Comparative assessment of mortality risk factors between admission and follow-up models among patients hospitalized with COVID-19

Objectives: This study aimed to compare differences in mortality risk factors between admission andfollow-up incorporated models.Methods: A retrospective cohort study of 524 patients with confirmed COVID-19 infection admitted to atertiary medical center in São Paulo, Brazil from 13 March to 30 April 2020. Data were collected onadmission, and the third, eighth and fourteenth days of hospitalization. The hazard ratio (HR) wascalculated and 28-day in-hospital mortality risk factors were compared between admission and follow-up models using a time-dependent Cox regression model.Results: Of 524 patients, 50.4% needed mechanical ventilation. The 28-day mortality rate was 32.8%.Compared with follow-up, admission models under-estimated the mortality HR for peripheral oxygensaturation 100 bpm (1.19 versus 2.04), respiratory rate >24/min (1.01versus 1.82) and mechanical ventilation (1.92 versus 12.93). Low oxygen saturation, higher oxygensupport and more biomarkers–including lactate dehydrogenase, C-reactive protein, neutrophil-lymphocyte ratio, and urea remained associated with mortality after adjustment for clinical factorsat follow-up compared with only urea and oxygen support at admission.Conclusions: The inclusion of follow-up measurements changed mortality hazards of clinical signs andbiomarkers. Low oxygen saturation, higher oxygen support, lactate dehydrogenase, C-reactive protein,neutrophil-lymphocyte ratio, and urea could help with prognosis of patients during follow-up

Conhecimento tradicional das marisqueiras de Barra Grande, área de proteção ambiental do delta do Rio Parnaíba, Piauí, Brasil

Na comunidade de Barra Grande localizada no litoral do Piauí, as mulheres dos pescadores, conhecidas localmente como marisqueiras, extraem do manguezal vários tipos de moluscos para comercialização e em maior escala para a subsistência. Dados sobre a atividade de mariscagem, conceitos de conservação e aspectos socioeconômicos do contexto em que ocorre a atividade de cata dos moluscos, foram revelados após a aplicação de protocolos estruturados e semiestruturados. O molusco bivalve Anomalocardia brasiliana (Gmelin, 1791), popularmente denominado de marisco, é caracterizado por ser um importante recurso para a subsistência, sendo o mais coletado pela comunidade, seguido da Mytella charruana (d'Orbigny, 1842), o sururu, explorado para a comercialização por ter o maior valor de mercado. O conhecimento das marisqueiras sobre A. brasiliana foi comparado com literatura especializada, muitas vezes mostrando-se em harmonia com esta. Demonstra-se assim que o conhecimento tradicional deve ser valorizado para delineamento de programas de gestão de recursos pesqueiros da região. Quanto aos modos de pensar, foi revelado que 82,81% das marisqueiras praticam manejo para a conservação da A. brasiliana ao coletar apenas os indivíduos de maior tamanho, e 80,86% consideram que não existe poluição nos pontos de coletas. O surgimento de uma Associação exclusiva e cooperativa para as marisqueiras é necessário para a valorização do trabalho por elas desenvolvido, visto que há uma média estimada de 351 kg de carne sendo extraídos mensalmente.<br>En la comunidad de Barra Grande, situada en la costa del estado de Piaui, las esposas de los pescadores, localmente llamadas de "marisqueiras", extraen de los manglares diversos tipos de moluscos para su comercialización, haciendo de esta actividad en una fuente de subsistencia. Informaciones detalladas y sistemáticas sobre la actividad de cosecha de mariscos, del contexto en el que se desarrolla la recolección y sus aspectos socioeconómicos, asi como la percepción ambiental y los conceptos relacionados a la preservación que tienen las "marisqueiras", sólo fueron conocidas luego de la aplicación de protocolos estructurados y semi-estructurados. El molusco Anomalocardia brasiliana (Gmelin, 1791), popularmente conocido como "marisco", es una importante fuente de recursos, siendo el más cosechado por la comunidad; le sigue en importancia el Mytella charruana (d'Orbigny, 1842), conocido como "sururu", cuya explotación se destina principalmente a la comercialización debido a su superior valor de mercado. El conocimiento que las "marisqueiras" tienen de la A. brasiliana fue comparado con el disponible en la literatura especializada, quedando evidente su compatibilidad, lo cual fundamenta la importancia de su valorización en el diseño de programas de gestión de los recursos pesqueros en la región. Estudios sobre el impacto ambiental de la actividad revelaron que el 82,81% de las "marisqueiras" tienen en cuenta las consecuencias de su actividad sobre la preservación, cosechando sólo los ejemplares más grandes, mientras que 80,86% de las trabajadoras considera que no hay contaminación en las zonas de cosecha. En el contexto actual se hace necesaria la creación de una Asociación de "marisqueiras", así como una cooperativa, con el propósito de jerarquizar la actividad, la cual es responsable por la producción estimada en promedio de 351 kg de carne por mes.<br>In the community of Barra Grande located at the coast of Piauí, the wives of fishermen, locally known as "marisqueiras" (female shellfish catcher), extract from the mangrove various kinds of shellfish for commercial purposes and a great amount for subsistence. For a better understanding, data on the activity of "marisqueiras", concepts of conservation and socioeconomic aspects of the context in which occurs the activity of shellfish catching were revealed after the application of semi-structured and structured protocols. The bivalve mussel Anomalocardia brasiliana (Gmelin, 1791), popularly known as "marisco", is characterized as an important resource for subsistence being most of it collected by the community, followed by Mytella charruana (d'Orbigny, 1842) the "sururu", extract for commercial purposes due to its highest market value. The knowledge of the "marisqueiras" about A. brasiliana was compared with literature which proved to be compatible, thus showing that it should be valued for the design of programs for the management of fishing resources in the region. About the way of thinking, it was revealed that 82.81% of "marisqueiras" practice the conservation of the A. brasiliana by collecting only the larger individuals and 80.86% consider that there is no pollution at the collection points. The creation of a unique association and a cooperative for the "marisqueiras" is required to value the work by themselves developed, since there are an estimated average of 351 kg of meat being extracted monthly

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)