COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Relatório de Estágio Curricular – PortoBay Hotels & Resorts – Porto Santa Maria (Funchal)

No âmbito da unidade curricular Projeto/Estágio foi realizado um estágio com vista à conclusão da Licenciatura em Comunicação e Relações Públicas. Assim sendo, este relatório traduz a experiência, na área da comunicação, realizada no Hotel Porto Santa Maria, do grupo PortoBay Hotels & Resorts. O estágio teve uma duração de três meses, com início a 2 de julho e final a 2 de outubro de 2018. As atividades desenvolvidas durante este período ocorreram no contexto das Relações Públicas, nomeadamente nos departamentos de Guest Relations e Receção. Em termos de estrutura, está dividido em dois grandes capítulos: o primeiro onde é apresentada a contextualização da empresa e o segundo onde se descrevem todas as atividades realizadas. O principal objetivo teve por base a integração, a aplicação e o desenvolvimento de conhecimentos teóricos, obtidos ao longo dos três anos da Licenciatura, na prática concretizada durante o estágio

Herpes simplex type-1 pneumonia in an immunocompetent patient: a case report

Herpes simplex virus type-1 pneumonia is unusual and rarely described without any degree of immunosuppression. We share a case of herpes simplex virus type-1 pneumonia in an immunocompetent patient, not only by its rarity, but to call attention to the importance of thinking about this entity when respiratory symptoms persist despite various antibiotic schemes, especially in the presence of ground glass or multifocal pulmonary infiltrates, regardless of patients’ immune statu

Development of culvert risk condition evaluation for decision-making within road infrastructure management

Regarding road infrastructure management systems, culverts need to be assessed in order to avoid failures and road collapses. So, periodic inspections framework and condition rating implementation has an important role for life service estimation and reliability evaluation. In addition, the risk can be avoided through condition rating merged with culverts exposure and vulnerabilities. This will provide information to support decision-making and prioritize interventions. In this paper a new approach for decision-making process is presented taking into consideration the global risk index (αG). The proposal includes a set of culverts descriptors, weight attribution and aggregation rules complying with external factors such as hazards, condition rates and consequences. Moreover, a case study with 25 different systems is conducted to qualitatively assess culverts global risk index and prioritize needed interventions.(undefined

Exploring educational immersive videogames: an empirical study with a 3D multimodal interaction prototype

Gestural interaction devices emerged and originated various studies on multimodal human-computer interaction to improve user experience (UX). However, there is a knowledge gap regarding the use of these devices to enhance learning. We present an exploratory study which analysed the UX with a multimodal immersive videogame prototype, based on a Portuguese historical/cultural episode. Evaluation tests took place in high school environments and public videogaming events. Two users would be present simultaneously in the same virtual reality (VR) environment: one as the helmsman aboard Vasco da Gama's fifteenth-century Portuguese ship and the other as the mythical Adamastor stone giant at the Cape of Good Hope. The helmsman player wore a VR headset to explore the environment, whereas the giant player used body motion to control the giant, and observed results on a screen, with no headset. This allowed a preliminary characterisation of UX, identifying challenges and potential use of these devices in multi-user virtual learning contexts. We also discuss the combined use of such devices, towards future development of similar systems, and its implications on learning improvement through multimodal human-computer interaction

Boas práticas ao Serviço do Utente - Centro Hospitalar do Tâmega e Sousa, EPE

O CHTS pretende e ambiciona na literacia em saúde, na vertente do cidadão, que haja mais igualdades em saúde e que, este cidadão perante a necessidade de tomar decisões de forma autónoma (muitas vezes de elevada complexidade), sobre a promoção de saúde, prevenção das doenças ou seu tratamento, esteja informado e com conhecimentos para o fazer. Pretende que o cidadão seja capaz de obter melhor acesso aos cuidados de saúde, usar e usufruir da forma mais adequada e, de forma intencional e consciente, possa obter os maiores benefíciospara a manutenção do seu estado de saúde. A OMS, define Literacia em Saúde como “o grau em que os indivíduos têm a capacidade de obter, processar e entender as informações básicas de saúde para utilizarem os serviços e tomarem decisões adequadas de saúde”, ou seja, a literacia em saúde contempla um conjunto de conhecimentos, atitudes, habilidades e até competências que capacitam a pessoa no acesso, compreensão das informações para que possa avaliar de forma critica a sua relevância no uso responsável desse conhecimento. Foi, neste contexto, que surgiu no CHTS uma nova ótica de leitura e de intervenção das suas equipas multidisciplinares, na consecução de projetos e ações que visam reforçar os níveis de literacia, de forma multidimensional e colaborativa, aproximando-se cada vez mais da centralidade no cidadão, bem como de uma maior eficiência e eficácia dos serviços, qualidade assistencial e satisfação do cidadão e profissional. Deve-se muito à capacidade dos profissionais de saúde, mesmo com diferenças de uns para outros, em identificar as necessidades das pessoas, em estarem disponíveis para promover mudança, a avaliar diariamente o nível de compreensão, capacidades para realizar tarefas prescritas, motivação e nível de mudança comportamental do cidadão, tendo em conta a sua idade e o seu estado de saúde. José Ribeiro Nunes, Enf. Diretor, Prefácioinfo:eu-repo/semantics/publishedVersio

An international observational study to assess the impact of the Omicron variant emergence on the clinical epidemiology of COVID-19 in hospitalised patients

Background: Whilst timely clinical characterisation of infections caused by novel SARS-CoV-2 variants is necessary for evidence-based policy response, individual-level data on infecting variants are typically only available for a minority of patients and settings. Methods: Here, we propose an innovative approach to study changes in COVID-19 hospital presentation and outcomes after the Omicron variant emergence using publicly available population-level data on variant relative frequency to infer SARS-CoV-2 variants likely responsible for clinical cases. We apply this method to data collected by a large international clinical consortium before and after the emergence of the Omicron variant in different countries. Results: Our analysis, that includes more than 100,000 patients from 28 countries, suggests that in many settings patients hospitalised with Omicron variant infection less often presented with commonly reported symptoms compared to patients infected with pre-Omicron variants. Patients with COVID-19 admitted to hospital after Omicron variant emergence had lower mortality compared to patients admitted during the period when Omicron variant was responsible for only a minority of infections (odds ratio in a mixed-effects logistic regression adjusted for likely confounders, 0.67 [95% confidence interval 0.61-0.75]). Qualitatively similar findings were observed in sensitivity analyses with different assumptions on population-level Omicron variant relative frequencies, and in analyses using available individual-level data on infecting variant for a subset of the study population. Conclusions: Although clinical studies with matching viral genomic information should remain a priority, our approach combining publicly available data on variant frequency and a multi-country clinical characterisation dataset with more than 100,000 records allowed analysis of data from a wide range of settings and novel insights on real-world heterogeneity of COVID-19 presentation and clinical outcome

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable