Burden of COVID-19 during the omicron predominance in Brazil: a nationwide retrospective database study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has imposed significant burden on Brazil's health system. This study aimed to examine clinical characteristics, overall vaccine uptake, and to assess healthcare resource utilization (HCRU) and costs associated with acute COVID-19 in Brazil during the Omicron predominant period. METHODS: A nationwide retrospective study was conducted using various Brazilian databases including, COVID-19 related databases, public health systems, and other surveillance/demographic datasets. Individuals with positive COVID-19 test results between January 1 2022 and April 30 2022, during Omicron BA.1/BA.2 wave, were identified. Patients' demographics, vaccine uptake, HCRU and corresponding costs were described by age groups. RESULTS: A total of 8,160,715 (3.80%) COVID-19 cases were identified in the study cohort, ranging from 2.43% in <5 years to 62.05% in 19-49 years. The uptake of partial (Dose 1) or full immunization (Dose 2) was less than 0.1% in children aged <5 years, whereas in individuals ≥ 19 years, it exceeded 89.78% for Dose 1 and 84.07% for Dose 2. Overall booster vaccine uptake was 38.06%, which was significantly higher among individuals aged ≥ 65 years, surpassing 74.79%. Regardless of vaccination status, 87.2% cases were symptomatic, and 1.48% were hospitalized due to acute COVID-19 (<5 years: 2.33%, 5-11 years: 0.99%, 12-18 years: 0.32%, 19-49 years: 0.40%; 50-64 years: 1.50%, 65-74 years: 5.43%, and ≥ 75 years: 17.89%). Among the hospitalized patients (n = 120,450), 32.57% were admitted to ICU, of whom 31,283 (79.75%) individuals required mechanical ventilation (MV) support. The average cost per day in normal ward and ICU without MV in public/general hospital settings was $104.36 and $302.81, respectively. While average cost per day in normal ward and ICU with MV was $75.91 and $301.22 respectively. CONCLUSIONS: This study quantified the burden of COVID-19 in Brazil, suggesting substantial healthcare resources required to manage the COVID-19 pandemic.

Using Thermomechanical Properties to Reassess Particles' Dispersion in Nanostructured Polymers: Size vs. Content.

Nanoparticle-filled polymers (i.e., nanocomposites) can exhibit characteristics unattainable by the unfilled polymer, making them attractive to engineer structural composites. However, the transition of particulate fillers from the micron to the nanoscale requires a comprehensive understanding of how particle downsizing influences molecular interactions and organization across multiple length scales, ranging from chemical bonding to microstructural evolution. This work outlines the advancements described in the literature that have become relevant and have shaped today's understanding of the processing-structure-property relationships in polymer nanocomposites. The main inorganic and organic particles that have been incorporated into polymers are examined first. The commonly practiced methods for nanoparticle incorporation are then highlighted. The development in mechanical properties-such as tensile strength, storage modulus and glass transition temperature-in the selected epoxy matrix nanocomposites described in the literature was specifically reviewed and discussed. The significant effect of particle content, dispersion, size, and mean free path on thermomechanical properties, commonly expressed as a function of weight percentage (wt.%) of added particles, was found to be better explained as a function of particle crowding (number of particles and distance among them). From this work, it was possible to conclude that the dramatic effect of particle size for the same tiny amount of very small and well-dispersed particles brings evidence that particle size and the particle weight content should be downscaled together.

Prognostic role of renal replacement therapy among hospitalized patients with heart failure in the Brazilian national public health system.

Introduction: Data on patients hospitalized with acute heart failure in Brazil scarce. Methods: We performed a cross-sectional, retrospective, records-based study using data retrieved from a large public database of heart failure admissions to any hospital from the Brazilian National Public Health System (SUS) (SUS Hospital Information System [SIHSUS] registry) to determine the in-hospital all-cause mortality rate, in-hospital renal replacement therapy rate and its association with outcome. Results: In total, 910,128 hospitalizations due to heart failure were identified in the SIHSUS registry between April 2017 and August 2021, of which 106,383 (11.7%) resulted in in-hospital death. Renal replacement therapy (required by 8,179 non-survivors [7.7%] and 11,496 survivors [1.4%, p < 0.001]) was associated with a 56% increase in the risk of death in the univariate regression model (HR 1.56, 95% CI 1.52 -1.59), a more than threefold increase of the duration of hospitalization, and a 45% or greater increase of cost per day. All forms of renal replacement therapy remained independently associated with in-hospital mortality in multivariable analysis (intermittent hemodialysis: HR 1.64, 95% CI 1.60 -1.69; continuous hemodialysis: HR 1.52, 95% CI 1.42 -1.63; peritoneal dialysis: HR 1.47, 95% CI 1.20 -1.88). Discussion: The in-hospital mortality rate of 11.7% observed among patients with acute heart failure admitted to Brazilian public hospitals was alarmingly high, exceeding that of patients admitted to North American and European institutions. This is the first report to quantify the rate of renal replacement therapy in patients hospitalized with acute heart failure in Brazil.

Cement replacement by sugar cane bagasse ash: CO2 emissions reduction and potential for carbon credits.

This paper presents a study of cement replacement by sugar cane bagasse ash (SCBA) in industrial scale aiming to reduce the CO(2) emissions into the atmosphere. SCBA is a by-product of the sugar/ethanol agro-industry abundantly available in some regions of the world and has cementitious properties indicating that it can be used together with cement. Recent comprehensive research developed at the Federal University of Rio de Janeiro/Brazil has demonstrated that SCBA maintains, or even improves, the mechanical and durability properties of cement-based materials such as mortars and concretes. Brazil is the world's largest sugar cane producer and being a developing country can claim carbon credits. A simulation was carried out to estimate the potential of CO(2) emission reductions and the viability to issue certified emission reduction (CER) credits. The simulation was developed within the framework of the methodology established by the United Nations Framework Convention on Climate Change (UNFCCC) for the Clean Development Mechanism (CDM). The State of São Paulo (Brazil) was chosen for this case study because it concentrates about 60% of the national sugar cane and ash production together with an important concentration of cement factories. Since one of the key variables to estimate the CO(2) emissions is the average distance between sugar cane/ethanol factories and the cement plants, a genetic algorithm was developed to solve this optimization problem. The results indicated that SCBA blended cement reduces CO(2) emissions, which qualifies this product for CDM projects.

PRE-PLANNING ANKLE ARTHRODESIS USING 3D RECONSTRUCTED TOMOGRAPHIES.

OBJECTIVE: To implement one analysis method of the ankle bone contour that could make a more precise ankle arthrodesis. METHODS: Twenty tomographies were submitted to 3D reconstruction. Seven points of anatomic interest for ankle arthrodesis with the three screws technique were marked with a triplannar marker. The median of the position of markers was estimated, and the union of the seven median points allow the construction of one median ankle for that population. Using this median ankle, sizes and angles for the screws position were determined. RESULTS: Two median ankles were reconstructed, left and right. The position of the screw passage were determined considering the anatomical parameters. In the right ankle the lateral to medial screw should enter 4.56 cm and 0.79 above and posterior to lateral malleolus, with one inclination of 17.34° in relation to tibial longitudinal axis; and 0° in relation to tibial axial plane. The position for the other two screws is also described. CONCLUSION: Our article is the first to presents one precise guide for ankle arthrodesis based on a populational assessment. Level of evidence II, Diagnostic Studies.

OBJETIVO: Implementar método de análise do contorno e alinhamento ósseos no tornozelo de uma população normal, possibilitando uma artrodese tibiotársica mais precisa. MÉTODOS: Tomografias de vinte tornozelos foram submetidas à reconstrução 3D. Nesses exames, 7 pontos anatômicos de interesse para a técnica de fixação com 3 parafusos foram identificados e marcados com indicadores da posição triplanar. As médias das localizações de cada ponto foram calculadas. A união dessas médias permitiu a reconstrução de um tornozelo padrão daquela população. Nesses tornozelos médios estudou-se os comprimentos e ângulos para a passagem dos parafusos. RESULTADOS: Dois tornozelos, direito e esquerdo, foram reconstruídos. A posição para a passagem dos parafusos em relação a parâmetros anatômicos foi determinada. Para o tornozelo direito, a passagem do parafuso de lateral para medial deve ocorrer com o ponto de entrada 4,56 cm acima e 0,79 cm posterior à ponta do maléolo lateral, com inclinação de 17,34° em relação ao eixo longitudinal e 0° em relação ao eixo axial da tíbia. As posições dos outros dois parafusos também estão descritas. CONCLUSÃO: Esse é o primeiro trabalho que apresenta um guia preciso para realização da artrodese do tornozelo, baseado em um estudo populacional. Nível de evidência II, Estudos Diagnósticos.

Pozzolanic properties of ultrafine sugar cane bagasse ash produced by controlled burning.

This paper evaluated the feasibility of using residual sugar cane bagasse ash with a high carbon content (as-received SCBA) as raw material to produce a pozzolan after controlled recalcination and grinding. Initially, the as-received SCBA was re-burned using rotary (continuous) and muffle (batch) kilns, both at 600 °C for 1 h. Next, the resulting ash was ground in a closed-circuit ball mill with an air classifier system to obtain a product with 50% passing particle size of approximately 10 µm (SCBA600). SCBA600 was then characterized in terms of oxide composition, loss on ignition, density, specific surface area, and pozzolanic activity. A hydration study was carried out using isothermal calorimetry, thermogravimetric analysis and mercury intrusion porosimetry. Additionally, the performance of SCBA600 in mortars was evaluated by axial compression tests. The combination of recalcination at 600 °C, low-energy ultrafine grinding of the material and classification resulted in pozzolanic SCBA. The results also showed that including SCBA600 in cement mortars reduced total accumulated heat and portlandite content in cement-based pastes, in addition to refining pore structure and significantly increasing compressive strength after 3 days of curing.

Pre-planning ankle arthrodesis using 3d reconstructed tomographies / Desenvolvimento da artrodese do tornozelo baseada na tomografia com reconstrução 3d

ABSTRACT Objective: To implement one analysis method of the ankle bone contour that could make a more precise ankle arthrodesis. Methods: Twenty tomographies were submitted to 3D reconstruction. Seven points of anatomic interest for ankle arthrodesis with the three screws technique were marked with a triplannar marker. The median of the position of markers was estimated, and the union of the seven median points allow the construction of one median ankle for that population. Using this median ankle, sizes and angles for the screws position were determined. Results: Two median ankles were reconstructed, left and right. The position of the screw passage were determined considering the anatomical parameters. In the right ankle the lateral to medial screw should enter 4.56 cm and 0.79 above and posterior to lateral malleolus, with one inclination of 17.34° in relation to tibial longitudinal axis; and 0° in relation to tibial axial plane. The position for the other two screws is also described. Conclusion: Our article is the first to presents one precise guide for ankle arthrodesis based on a populational assessment. Level of evidence II, Diagnostic Studies.

RESUMO Objetivo: Implementar método de análise do contorno e alinhamento ósseos no tornozelo de uma população normal, possibilitando uma artrodese tibiotársica mais precisa. Métodos: Tomografias de vinte tornozelos foram submetidas à reconstrução 3D. Nesses exames, 7 pontos anatômicos de interesse para a técnica de fixação com 3 parafusos foram identificados e marcados com indicadores da posição triplanar. As médias das localizações de cada ponto foram calculadas. A união dessas médias permitiu a reconstrução de um tornozelo padrão daquela população. Nesses tornozelos médios estudou-se os comprimentos e ângulos para a passagem dos parafusos. Resultados: Dois tornozelos, direito e esquerdo, foram reconstruídos. A posição para a passagem dos parafusos em relação a parâmetros anatômicos foi determinada. Para o tornozelo direito, a passagem do parafuso de lateral para medial deve ocorrer com o ponto de entrada 4,56 cm acima e 0,79 cm posterior à ponta do maléolo lateral, com inclinação de 17,34° em relação ao eixo longitudinal e 0° em relação ao eixo axial da tíbia. As posições dos outros dois parafusos também estão descritas. Conclusão: Esse é o primeiro trabalho que apresenta um guia preciso para realização da artrodese do tornozelo, baseado em um estudo populacional. Nível de evidência II, Estudos Diagnósticos.

Satisfação de médicos no trabalho da atenção primária à saúde / Satisfaction of physicians working in primary health care

Neste estudo avaliou-se a satisfação no trabalho dos médicos da Atenção Primária de uma capital do sul do Brasil. Foram entrevistados quinze médicos de Unidades de Saúde. As principais motivações citadas para atuarem na Atenção Primária foram a estabilidade do emprego público, a dificuldade de se estabelecer na iniciativa privada e a defesa do direito universal à saúde. As principais questões geradoras de insatisfação relacionaram-se ao elevado número de consultas, falta de respaldo dos níveis secundário e terciário de atenção à saúde, limitações da autonomia decisória, desgaste físico e emocional, baixa resolubilidade dos serviços, desvalorização perante aos colegas e opinião pública.

This study assessed work satisfaction among Primary Health Care doctors from a capital city in Southern Brazil. Fifteen physicians from Basic Health Units were interviewed. The main motivations cited for working in Primary Health Care were the stability of the public service job, the difficulty of establishing a career in the private sector, and the defense of the universal right to health access. The main points that generated dissatisfaction were related to the high number of appointments per working hour, lack of support from the secondary and tertiary health care levels, limited decision-making autonomy, elevated physical and emotional distress, low resolution capability of health services, and lack of esteem from colleagues and society.

Ensaio biomecânico da túnica albugínea bovina conservada em glicerina 98% para utilização como membrana biológica / Biomechanical test of bovine tunica albuginea preserved in 98% glycerin for use as a biological membrane

As membranas biológicas são biomateriais de origem orgânica, geralmente constituídas por colágeno. São utilizadas em diversos fins, dependendo da característica de cada material conservado. A túnica albugínea está sendo mais utilizada atualmente como uma membrana biológica e suas características ainda precisam ser estudadas. O objetivo deste trabalho foi avaliar as características estruturais relacionadas à biomecânica da túnica albugínea bovina conservada em glicerina 98% para utilização como membrana biológica. Para a análise da influência da idade do animal doador sobre a resistência da membrana, foram separados dois grupos. Foram testadas 34 amostras, sendo 17 amostras de membranas oriundas de animais com até um ano e onze meses de idade e o mesmo número de amostras oriundas de animais com idade entre dois e quatro anos. Sendo assim, formou-se um subgrupo com corpos de prova testados a partir de um corte transversal ao sentido longitudinal da membrana com 12 amostras, e outro constituído por corpos de prova testados a partir de cortes feitos na direção longitudinal da membrana, também com 12 amostras. Os resultados de resistência à tração não mostraram diferenças entre os grupos em nenhuma das comparações.

The biological membranes are biomaterials formed by structures of organic origin, usually collagen. They are used for many purposes depending on the characteristics of this material. The tunica albuginea is being used recently as a biological membrane and its characteristics however need to be studied and discussed. The aim of this study was to evaluate the structural features related to the biomechanics of bovine túnica albugínea preseved in 98% glycerin for use as a biological membrane. To analyze the influence of age on the resistance of the membrane, they were separated in two groups. There were tested 34 samples, 17 samples of membranes from animals up to one year and eleven months and 17 samples from animals with two until four years old. Two groups were formed in order to sense the correlation of membrane tension and resistance of the material. Thus was formed a sub-group with specimens tested from a longitudinal cross-section of the membrane with 12 samples and another sub-group composed of samples tested from cuts made in the longitudinal direction of the membrane with 12 samples. The results of tensile strength test did not show differences between groups in any of the comparisons.