluated scenarios, our findings emphasize the necessity of considering meteorological and economic factors in studies of this nature.
Assuntos
Poluentes Atmosféricos , Poluição do Ar , Cidades , Monitoramento Ambiental , Material Particulado , Brasil , Material Particulado/análise , Poluentes Atmosféricos/análise , Poluição do Ar/estatística & dados numéricos , Conceitos Meteorológicos , Estações do Ano , Urbanização , COVID-19/epidemiologiaRESUMO
This article aimed to analyze the epidemiological and toxicological profile of died of suicides in the state of Santa Catarina, Brazil, over a period of 6 years, and understand how the COVID-19 pandemic influenced it. A cross-sectional, quantitative, descriptive, and retrospective study was conducted based on the suicide cases registered in the Scientific Police of Santa Catarina over six years. A total of 3,557 cases were analyzed, with small variations being observed between the years in question. The victims were predominantly male (79.73%) and adults, most of whom were aged 50 to 59 (14.76%). In 43.18% of cases, at least one psychoactive substance was identified, with antidepressants (20.65%), anxiolytics (18.48%), and cocaine (13.35%) standing out. In most cases (72.52%), the alcohol concentration was less than 1 dg/L. The use of medication, drugs, and alcohol before suicide was more prevalent in women (p < 0.05), whereas cocaine was more prevalent among men (p < 0.05). The data characterize the epidemiological profile of suicide victims, in addition to demonstrating the low variations in the number of suicides comparing the year with the COVID-19 Pandemic and without a pandemic, in the short term.