Deaths by COVID-19 in a hospital from a city from Legal Amazon region: what lessons could be learned?

Objetivo: Descrever a epidemiologia de mortes por COVID-19 em um hospital na região da Amazônia em um período de 64 dias, que corresponde à curva de crescimento da primeira onda da pandemia de COVID-19 em 2020. Métodos: Os dados foram obtidos de 152 óbitos registrados em prontuários de adultos e idosos hospitalizados. Os dados foram também comparados com o número de óbitos em anos anteriores, no mesmo período estudado, de forma a avaliar o impacto da pandemia neste hospital. O estudo também avalia o impacto das transferências intra-hospitalares, contabilizando o número de vezes que os pacientes que faleceram realizaram transferências entre setores do hospital. Resultados: No período analisado, houve aumento de óbitos em relação aos anos anteriores. A maioria dos pacientes mortos era do sexo masculino, com idade entre 34 e 96 anos. Os óbitos foram associados a comorbidades como hipertensão arterial, diabetes mellitus e doença renal. A infecção por SARS-CoV-2 foi confirmada em 91 casos. Entre eles, 15 indivíduos foram internados sem condições relacionadas à infecção por SARS-CoV-2; eles tiveram um número três vezes maior de transferências hospitalares do que aqueles admitidos com sintomas de infecção por SARS-CoV-2. Dezesseis pacientes com infecção por SARS-CoV-2 desenvolveram sintomas respiratórios logo após a hospitalização. O exame diagnóstico para infecção por SARS-CoV-2 foi realizado em média 4 (± 6) dias após o início dos sintomas e 6 (± 6) dias após a admissão, e o tempo médio do início dos sintomas respiratórios até o óbito foi de 4 ( ± 6) dias. Conclusões: Esses dados sugerem alta presença de infecção hospitalar por SARS-CoV-2 na região amazônica brasileira, o que pode estar relacionado ao número de transferências setoriais, demora na confirmação do diagnóstico e falta de manejo. Relatamos um grave problema de saúde pública, pois demonstra a fragilidade das instituições de saúde no ambiente hospitalar.Objectives: Describe the epidemiology of COVID-19 deaths within a hospital in the Amazon region in a period of 64 days, which corresponds to the growth curve of the COVID-19 first-wave pandemic in 2020. Methods: The data were obtained from medical records of 152 deaths registered for adults and elderly hospitalized. The data were also compared with the number of deaths in previous years during the same period studied to assess the impact of the pandemic on this hospital. The study also assesses the impact of intra-hospital transfers, accounting for the number of times patients who died performed transfers between sectors of the hospital. Results: During the period analyzed, there was an increase in deaths compared to the previous years. The majority of dead patients were male, aged between 34 and 96 years. The deaths were associated comorbidities such as arterial hypertension, diabetes mellitus, and kidney disease. The SARS-CoV-2 infection was confirmed in 91 cases. Among them, 15 individuals were admitted without conditions related to SARS-CoV-2 infection; they had a three-fold higher number of hospital transfers than those admitted with SARS-CoV-2 infection symptoms. Sixteen patients with SARS-CoV-2 infection developed respiratory symptoms just after hospitalization. The diagnostic exam for SARS-CoV-2 infection was performed on average 4 (± 6) days after the onset of symptoms and 6 (± 6) days after admission, and the average time from the onset of respiratory symptoms to death was 4 (± 6) days. Conclusions: These data suggest the high presence of hospital infection by SARS-CoV-2 in the Brazilian Amazon region, which may be related to the number of sectorial transfers, delay in confirming the diagnosis, and lack of management. We report a serious public health problem, as it demonstrates the fragility of healthcare institutions in the hospital environment

Heavy metals in soils from Fernando de Noronha, Brazil

O arquipélago de Fernando de Noronha situa-se distante do litoral e integra as Ilhas Vulcânicas Oceânicas do Brasil. Atualmente é um Parque Nacional Marinho protegido pelo Instituto Chico Mendes de Conservação da Biodiversidade-ICMBio, representando um ambiente pouco alterado e, por estar afastado de fontes de contaminação antrópica, pode representar bem os teores naturais de metais em solos de origem vulcânica. Por esta razão, este trabalho objetivou a determinação dos teores naturais de Ag, Ba, Co, Cr, Cu, Mo, Ni, Sb, V e Zn, e o estabelecimento de valores de referência de qualidade (VRQ) para nove solos da Ilha de Fernando de Noronha. As amostras de solo foram submetidas à digestão ácida pelo método 3051A, em conformidade com as especificações da legislação vigente no país, e as determinações realizadas por espectrofotometria de emissão por plasma. De modo geral, os teores naturais de metais pesados observados para a ilha foram maiores que teores normalmente observados em áreas continentais. Estes teores variaram em função da ordem de solo e do material de origem, sendo constatados no Neossolos os teores mais baixos e, nos Cambissolos, os mais altos, para a maioria dos metais analisados. Os VRQ calculados para Ag, Co, Cu, Mo, V e Zn indicam que os solos avaliados apresentam teores destes metais que atendem ao critério de valor de qualidade exigido pelo Conselho Nacional do Meio Ambiente (CONAMA). Para os elementos Ni, Cr, Sb e Ba foram calculados teores que ultrapassam o valor de prevenção adotado pelo CONAMA.The archipelago of Fernando de Noronha lies 360 km from the continent and is part of the Volcanic Islands of Brazil. Fernando de Noronha is a Marine National Park protected by The Institute Chico Mendes for Biodiversity Conservation and represents a low impacted environment where natural concentrations of metals in soil cand be studied. Thus, the work was carried out to determine the natural concentrations of Ag, Ba, Co, Cr, Cu, Mo, Ni, Sb, V and Zn in such soils. Additionally, the guidelines values of metals required by the Brazilian legislation (CONAMA, 2009) were also provided. In general, the natural concentrations of metals in the archipelago soils were higher than observed for continental soils. The concentrations varied according to the parent material, being highest in Cambisols and lowest in Arenosols for the majority of metals analyzed. The Soil Quality Values calculated to Ag, Co, Cu, Mo, V and Zn indicated that Fernando de Noronha soils pose no risks for human health and ecosystem. On the other hand, the concentrations of Ni, Cr, Sb, and Ba are above the Prevention Value and monitoring is mandatory to assess the contamination risks

Deaths by COVID-19 in a hospital from a city from Legal Amazon region: what lessons could be learned?

Objectives: Describe the epidemiology of COVID-19 deaths within a hospital in the Amazon region in a period of 64 days, which corresponds to the growth curve of the COVID-19 first-wave pandemic in 2020. Methods: The data were obtained from medical records of 152 deaths registered for adults and elderly hospitalized. The data were also compared with the number of deaths in previous years during the same period studied to assess the impact of the pandemic on this hospital. The study also assesses the impact of intra-hospital transfers, accounting for the number of times patients who died performed transfers between sectors of the hospital. Results: During the period analyzed, there was an increase in deaths compared to the previous years. The majority of dead patients were male, aged between 34 and 96 years. The deaths were associated comorbidities such as arterial hypertension, diabetes mellitus, and kidney disease. The SARS-CoV-2 infection was confirmed in 91 cases. Among them, 15 individuals were admitted without conditions related to SARS-CoV-2 infection; they had a three-fold higher number of hospital transfers than those admitted with SARS-CoV-2 infection symptoms. Sixteen patients with SARS-CoV-2 infection developed respiratory symptoms just after hospitalization. The diagnostic exam for SARS-CoV-2 infection was performed on average 4 (± 6) days after the onset of symptoms and 6 (± 6) days after admission, and the average time from the onset of respiratory symptoms to death was 4 (± 6) days. Conclusions: These data suggest the high presence of hospital infection by SARS-CoV-2 in the Brazilian Amazon region, which may be related to the number of sectorial transfers, delay in confirming the diagnosis, and lack of management. We report a serious public health problem, as it demonstrates the fragility of healthcare institutions in the hospital environment