Influence of Mechanical Cycling on Torque Values of Tapped-In and Screw-In Implant-Supported Crowns.

This study investigated the influence of mechanical cycling on screwed-in and tappedin implants restored with screw-retained metallic crowns. Three implant-abutmentcrown systems were evaluated: T1 (multi abutment) and T2 (standard abutment) received tapped-in abutments and S received a screwed-in abutment. The specimens were subjected to two million cycles of 0-150 N load, at 2 Hz, 30° inclination in a dry medium, and torque evaluation. Survival and removal torque were analyzed using chisquare, ANOVA, followed by Tukey's test. Differences between installation and removal torque were determined using a T-test for dependent samples. Analyses were performed in SPSS, considering α = 0.05. All specimens survived mechanical cycling in S, 40% in T1, 80% in T2 (p=0.008). Failures occurred due to loosening of the crown screw. A significant decrease in torque (p=0.000) was found. Group T1 had the lowest removal torque (1.6 ± 0.84 N.Cm²), followed by T2 (3 ± 1.49 N.Cm²) and S (6.3 ± 1.16 N. Cm²), and a statistical difference was found between Groups T1 and S. Both types of implantabutment connections were stable and can be considered for rehabilitative treatment, but failure and removal torque were influenced by the design of prosthetic abutment. Crowns were more susceptible to becoming loose in tapped-in systems.

Lifestyle improvement reduces the consumption of ultra-processed foods in adults with metabolic syndrome.

BACKGROUND AND AIMS: The high consumption of ultra-processed products is a concern because it is positively associated with the incidence of chronic non-communicable diseases, as metabolic syndrome (MetS). The aim is to evaluate the effects of three different interventions to modify lifestyle on the consumption of ultra-processed foods in adults with MetS. METHODS AND RESULTS: This was a randomized clinical trial, in which the participants were divided into three groups: Standard Intervention (SI), Group Intervention (GI) and Individual Intervention (II). The interventions were carried out over a three-month period and the data was collected in a 24-h food record, taken at the beginning and end of the intervention. The food they ate was classified into four groups according to the degree of processing (unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods) in accordance with the NOVA food classification. Seventy adults took part in the study with a mean age of 51.2 ± 6.6 years old; most of whom were female (55.7%). The amount of ultra-processed food consumed by the three groups (SI, GI and II) was significantly reduced (46%, 34%, and 33%, respectively). The amount of processed food consumed only reduced in the II group. The Total Energy Value (TEV) consumed by the SI and II groups decreased. CONCLUSIONS: The interventions that were intended to alter lifestyles were able to reduce the amount of ultra-processed food consumed, which can have an impact on the prevention and treatment of MetS. REGISTRATION: registered in the Brazilian Registry of Clinical Trials, ReBEC, under number: RBR-9wz5fc.

Community of Monogenea in Populations of Cichla Monoculus from Two Tributaries of the Amazon River in the Northern Brazil.

This study compared the monogeneans community in C. monoculus from the Tapajós River (state of Pará) and Jari River (state of Amapá), northern Brazil. A total of 2188 monogeneans belonging to eight taxa were collected from the gills of fish: Gussevia arilla, Gussevia longihaptor, Gussevia tucunarense, Gussevia undulata, Sciadicleithrum ergensi, Sciadicleithrum umbilicum, Sciadicleithrum uncinatum and Tucunarella cichlae. Gussevia arilla was the dominant species for C. monoculus from the Tapajós River basin, while S. umbilicum predominated among the hosts from the Jari River basin. For the two populations of C. monoculus, the prevalence, mean intensity and mean abundance of monogeneans were different and the of parasites community had a high qualitative similarity (87.5 %). The monogeneans community of C. monoculus was characterized by high species richness, with infection values varying from low to moderate. The geographic distance and differences in environmental characteristics arising from the same did not influence the richness of species of monogeneans infesting C. monoculus in the Tapajós and Jari rivers, but appear to have been determinants in the differences observed in the structure of the monogenean communities in each region.

Comparison of The Endoparasite Fauna of Hoplias Malabaricus and Hoplerythrinus Unitaeniatus (Erythrinidae), Sympatric Hosts in the Eastern Amazon Region (Brazil).

Hoplias malabaricus and Hoplerythrinus unitaeniatus are Erythrinidae family widely distributed in the Amazon River system of great value to both commercial and subsistence fishing for riverine populations. As such, the objective of the present study was to investigate the endoparasite communities of H. malabaricus and H. unitaeniatus of a tributary of the Amazon River in the north of Brazil. The endoparasite communities of H. unitaeniatus and H. malabaricus were taxonomically similar (85%) and consisted of Clinostomum marginatum, Contracaecum sp., Guyanema seriei seriei, Procamallanus (Spirocamallanus) inopinatus, Pseudoproleptus sp. and Gorytocephalus spectabilis, although the dominant endoparasite was C. marginatum, which was the most prevalent and abundant. All the specimens of both H. malabaricus and H. unitaeniatus were parasitized, with a total of 1237 helminths collected in the former host and 1151 helminths collected in the latter. Hoplerythrinus unitaeniatus possessed greater parasite species richness. Both hosts had an aggregate dispersion of parasites, and the abundance of C. marginatum, Contracaecum sp. and G. spectabilis correlated positively with the weight and length of the hosts. The condition factor was not affected by parasitism, but the abundance of C. marginatum and Contracaecum sp. increased when the condition factor of the hosts decreased. This is the first report of G. seriei seriei for H. malabaricus and Pseudoproleptus sp. for H. unitaeniatus.

Population genetic structure of three species in the genus Astrocaryum G. Mey. (Arecaceae).

We assessed the level and distribution of genetic diversity in three species of the economically important palm genus Astrocaryum located in Pará State, in northern Brazil. Samples were collected in three municipalities for Astrocaryum aculeatum: Belterra, Santarém, and Terra Santa; and in two municipalities for both A. murumuru: Belém and Santo Antônio do Tauá and A. paramaca: Belém and Ananindeua. Eight microsatellite loci amplified well and were used for genetic analysis. The mean number of alleles per locus for A. aculeatum, A. murumuru, and A. paramaca were 2.33, 2.38, and 2.06, respectively. Genetic diversity was similar for the three species, ranging from HE = 0.222 in A. aculeatum to HE = 0.254 in A. murumuru. Both FST and AMOVA showed that most of the genetic variation was found within populations for all three species, but high genetic differentiation among populations was found for A. aculeatum. Three loci were not in Hardy-Weinberg equilibrium, with populations of A. paramaca showing a tendency for the excess of heterozygotes (FIS = -0.144). Gene flow was high for populations of A. paramaca (Nm = 19.35). Our results suggest that the genetic diversity within populations followed the genetic differentiation among populations due to high gene flow among the population. Greater geographic distances among the three collection sites for A. aculeatum likely hampered gene flow for this species.

Genetic variability analysis of Byrsonima crassifolia germplasm collected in Pará State using ISSR markers.

Native of the Amazon, the nanche (Byrsonima crassifolia) is a fruit cultivated by family farmers and used in cooking; as such, it represents an opportunity for regional agribusiness. The Embrapa Eastern Amazon set up an active germplasm bank (BAG) consisting of 22 accessions sampled in 11 municipalities of Pará State. Due to its economic potential, there is an interest to advance the genetic breeding program of this species. The aim of this study was to characterize the BAG nanche collection using inter-simple sequence repeat (ISSR) markers. Accessions were genotyped using 23 pre-selected ISSR primers resulting in 109 amplified polymorphic and 51 monomorphic bands. With eight polymorphic bands each, the most polymorphic primers were UBC 809 and UBC 848. An unweighted pair-group method with arithmetic average cluster analysis based on Jaccard's coefficient indicated that the individuals clustered into two distinct groups. Accessions Igarapé Açu-2 and Augusto Corrêa-Pl 1 were most similar. The genetic dissimilarity values ranged from 0.10 to 0.59. We conclude that the ISSR markers were efficient in detecting polymorphisms in the nanche accessions, and that it is possible to infer the genetic variability among accessions of the collection. This demonstrate the importance of using molecular markers in poorly studied species and the advantages that this information can bring to the genetic improvement of such species.

Purely elastic flow instabilities in microscale cross-slot devices.

We present an experimental investigation of viscoelastic fluid flow in a cross-slot microgeometry under low Reynolds number flow conditions. By using several viscoelastic fluids, we investigate the effects of the microchannel bounding walls and the polymer solution concentration on the flow patterns. We demonstrate that for concentrated polymer solutions, the flow undergoes a bifurcation above a critical Weissenberg number (Wi) at which the flow becomes asymmetric but remains steady. The appearance of this elastic instability depends on the channel aspect ratio, defined as the ratio between the depth and the width of the channels. At high aspect ratios, when bounding wall effects are reduced, two types of elastic instabilities were observed, one in which the flow becomes asymmetric and steady, followed by a second instability at higher Wi, in which the flow becomes time-dependent. When the aspect ratio decreases, the bounding walls have a stabilizing effect, preventing the occurrence of steady asymmetric flow and postponing the transition to unsteady flow to higher Wi. For less concentrated solutions, the first elastic instability to steady asymmetric flow is absent and only the time-dependent flow instability is observed.

Susceptibility of multiresistant gram-negative bacteria to fosfomycin and performance of different susceptibility testing methods.

Fosfomycin may be a treatment option for multiresistant Gram-negative bacteria. This study compared susceptibility methods using 94 multiresistant clinical isolates. With agar dilution (AD), susceptibilities were 81%, 7%, 96%, and 100% (CLSI) and 0%, 0%, 96%, and 30% (EUCAST), respectively, for Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterobacter spp. Categorical agreement between Etest and AD for Enterobacteriaceae and A. baumannii was ≥80%. Disk diffusion was adequate only for Enterobacter. CLSI criteria for urine may be adequate for systemic infections.

Trauma is associated with a better prognosis in intensive care patients with Acinetobacter infections.

PURPOSE: Acinetobacter baumannii has emerged as a common cause of infection in war-related trauma, civilian trauma and other surgical emergencies. The aim of this study was to determine prognostic factors especially trauma, in critically ill surgical patients with Acinetobacter spp. infection in a reference emergency ICU. METHODS: A retrospective review of medical records was conducted for all patients admitted to the ICU who developed Acinetobacter spp. infection from January 2007 to December 2009. Bivariate and multivariate analyses were made for 36 patients. The end-point analyzed was the in-hospital mortality. RESULTS: The initial analysis revealed a majority of young (43.6 years ± 17.1) men (92 %), trauma victims (78 %) and an in-hospital mortality of 30 %. Patients who had not suffered trauma presented with other surgical conditions and were on average older than trauma patients (57 ± 12 versus 40 ± 16 years). The overall APACHE II score average was 15.3. The ventilator-associated pneumonia was the main Acinetobacter infection diagnosed. In bivariate analysis lower Glasgow coma scale (p = 0.01) was associated with increased chance of death and being victim of trauma was a protecting factor (OR: 0.16; 95 % CI: 0.03-0.89). Receiving adequate treatment made no difference to outcome (OR: 0.55; 95 % CI: 0.05-3.15). Multivariate analysis showed that only the presence of trauma was independently associated with prognosis and was a protecting factor. CONCLUSION: Trauma was a marker of good prognosis in emergency ICU patients with Acinetobacter spp. infection.

Risk factor for death in hematopoietic stem cell transplantation: are biomarkers useful to foresee the prognosis in this population of patients?

BACKGROUND: The morbidity and mortality in hematopoietic stem cell transplantation (HSCT) occur due to infectious complications and constitute the major clinical problems in HSCT recipients. The role of the use of biomarkers in post-HSCT patients is still controversial. OBJECTIVES: To assess the serum values of biomarkers interleukin 6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) and risk factors for post-HSCT death. PATIENTS AND METHODS: Prospective study conducted in patients submitted to HSCT at a university hospital. Biomarkers (IL-6, PCT and CRP) were assessed on the day afebrile neutropenia was detected, in the febrile event, 24 and 72 h after fever onset and 48 h or 5 days if fever persisted. Patients were compared as to the death outcome within 30 days from the HSCT. Variables with p < 0.15 were included in the multivariate analysis model (MVA) that were performed for all patients included in the study and separated for autologous and allogeneic HSCT patients. RESULTS: 296 patients with ages ranging between 15 and 70 years, neutropenic, submitted to HSCT, being 216 (73%) autologous and 80 (20%) allogeneic were assessed. One hundred and ninety (64.2%) patients presented fever after the transplantation and infection microbiologically controlled in 78 (26.4%). Twenty-three cases (7.8%) evolved to death. The risk factors associated with death in the bivariate analysis were age, allogeneic transplantation, unrelated transplantation, GVHD, bloodstream infection by Gram-negative, IL-6 >140 pg/mL and CRP ≥ 120 mg/L and the protective ones were lymphoma and hospital outpatient support. The independent variables in the MVA associated with death were allogeneic and unrelated transplantation, blood stream infection (BSI) by Gram-negative, LDH ≥ 390 UI/L, urea ≥ 25 mg/dL and CRP ≥ 120 mg/L for HSCT transplanted patients and BSI due to Gram-negative and CRP ≥ 120 mg/L for allogeneic HSCT, however, CRP ≥ 120 mg/L did not remain in the model when urea ≥ 25 mg/L was included. No independent risk factor was found for autologous patients. CONCLUSIONS: Out of the biomarkers assessed, only CRP ≥ 120 mg/L was independently associated with death. Other risk factors found were: type of transplantation (allogeneic and unrelated), bloodstream infection by Gram-negative, LDH ≥ 390 UI/L and urea ≥ 25 mg/dL. For allogeneic patients only CRP ≥ 120 mg/L and BSI due to Gram-negative were risk factors for death; however, CRP did not remain in the model when urea ≥ 25 mg/L was included.

Physical fitness percentile charts for children aged 6-10 from Portugal.

AIM: The present study aims (1) to provide reference percentile charts for the following measures of Physical Fitness (PF): the sit-and-reach, handgrip, standing long jump, 50 yards' dash, 4x10m shuttle run and 1-mile run/walk tests in children aged 6 to 10 years, and (2) to compare the performance of the Portuguese children with their age- and sex peers. METHODS: A total of 3804 Portuguese children (1985 boys and 1819 girls) aged 6-10 years old participated in this study. The sample was stratified from 20 public elementary schools and children were randomly selected in each school. Charts were separately built for each sex using the LMS method. RESULTS: Boys showed better results than girls in handgrip, standing long jump, 50 yards' dash, 4x10 m shuttle run and 1-mile run/walk, while girls are better performers than boys in sit-and-reach. CONCLUSION: Age- and gender- percentiles for a set of physical fitness tests for 6-10 year old (primary school) Portuguese children have been established. Boys showed greater overall PF than girls, except in the flexibility test, in which girls performed better. The reported normative values provide ample opportunities to accurately detect individual changes during childhood. These reference values are especially important in healthcare and educational settings, and can be added to the worldwide literature on physical fitness values in children.

The inhibitor of the redox activity of APE1/REF-1, APX2009, reduces the malignant phenotype of breast cancer cells.

Apurinic/apyrimidinic endonuclease 1/redox factor-1 (APE1/REF-1) is a multifunctional protein acting on cellular signaling pathways, including DNA repair and redox activities. APE1/REF-1 has emerged as a target for cancer therapy, and its role in breast cancer models would reveal new strategies for cancer therapy. APX2009 is a specific APE1/REF-1 redox inhibitor whose anticancer properties have not been described in breast cancer cells. Here, we investigated the effect of the APX2009 treatment in the breast cancer cell lines MDA-MB-231 and MCF-7. Breast cancer cell lines were cultured, and WST1 and colony formation assays were performed to evaluate cell proliferation. Annexin V-FITC/7-AAD and LDH-Glo™ assays were performed to evaluate cell death. The wound healing assay and Matrigel transwell assay were performed after APX2009 treatment to evaluate the cellular migration and invasion processes, respectively. Our findings demonstrated that APX2009 treatment decreased breast cancer cell proliferative, migratory, and invasive properties. Furthermore, it induced apoptosis in both cell lines. Our study is the first to show the effects of APX2009 treatment on apoptosis in a breast cancer cell. Therefore, this study suggested that APX2009 treatment is a promising anticancer molecule for breast cancer.

Leishmanicidal activity of the venoms of the Scorpions Brotheas amazonicus and Tityus metuendus.

Leishmaniasis is a vector-transmitted zoonosis caused by different species of the genus Leishmania, with a wide clinical spectrum. It is a public health problem aggravated by a series of limitations regarding treatment. In the search for new therapeutic alternatives, scorpion venoms are a source of multifunctional molecules that act against the natural resistance of pathogens. This work evaluated the antileishmanial potential of Brotheas amazonicus and Tityus metuendus venoms against the promastigote forms of Leishmania amazonensis e Leishmania guyanensis. The venoms of B. amazonicus and T. metuendus were evaluated for their constituents using Fourier Transform Infrared (FTIR). Growth inhibition and death of promastigotes were evaluated in the presence of diferente crude venom concentrations (100 µg/mL, 50 µg/mL, 10 µg/mL, 1 µg/mL) after one hour of incubation at 25 °C. The FTIR spectra of both venoms exhibited bands in approximate regions, revealing that both exhibit similar functional groups. Crude venom from both scorpion species showed similar or superior leishmanicidal effects to the standart drug N-methylglucamine antimoniate. At the highest concentration of 100 µg/mL, cultures of L. guyanensis treated with the venom of B. amazonicus showed the highest mortality percentages, above 28%, while T. metuendus venom showed the highest activity against L. amazonensis, with mortality above 7%. This preliminar study demonstrates that B. amazonicus and T. metuendus venoms can be important tools in the search for new drugs Against leishmaniasis. Next step involves evaluating the activity against the amastigote forms and purifying the venom proteins in order to identify the best anti-leishmania candidates.

The KMT2A recombinome of acute leukemias in 2023.

Chromosomal rearrangements of the human KMT2A/MLL gene are associated with de novo as well as therapy-induced infant, pediatric, and adult acute leukemias. Here, we present the data obtained from 3401 acute leukemia patients that have been analyzed between 2003 and 2022. Genomic breakpoints within the KMT2A gene and the involved translocation partner genes (TPGs) and KMT2A-partial tandem duplications (PTDs) were determined. Including the published data from the literature, a total of 107 in-frame KMT2A gene fusions have been identified so far. Further 16 rearrangements were out-of-frame fusions, 18 patients had no partner gene fused to 5'-KMT2A, two patients had a 5'-KMT2A deletion, and one ETV6::RUNX1 patient had an KMT2A insertion at the breakpoint. The seven most frequent TPGs and PTDs account for more than 90% of all recombinations of the KMT2A, 37 occur recurrently and 63 were identified so far only once. This study provides a comprehensive analysis of the KMT2A recombinome in acute leukemia patients. Besides the scientific gain of information, genomic breakpoint sequences of these patients were used to monitor minimal residual disease (MRD). Thus, this work may be directly translated from the bench to the bedside of patients and meet the clinical needs to improve patient survival.

Nanocrystalline diamond coating on non-planar silicon substrates.

Micro and nanosystems-based products will be an important contributor to the industrial and economic future, as a key value adding element for many sectors. The adoption of micro and nano manufacturing technologies making use of a variety of materials, components and knowledge based technologies will most probably provide functionality and intelligence to highly miniaturised systems. Chemical Vapour Deposited (CVD) diamond is a hard material of high mechanical strength and thermal stability and therefore an ideal candidate for microelectromechanical devices. The latter, is already being used to manufacture sensors, resonators, actuators, biological devices or even plastic moulding impressions, by depositing the film on a structured substrate, by selective growth of diamond on Si using SiO2 masks, or by pattern etching on oxygen-containing plasma. The diamond shaping may also be performed by a fine tuning of the nucleation and growth process. In this paper, it is presented the results of diamond coated structures and an evaluation of its morphology variation with the substrate configuration. The grown films were characterized for quality, surface roughness and microstructure using scanning electron microscopy, Raman and X-ray diffraction spectroscopy and surface profilometry.

Genetic diversity in a germplasm bank of Oenocarpus mapora (Arecaceae).

Oenocarpus mapora is an Amazonian palm species commonly used by native populations for food and in folk medicine. We measured genetic variability, using RAPD markers, of material kept in a germplasm bank composed of accessions sampled from the Brazilian Amazon. These included 74 individuals from 23 accessions sampled from 9 localities in three States of the Brazilian Amazon. Jaccard genetic similarities were calculated based on 137 polymorphic bands, amplified by 15 primers. Dendrograms constructed based on the genetic similarities among individuals and sample localities demonstrated genetic separation of Acre State from the States of Amazonas and Pará. Two models in three hierarchical levels were considered for AMOVA: one considering the grouping of sampling sites in each state, and the other considering sampling sites in each subgroup formed by the dendrograms. The first model showed no significant genetic variation among states. On the other hand, genetic variation among subgroups was significant. In this model, the within-sample-site genetic diversity was 47.15%, which is considered to be low, since O. mapora is allogamous. By means of Bayesian analysis, the sample sites were clustered into five groups, and their distribution was similar to what we found in the dendrograms based on genetic similarity.

Enamel Developmental Defect Masking on Central Incisor with Infiltrant Resin.

The aim of this paper is to present a case of masking of a hypoplastic lesion using the infiltrating resin technique, without use of drilling or any loss of tooth structure. A 22-year-old female patient complained of a noncarious white spot on the buccal surface of the upper right central incisor which affected the esthetics of her smile. Despite the tooth discoloration, the tooth structure was intact, with no depressions, cracks, or grooves. During the anamnesis, she reported that the white spot had been present since childhood. On the basis of the information provided by the patient and collected during intraoral clinical examination, it was determined that the stain was suggestive of enamel hypoplasia. The treatment proposed to the patient was the application of infiltrating resin to mask the hypoplasia on the surface of the tooth enamel without any loss of tooth structure. In this case, Icon infiltrating resin proved to be efficient in masking the hypoplastic lesion. The final appearance of the treated tooth was satisfactory, with homogeneity and gloss on the surface, which minimized the characteristics of an unpleasant smile.

A role of Na+, K+ -ATPase in spatial memory deficits and inflammatory/oxidative stress after recurrent concussion in adolescent rats.

Sports-related concussions are particularly common during adolescence, and there is insufficient knowledge about how recurrent concussions in this phase of life alter the metabolism of essential structures for memory in adulthood. In this sense, our experimental data revealed that seven recurrent concussions (RC) in 35-day-old rats decreased short-term and long-term memory in the object recognition test (ORT) 30 days after injury. The RC protocol did not alter motor and anxious behavior and the immunoreactivity of brain-derived neurotrophic factor (BDNF) in the cerebral cortex. Recurrent concussions induced the inflammatory/oxidative stress characterized here by increased glial fibrillary acidic protein (GFAP), interleukin 1ß (IL 1ß), 4-hydroxynonenal (4 HNE), protein carbonyl immunoreactivity, and 2',7'-dichlorofluorescein diacetate oxidation (DCFH) levels and lower total antioxidant capacity (TAC). Inhibited Na+,K+-ATPase activity (specifically isoform α2/3) followed by Km (Michaelis-Menten constant) for increased ATP levels and decreased immunodetection of alpha subunit of this enzyme, suggesting that cognitive impairment after RC is caused by the inability of surviving neurons to maintain ionic gradients in selected targets to inflammatory/oxidative damage, such as Na,K-ATPase activity.

Nationwide surveillance system to evaluate hospital-acquired COVID-19 in Brazilian hospitals.

BACKGROUND: Although the risk of SARS-CoV-2 transmission within hospitals has been well recognized, there is a paucity of data on its occurrence. Our aim was to report the incidence of hospital-acquired (HA) COVID-19 at Brazilian hospitals. METHODS: We investigated the incidence of HA COVID-19 in Brazilian hospitals using data from a national surveillance system, from August 2020 through September 2021. Definitions of HA COVID-19 were: (1) symptom onset >14 days after hospital admission plus a positive SARS-CoV-2 RNA or antigen test; (2) symptom onset on days 8-14 after admission, plus a positive SARS-CoV-2 RNA or antigen test positive, plus documented high-risk exposure. We performed descriptive analyses and reported HA COVID-19 rates using pooled mean and percentile distribution. RESULTS: A total of 48,634 cases of HA COVID-19 were reported from 1428 hospitals. Incidence ranged from 0.16/1000 patient-days at neonatal intensive care units (ICUs) to 5.8/1000 patient-days at adult ICUs. The highest incidence of HA COVID-19 was during the months March to July 2021, similar to that which was observed for community-acquired COVID-19. CONCLUSIONS: This report provides a national view of the burden of HA COVID-19. The highest incidence of HA COVID-19 similar that which was observed for community-acquired COVID-19. We believe that this reflects the difficulty of implementing preventive measures. Further studies evaluating risk factors for the hospital transmission of SARS-Cov-2 should clarify strategies to minimize the risk of HA COVID-19 and may be applicable to other respiratory diseases. Furthermore, the implementation of a national system to evaluate HA COVID-19 has the potential to shine a light on this problem and lead to interventions in each hospital.