Correlacao entre temperatura corporal, pressao arterial e concentracao plasmatica de oxido nitrico em pacientes com sepse

OBJETIVO: investigar si existe una relación entre los niveles plasmáticos de nitrato y los valores de temperatura corporal y presión arterial en pacientes con sepsis, sepsis grave y choque séptico. MÉTODO: estudio prospectivo observacional, desarrollado en un hospital brasileño; los datos fueron recolectados entre julio y diciembre de 2009. El número de pacientes incluidos en el estudio fue de 29 y las muestras de sangre fueron 30. Se realizó la recolección de la sangre (10 ml) para posterior análisis, en laboratorio, de los valores de los niveles plasmáticos de nitrato. RESULTADOS: la síntesis de óxido nítrico está aumentada en pacientes con choque séptico y está inversamente relacionada a los valores de la temperatura corporal. CONCLUSIÓN: estos datos muestran que la medición de la temperatura corporal y la observación de cuadros hipotérmicos en pacientes sépticos pueden ser importantes para orientar a la enfermería en lo que se refiere a la evolución de individuos con sepsis para choque séptico.OBJETIVO: pesquisar se há relação entre os níveis plasmáticos de nitrato e os valores da temperatura corporal e os da pressão arterial em pacientes com sepse, sepse grave e choque séptico. MÉTODO: estudo prospectivo observacional, desenvolvido em hospital brasileiro. Os dados foram coletados entre julho e dezembro de 2009. Vinte e nove pacientes foram incluídos na amostra. Foi realizada a coleta do sangue (10mL) para posterior análise dos níveis plasmáticos de nitrato, em laboratório. RESULTADOS: a síntese de óxido nítrico está aumentada em pacientes com choque séptico e está inversamente relacionada aos valores de temperatura corporal. CONCLUSÃO: esses dados mostram que a medição da temperatura corporal e a observação de quadros hipotérmicos em pacientes sépticos podem ser importantes para guiar a enfermagem, no que se refere à evolução de sujeitos com sepse, para o estado de choque séptico.OBJECTIVE: to investigate whether there is a relationship between plasmatic levels of nitrate, body temperature, and blood pressure values in patients with sepsis, severe sepsis and septic shock. METHOD: prospective observational study performed in a Brazilian hospital; data were collected from July to December 2009. Thirty blood samples were obtained from a total of 29 patients. Blood samples (10ml) were collected for subsequent laboratory analysis to determine nitrate levels in the plasma. RESULTS: nitric oxide synthesis is increased in patients with septic shock, and is inversely correlated to the body temperature values. CONCLUSION: these data show that the measurement of body temperature and the observation of hypothermic conditions in septic patients could be important to guide the nursing regarding the evolution of individuals with sepsis to septic shock

O programa de aprimoramento profissional em psicologia na perspectiva do egresso

Os Programas de Aprimoramento Profissional foram criados na década de setenta, e tem seu valor reconhecido como formação de pós-graduação na modalidade latu sensu dentro do território do estado de São Paulo. O presente estudo teve por objetivo identificar o impacto dos Programas de Aprimoramento Profissional na formação e exercício profissional do psicólogo, especialmente na área da saúde, de acordo com a percepção dos egressos. Trata-se de um estudo transversal, descritivo, de abordagem quanti-qualitativa. Grande parte dos egressos (93,1%) encontra-se inserida no mercado de trabalho, atuando como psicólogo. As atividades práticas foram melhores avaliadas do que as atividades teóricas. Conclui-se, com o presente estudo, que a realização do Programa de Aprimoramento Profissional possibilitou o aperfeiçoamento e a capacitação do profissional para atuação qualificada e diferenciada na área da saúde. Por fim, cabe ressaltar, a necessidade de adequação dos Programas de Aprimoramento às novas demandas em saúde

Avaliação dos testes rápidos para diagnóstico da dengue no Brasil

Introduction: The increasing number of dengue cases worldwide has stimulated the interest to develop products for the diagnosis of this disease in national and international markets. Objective: To evaluate the sensitivity and diagnostic specificity of immunochromatographic Rapid Tests (RT) for the detection of NS1 antigen (Ag), antibodies (Ab) IgG and IgM of dengue virus (DENV), and for the detection of combined AgNS1/AbIgG/IgM received from May 2016 to December 2018 at the National Institute for Quality Control in Health from Oswaldo Cruz Foundation for previous analysis and registration by the National Health Surveillance Agency (Anvisa) from Brazil. Method: The evaluation was performed using true positive and true negative samples for Ag NS1, Ab IgM and IgG to DENV, commercial performance panels and international standard of the National Institute for Biological Standards and Control/ World Health Organization (NIBSC/WHO). RT that presented sensitivity and/or specificity values higher than or equal to those stated by the manufacturers were considered satisfactory and those with lower values were unsatisfactory. Results: A total of 32 RT were evaluated, 23 (71.9%) were satisfactory for sensitivity and specificity, 9 (39.1%) for NS1, 11 (47.8%) for IgG/IgM and 3 (13.0%) for the combined detection NS1/IgG/IgM. From 9 RT considered unsatisfactory, 4 (44.4%) were for the detection of NS1; 2 (22.2%) for IgG/IgM and 3 (33.3%) for NS1/IgG/IgM. Unsatisfactory RT were not registered by Anvisa in Brazil. Conclusions: The previous analysis as foreseen in Brazilian regulation is important for the maintenance of RT quality offered to the national market.Introdução: O aumento do número de casos de dengue no mundo estimulou o desenvolvimento  e a disponibilização no mercado nacional e internacional de testes de execução rápida e simples para o diagnóstico da doença. Objetivo: Avaliar a sensibilidade e especificidade diagnóstica de Testes Rápidos (TR) imunocromatográficos para detecção de antígeno (Ag) NS1 e de anticorpos (Ac) das classes G (IgG) e M (IgM) e detecção combinada de Ag e Ac (NS1/ IgG/IgM) do vírus da dengue (DENV), encaminhados para análise prévia no INCQS/Fiocruz, no período de maio de 2016 a dezembro de 2018 para obtenção de registro junto à Anvisa do Brasil. Método: A sensibilidade  e a especificidade foram avaliadas frente a painéis de amostras verdadeiramente positivas e verdadeiramente negativas para Ag NS1, Ac IgM e IgG do DENV, painéis de desempenho e padrão internacional do National Institute for Biological Standards and Control/Organização Mundial da Saúde (NIBSC/OMS). Os TR que apresentaram valores de sensibilidade e especificidade superiores ou iguais aos declarados pelos fabricantes foram considerados satisfatórios e os com valores inferiores, insatisfatórios. Resultados: Do total de 32 TR  avaliados, 23 (71,9%) foram satisfatórios para sensibilidade e especificidade, destes, nove (39,1%), para NS1, 11 (47,8%) para IgG/IgM e três (13,0%), para os testes combinados NS1/IgG/IgM. Dos nove TR insatisfatórios, quatro (44,4%) foram para detecção de NS1; dois (22,2%), para IgG/IgM e três (33,3%), para NS1/IgG/IgM. Os TR considerados insatisfatórios não foram registrados no Brasil. Conclusões: A análise prévia como prevista na legislação brasileira é de grande importância para a manutenção  da qualidade dos TR ofertados ao mercado nacional

A assistência na Saúde da Família sob a perspectiva dos usuários

This descriptive exploratory study analyzed user satisfaction with the care received at a Family Health Unit in Ribeirão Preto, Brazil. In total, 40 users from families registered in the FHU were selected, using key informants and the snowball sampling technique, and interviewed. Thematic content analysis was used to analyze the empirical material. Interviewees were mostly female, over 50 years, resident in the catchment area of the unit for 10-30 years, had incomplete primary education and also did not perform work outside the home. The analysis identified three themes: access, team-user interaction and organization of work in the FHU. The subjects of this study expressed satisfaction with the accessibility provided together with the caring attention given to them, marked by a team-user interaction that takes place in a friendly and patience manner. Although not totally satisfied, the majority of users would recommend the health service to someone due to its quality.Este estudio exploratorio y descriptivo analizó la satisfacción del usuario en lo que se refiere a la atención recibida en una unidad de Salud de la Familia(USF) en Ribeirao Preto-SP, Brasil. Fueron entrevistados 40 usuarios de familias registradas por la USF, seleccionadas por informantes clave y muestreo por bola de nieve. El análisis temático de contenido se utilizó para analizar el material empírico. Los entrevistados son mayoritariamente mujeres, con más de 50 años, residentes en el área de alcance de la unidad, entre 10 y 30 años, tienen enseñanza primaria incompleta y no ejercían trabajo fuera del domicilio. El análisis identificó tres temas: acceso, interacción equipo-usuario y organización del trabajo en la USF. Los sujetos del estudio expresaron satisfacción con la accesibilidad desde que vinculada a la atención cuidadosa que recibían, marcada por una interacción equipo-usuario amigable y paciente. A pesar de que no están totalmente satisfechos, la mayoría de los usuarios indicaría este servicio por su calidad.Analisou-se satisfação do usuário quanto ao atendimento em uma Unidade de Saúde da Família (USF) em Ribeirão Preto, SP, Brasil. É um estudo exploratório descritivo. Foram entrevisados 40 usuários de famílias cadastradas pela USF, selecionados a partir de informantes chave e da técnica snowball para amostragem. Para análise do material empírico, utilizou-se análise de conteúdo na modalidade temática. Os entrevistados são majoritariamente mulheres, acima de 50 anos, residentes na área de abrangência da unidade, de 10-30 anos, possuíam ensino fundamental incompleto e também não exerciam trabalho fora do domicílio. A análise identificou três temas: acesso, interação equipe/usuário e organização do trabalho na USF. Os sujeitos deste estudo expressam satisfação com a acessibilidade desde que aliada à atenção cuidadosa que lhes é dispensada, marcada por interação equipe/usuário que se produz de forma amigável e pacienciosa. Embora não totalmente satisfeitos, a maioria dos usuários indicaria esse serviço de saúde a alguém, por sua qualidade

Stir bar-sorptive extraction, solid phase extraction and liquid-liquid extraction for levetiracetam determination in human plasma: comparing recovery rates

Levetiracetam (LEV), an antiepileptic drug (AED) with favorable pharmacokinetic profile, is increasingly being used in clinical practice, although information on its metabolism and disposition are still being generated. Therefore a simple, robust and fast liquid-liquid extraction (LLE) followed by high-performance liquid chromatography method is described that could be used for both pharmacokinetic and therapeutic drug monitoring (TDM) purposes. Moreover, recovery rates of LEV in plasma were compared among LLE, stir bar-sorptive extraction (SBSE), and solid-phase extraction (SPE). Solvent extraction with dichloromethane yielded a plasma residue free from usual interferences such as commonly co-prescribed AEDs, and recoveries around 90% (LLE), 60% (SPE) and 10% (SBSE). Separation was obtained using reverse phase Select B column with ultraviolet detection (235 nm). Mobile phase consisted of methanol:sodium acetate buffer 0.125 M pH 4.4 (20:80, v/v). The method was linear over a range of 2.8-220.0 µg mL-1. The intra- and inter-assay precision and accuracy were studied at three concentrations; relative standard deviation was less than 10%. The limit of quantification was 2.8 µg mL-1. This robust method was successfully applied to analyze plasma samples from patients with epilepsy and therefore might be used for pharmacokinetic and TDM purposes.</p

Proteolytic behavior of isolated Pseudomonas spp. from refrigerated raw milk in different concentrations and storage temperatures

The objective of the work was to evaluate the multiplication capacity and proteolytic activity of different Pseudomonas spp. cell counts inoculated in milk and storaged under different temperature. Strains isolated from refrigerated raw milk (RRM) were confirmed at genus level by Polymerase Chain Reaction (PCR). The Pseudomonas spp. was cultured in cephalothin-sodium fusidate-cetrimide (CFC) agar-base (30?C for 48 h) until it reached 2 log and 6 log CFU mL-1. Three of eight strains confirmed as Pseudomonas spp were inoculated in sterile reconstituted whole milk powder and incubated at 2°C, 4°C, and 8°C for 96 h. Primary proteolysis indices was determined by the Kjeldahl method. When taking into account the effect of storage time in Pseudomonas spp. population, it was found that the initial population (2 log CFU mL-1) showed significant difference in growth rates only from 0 h to 24 h, keeping at the same levels along 96 h. When a higher initial population was incubated (6 log CFU mL-1), it was not observed a significant difference for times tested. Related to the effect of storage time in proteolysis index, it was not observed a significant difference in samples inoculated with 2 and 6 log CFU mL-1 Pseudomonas spp. When we analyzed the influence of storage temperature on the bacterial multiplication, there was a significant difference in the Pseudomonas spp. population only between 2°C and 8°C after 96 h of milk storage with 2 log CFU/mL of initial inoculum. If we consider the temperature effect in the primary proteolysis index, there were significant differences at the inoculum of 2 log CFU mL-1 where the primary proteolysis at 24 h was lower at 2°C than at 8ºC. Low temperatures or short storage time had no influence on Pseudomonas spp. enumeration or in the primary proteolysis index when high initial contaminations are observed. At lower Pseudomonas spp. initial population, the smaller storage time tested influenced the population control, and linked with the reduction in the storage temperature, lower proteolysis index were observed

Neotropical xenarthrans: a data set of occurrence of xenarthran species in the neotropics

Xenarthrans -anteaters, sloths, and armadillos- have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. Have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become.Fil: Marques Santos, Paloma. Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas; BrasilFil: Bocchiglieri, Adriana. Universidade Federal de Sergipe; BrasilFil: Garcia Chiarello, Adriano. Universidade de Sao Paulo; BrasilFil: Pereira Paglia, Adriano. Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas; BrasilFil: Moreira, Adryelle. Amplo Engenharia e Gestão de Projetos ; BrasilFil: Abba, Agustin Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Estudios Parasitológicos y de Vectores. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Centro de Estudios Parasitológicos y de Vectores; ArgentinaFil: Paviolo, Agustin Javier. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Universidad Nacional de Misiones. Instituto de Biología Subtropical; ArgentinaFil: Gatica, Ailin. Universidad Nacional de San Luis; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Luis. Instituto Multidisciplinario de Investigaciones Biológicas de San Luis. Universidad Nacional de San Luis. Facultad de Ciencias Físico Matemáticas y Naturales. Instituto Multidisciplinario de Investigaciones Biológicas de San Luis; ArgentinaFil: Ochoa, Ana Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Luis. Instituto Multidisciplinario de Investigaciones Biológicas de San Luis. Universidad Nacional de San Luis. Facultad de Ciencias Físico Matemáticas y Naturales. Instituto Multidisciplinario de Investigaciones Biológicas de San Luis; ArgentinaFil: de Angelo, Carlos Daniel. Universidad Nacional de Rio Cuarto. Facultad de Cs.exactas Fisicoquimicas y Naturales. Instituto de Ciencias de la Tierra, Biodiversidad y Ambiente. - Consejo Nacional de Investigaciones Cientificas y Tecnicas. Centro Cientifico Tecnologico Conicet - Cordoba. Instituto de Ciencias de la Tierra, Biodiversidad y Ambiente.; ArgentinaFil: Tellaeche, Cintia Gisele. Universidad Nacional de Jujuy. Facultad de Ciencias Agrarias. Centro de Estudios Ambientales Territoriales y Sociales; Argentina. Universidad Nacional de Jujuy. Instituto de Ecorregiones Andinas. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Ecorregiones Andinas; ArgentinaFil: Varela, Diego Martin. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Vanderhoeven, Ezequiel Andres. Ministerio de Salud. Instituto Nacional de Medicina Tropical; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Caruso, María Flavia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Administración de Parques Nacionales. Delegación Regional del Noroeste; ArgentinaFil: Arrabal, Juan Pablo. Secretaria de Gobierno de Salud. Instituto Nacional de Medicina Tropical - Sede Puerto Iguazú Misiones; Argentina. Centro de Investigaciones del Bosque Atlántico; ArgentinaFil: Iezzi, María Eugenia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Di Bitetti, Mario Santiago. Centro de Investigaciones del Bosque Atlántico; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Cruz, Paula Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; Argentina. Centro de Investigaciones del Bosque Atlántico; ArgentinaFil: Reppucci, Juan Ignacio. Administración de Parques Nacionales. Delegación Regional del Noroeste; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Benito Santamaria, Silvia. Centro de Investigaciones del Bosque Atlántico; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Quiroga, Verónica Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Diversidad y Ecología Animal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto de Diversidad y Ecología Animal; ArgentinaFil: Di Blanco, Yamil Edgardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Marás, Gustavo Arnaldo. Administración de Parques Nacionales. Delegación Regional del Noroeste; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Camino, Micaela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Centro de Ecología Aplicada del Litoral. Universidad Nacional del Nordeste. Centro de Ecología Aplicada del Litoral; ArgentinaFil: Perovic, Pablo Gastón. Administración de Parques Nacionales. Delegación Regional del Noroeste; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Martínez Pardo, Julia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Costa, Sebastián Andrés. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Pinheiro, Fabiana. Universidade Federal do Rio Grande do Sul; BrasilFil: Volkmer de Castilho, Pedro. Universidade Federal de Santa Catarina; BrasilFil: Bercê, William. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Camara Assis, Julia. Universidade Estadual Paulista Julio de Mesquita Filho. Faculdade de Engenharia.; BrasilFil: Rodrigues Tonetti, Vinicius. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Alves Eigenheer, Milene. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Chinem, Simonne. Universidade de Sao Paulo; BrasilFil: Honda, Laura K.. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Bergallo, Helena de Godoy. Universidade do Estado de Rio do Janeiro; BrasilFil: Alberici, Vinicius. Universidade de Sao Paulo; BrasilFil: Wallace, Robert. Wildlife Conservation Society; Estados UnidosFil: Ribeiro, Milton Cezar. Universidade de Sao Paulo; BrasilFil: Galetti, Mauro. Universidade Estadual Paulista Julio de Mesquita Filho; Brasi

Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil

Background: To evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D).Methods: This multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups.Results: We obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). the majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001).Conclusions: Given the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.Farmanguinhos/Fundacao Oswaldo Cruz/National Health MinistryBrazilian Diabetes SocietyFundacao do Amparo a Pesquisa do Estado do Rio de JaneiroConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Estado Rio de Janeiro, Unit Diabet, BR-20551030 Rio de Janeiro, BrazilBaurus Diabet Assoc, São Paulo, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilFed Univ Hosp Porto Alegre, Porto Alegre, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Fed Rio de Janeiro, Rio de Janeiro, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilSanta Casa Misericordia, Belo Horizonte, MG, BrazilSanta Casa Misericordia São Paulo, São Paulo, BrazilUniv Fed Amazonas, Manaus, Amazonas, BrazilHosp Geral de Bonsucesso, Rio de Janeiro, BrazilHosp Univ Clementino Fraga Filho IPPMG, Rio de Janeiro, BrazilUniv Hosp São Paulo, São Paulo, BrazilFac Ciencias Med Santa Casa São Paulo, São Paulo, BrazilUniv São Paulo, Inst Crianca, Hosp Clin, São Paulo, BrazilUniv São Paulo, Fac Med Ribeirao Preto, Hosp Clin, Ribeirao Preto, BrazilAmbulatorio Fac Estadual Med Sao Jose Rio Preto, Ribeirao Preto, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilClin Endocrinol Santa Casa Belo Horizonte, Belo Horizonte, MG, BrazilUniv Estadual Londrina, Londrina, BrazilUniv Fed Parana, Hosp Clin, Porto Alegre, RS, BrazilInst Crianca Com Diabet Rio Grande Sul, Rio Grande Do Sul, RS, BrazilGrp Hosp Conceicao, Inst Crianca Com Diabet, Porto Alegre, RS, BrazilHosp Univ Santa Catarina, Florianopolis, SC, BrazilInst Diabet Endocrinol Joinville, Joinville, BrazilHosp Reg Taguatinga, Brasilia, DF, BrazilHosp Geral Goiania, Goiania, Go, BrazilCtr Diabet & Endocrinol Estado Bahia, Goiania, Go, BrazilUniv Fed Maranhao, Sao Luis, BrazilCtr Integrado Diabet & Hipertensao Ceara, Fortaleza, Ceara, BrazilUniv Fed Sergipe, Aracaju, BrazilHosp Univ Alcides Carneiro, Campina Grande, BrazilHosp Univ Joao de Barros Barreto, Belem, Para, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, São Paulo, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilWeb of Scienc

SARS-CoV-2 lineage B.1.1.7 is associated with greater disease severity among hospitalised women but not men: multicentre cohort study.

BACKGROUND: SARS-CoV-2 lineage B.1.1.7 has been associated with an increased rate of transmission and disease severity among subjects testing positive in the community. Its impact on hospitalised patients is less well documented. METHODS: We collected viral sequences and clinical data of patients admitted with SARS-CoV-2 and hospital-onset COVID-19 infections (HOCIs), sampled 16 November 2020 to 10 January 2021, from eight hospitals participating in the COG-UK-HOCI study. Associations between the variant and the outcomes of all-cause mortality and intensive therapy unit (ITU) admission were evaluated using mixed effects Cox models adjusted by age, sex, comorbidities, care home residence, pregnancy and ethnicity. FINDINGS: Sequences were obtained from 2341 inpatients (HOCI cases=786) and analysis of clinical outcomes was carried out in 2147 inpatients with all data available. The HR for mortality of B.1.1.7 compared with other lineages was 1.01 (95% CI 0.79 to 1.28, p=0.94) and for ITU admission was 1.01 (95% CI 0.75 to 1.37, p=0.96). Analysis of sex-specific effects of B.1.1.7 identified increased risk of mortality (HR 1.30, 95% CI 0.95 to 1.78, p=0.096) and ITU admission (HR 1.82, 95% CI 1.15 to 2.90, p=0.011) in females infected with the variant but not males (mortality HR 0.82, 95% CI 0.61 to 1.10, p=0.177; ITU HR 0.74, 95% CI 0.52 to 1.04, p=0.086). INTERPRETATION: In common with smaller studies of patients hospitalised with SARS-CoV-2, we did not find an overall increase in mortality or ITU admission associated with B.1.1.7 compared with other lineages. However, women with B.1.1.7 may be at an increased risk of admission to intensive care and at modestly increased risk of mortality.This report was produced by members of the COG-UK-HOCI Variant substudy consortium. COG-UK-HOCI is part of COG-UK. COG-UK is supported by funding from the Medical Research Council (MRC) part of UK Research & Innovation (UKRI), the National Institute of Health Research (NIHR) and Genome Research Limited, operating as the Wellcome Sanger Institute