Reduction in hospitalised COPD exacerbations during COVID-19: A systematic review and meta-analysis

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Malaltia pulmonar obstructiva crònica; Factors de risc mèdicsCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Enfermedad pulmonar obstructiva crónica; Factores de riesgo médicosCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Chronic obstructive pulmonary disease; Medical risk factorsBackground Reports have suggested a reduction in exacerbations of chronic obstructive pulmonary disease (COPD) during the coronavirus disease 2019 (COVID-19) pandemic, particularly hospital admissions for severe exacerbations. However, the magnitude of this reduction varies between studies. Method Electronic databases were searched from January 2020 to May 2021. Two independent reviewers screened titles and abstracts and, when necessary, full text to determine if studies met inclusion criteria. A modified version of the Newcastle-Ottawa Scale was used to assess study quality. A narrative summary of eligible studies was synthesised, and meta-analysis was conducted using a random effect model to pool the rate ratio and 95% confidence intervals (95% CI) for hospital admissions. Exacerbation reduction was compared against the COVID-19 Containment and Health Index. Results A total of 13 of 745 studies met the inclusion criteria and were included in this review, with data from nine countries. Nine studies could be included in the meta-analysis. The pooled rate ratio of hospital admissions for COPD exacerbations during the pandemic period was 0.50 (95% CI 0.44–0.57). Findings on the rate of community-treated exacerbations were inconclusive. Three studies reported a significant decrease in the incidence of respiratory viral infections compared with the pre-pandemic period. There was not a significant relationship between exacerbation reduction and the COVID-19 Containment and Health Index (rho = 0.20, p = 0.53). Conclusion There was a 50% reduction in admissions for COPD exacerbations during the COVID-19 pandemic period compared to pre-pandemic times, likely associated with a reduction in respiratory viral infections that trigger exacerbations. Future guidelines should consider including recommendations on respiratory virus infection control measures to reduce the burden of COPD exacerbations beyond the pandemic period.The author(s) received no specific funding for this work

Gastroesophageal reflux and chest physiotherapy: review

Objective: to present scientific evidence on the impact of respiratory physiotherapy techniques (RPT) in episodes of gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) in pediatric population, as well as characteristics of the studied samples, evaluation tools, RPT applied and the results obtained. Method: Systematic review operationalized through electronic search of three databases: LILACS, MEDLINE and Science Direct, in the period February to April 2014, using the keywords: gastroesophageal reflux, gastro-oesophageal reflux, physiotherapy / physical therapy, respiratory / chest. Studies evaluating the effects of RPT (conventional and modern) in children with GER and / or diagnosed with GERD were selected. Results: 73 articles were identified on the subject, and a sequential process excluded those who did not meet the inclusion criteria previously established. At the end of the calculation we included eight articles, seven clinical trials and one report series of cases. There was a higher frequency in the assessment of the impact on the conventional RPT about GER in children with cystic fibrosis, and postural drainage, associated or not with other techniques, applied in most studies, however, the effects of the described RPT may be still controversial. More recent studies have analyzed other RPT (increased expiratory flow handlings and method thoracoabdominal rebalancing) verifying their capability of causing reflux and security in the application of handlings. Conclusions: there is lack of research on the subject, there is no consensus as to the effect of RPT on GER in the pediatric population, especially in children with cystic fibrosis. In these investigations it was found that most of the examination of images used for the identification of GER.Objetivo: apresentar evidências científicas sobre a repercussão das técnicas de fisioterapia respiratória (TFR) nos episódios de refluxo gastroesofágico (RGE) e na doença do refluxo gastroesofágico (DRGE) na população pediátrica, bem como, características das amostras estudadas, instrumentos de avaliação utilizados, TFR aplicadas e os resultados obtidos. Método: revisão sistemática operacionalizada por meio de busca eletrônica em três bases de dados: LILACS, MEDLINE e Science Direct, no período de fevereiro a abril de 2014, utilizando os descritores: gastroesophageal reflux, gastro-oesophageal reflux, physiotherapy/ physical therapy, respiratory/ chest. Foram selecionados os estudos que avaliaram os efeitos de TFR (convencionais e modernas) em crianças com RGE e/ou com DRGE diagnosticada. Resultados: foram identificados 73 artigos sobre o tema, e excluídos por um processo sequencial aqueles que não corresponderam aos critérios de inclusão previamente estabelecidos. Ao final da apuração incluíram-se oito artigos, sendo sete ensaios clínicos e um relato de série de casos. Houve uma maior frequência na avaliação da repercussão de TFR convencionais sobre o RGE em crianças com fibrose cística, sendo a drenagem postural, associada ou não a outras técnicas, aplicada na maioria dos trabalhos, contudo, os efeitos descritos dessas TFR apresentam-se ainda controversos. Estudos mais recentes analisaram outras TFR (aumento do fluxo expiratório e manuseios do método reequilíbrio tóracoabdominal) verificando sua potencialidade refluxogênica e a segurança na aplicação dos manuseios. Conclusões: observa-se carência de pesquisas sobre o tema, não havendo um consenso quanto aos efeitos das TFR sobre o RGE na população pediátrica e em especial nas crianças com fibrose cística. Nas presentes investigações verificou-se que a maior parte utilizaram exames de imagens para a identificação dos episódios de RGE

Sistema de oscilometria de impulso em pediatria: revisão de literatura

Introduction: impulse oscillometry (IOS) is considered a method of evaluation of respiratory mechanics, and being non-invasive, has been increasingly mentioned in the care and research of pediatric patients. Studies have considered the interest of determining reference values and check the IOS relationship with other methods of respiratory assessment.Objective: to present an update of the literature regarding the system, technical criteria and interpretation of data, as well as the relationship of the system with other methods of respiratory assessment and its clinical applicability.Method: literature review with consultation in the databases MEDLINE / PubMed and Ebsco, using the keywords: “impulse oscillometry”, "reference  values” and “child”. It was considered all material with information about the equipment, their indications and application as an evaluation tool in different clinical situations.Results: 45 documents were identified, (41 trials and 4 reviews), supplemented with 20 papers (1 guideline, 1 manual on equipment and 18 articles on the subject). This material was characterized by approaching the equipment, its parameters evaluation, performance technique and positioning of the patient during the examination, criteria for acceptability and reproducibility, and interpretation of the data obtained. There are several publications of this tool in the evaluation of respiratory mechanics disorders such as asthma and cystic fibrosis, and making on reference values in healthy children. Conclusion: IOS is a relatively new feature, whose indication  in pediatrics has been increasing, but still required investigations, both technical and clinical investigations.Introdução: a oscilometria de impulso (IOS) é considerado um método de avaliação da mecânica respiratória, e por ser não invasivo, vem sendo crescentemente indicado na assistência e investigação do paciente pediátrico. Estudos tem tido como interesse a determinação de valores de referência e a verificação da relação do IOS com outros métodos de avaliação respiratória. Objetivo: Apresentar uma atualização da literatura quanto ao sistema, critérios técnicos e interpretação de dados, bem como, a relação do sistema com outros métodos de avaliação respiratória e sua aplicabilidade clínica.Método: revisão bibliográfica com consulta nas bases de dados MEDLINE/PubMed e Ebsco, utilizando as palavras-chaves: “impulse oscillometry”, “reference values” e “child”. Considerou-se todo material com informações sobre o equipamento, suas indicações e aplicação como instrumento de avaliação em diferentes situações clínicas.Resultados: foram identificados 45 documentos, sendo 41 ensaios clínicos e 4 revisões, complementados com 20 trabalhos: 1 guideline, 1 manual sobre o equipamento e 18 artigos referentes ao tema. Esse material foi caracterizado por abordar o equipamento, seus parâmetros de avaliação, técnica de execução e posicionamento do paciente durante o exame, critérios de aceitabilidade e reprodutibilidade e interpretação dos dados obtidos. São várias as publicações dessa ferramenta na avaliação da mecânica respiratória de disfunções como asma e fibrose cística e geração de valores de referência em crianças saudáveis.Conclusão: o IOS é um recurso relativamente novo, cuja indicação em pediatriatem sido crescente, mas que ainda carece investigações, tanto técnicas quanto clínicas

Cellulose nanocrystals from grape pomace: production, properties and cytotoxicity assessment

Cellulose nanocrystals (CNCs) were obtained from grape pomace through chemical and physical pretreatments. Bleached cellulose pulp was subjected to acid hydrolysis (AH) for 30 or 60min and an ultrasound treatment to obtain CNCs (AH30Sand AH60S). Compositional analyses of untreated (UGP) and pretreated (PGP) grape pomace showed the effectiveness of pretreatment in removing non-cellulosic components, recovering 80.1% cellulose in PGP (compared to 19.3% of UGP). Scanning and transmission electron microscopies were used to evaluate the CNCs morphology. AH in combination with ultrasound treatment led to needle-shaped structures and apparently more dispersed suspensions. Crystallinity index and thermal stability were studied by X-ray diffraction and thermogravimetric analysis, respectively. The AH60S sample presented high aspect ratio, crystallinity and thermal stability. CNCs toxicity was evaluated by exposing Caco-2 cells to CNCs suspension and evaluating their viability. Results showed that CNCs are non-toxic, opening the opportunity for their use on food and pharmaceutical applications.This study was supported by the Coordenacão de Aperfeiçoamento Pessoal de Ensino Superior (CAPES), Embrapa Agroindústria de Alimentos (EMBRAPA), FP7-PEOPLE-2013-IRSES-611493 (BiValBi – Biotechnologies to Valorise the regional food Biodiversity in Latin America) and Portuguese Foundation forScience andTechnology (FCT) under the scope of the strategic funding of UID/BIO/04469/2013 unit and COMPETE 2020 (POCI-01-0145-FEDER-006684) and BioTecNorte operation (NORTE-01-0145-FEDER-000004) funded by the European Regional Development Fund under the scope of Norte2020–Programa Operacional Regional do Norte. The work was also supported by the Norte Regional Operational Program 2014–2020 (Norte2020) through the European Regional Development Fund (ERDF) Nanotechnology based functional solutions (NORTE-01-0145-FEDER-000019). Michele Michelin is a recipient of a FCT fellowship (SFRH/BPD/100786/2014). The authors thank Paula Pereira for the technical support.info:eu-repo/semantics/publishedVersio

Stroke outcome measurements from electronic medical records : cross-sectional study on the effectiveness of neural and nonneural classifiers

Background: With the rapid adoption of electronic medical records (EMRs), there is an ever-increasing opportunity to collect data and extract knowledge from EMRs to support patient-centered stroke management. Objective: This study aims to compare the effectiveness of state-of-the-art automatic text classification methods in classifying data to support the prediction of clinical patient outcomes and the extraction of patient characteristics from EMRs. Methods: Our study addressed the computational problems of information extraction and automatic text classification. We identified essential tasks to be considered in an ischemic stroke value-based program. The 30 selected tasks were classified (manually labeled by specialists) according to the following value agenda: tier 1 (achieved health care status), tier 2 (recovery process), care related (clinical management and risk scores), and baseline characteristics. The analyzed data set was retrospectively extracted from the EMRs of patients with stroke from a private Brazilian hospital between 2018 and 2019. A total of 44,206 sentences from free-text medical records in Portuguese were used to train and develop 10 supervised computational machine learning methods, including state-of-the-art neural and nonneural methods, along with ontological rules. As an experimental protocol, we used a 5-fold cross-validation procedure repeated 6 times, along with subject-wise sampling. A heatmap was used to display comparative result analyses according to the best algorithmic effectiveness (F1 score), supported by statistical significance tests. A feature importance analysis was conducted to provide insights into the results. Results: The top-performing models were support vector machines trained with lexical and semantic textual features, showing the importance of dealing with noise in EMR textual representations. The support vector machine models produced statistically superior results in 71% (17/24) of tasks, with an F1 score >80% regarding care-related tasks (patient treatment location, fall risk, thrombolytic therapy, and pressure ulcer risk), the process of recovery (ability to feed orally or ambulate and communicate), health care status achieved (mortality), and baseline characteristics (diabetes, obesity, dyslipidemia, and smoking status). Neural methods were largely outperformed by more traditional nonneural methods, given the characteristics of the data set. Ontological rules were also effective in tasks such as baseline characteristics (alcoholism, atrial fibrillation, and coronary artery disease) and the Rankin scale. The complementarity in effectiveness among models suggests that a combination of models could enhance the results and cover more tasks in the future. Conclusions: Advances in information technology capacity are essential for scalability and agility in measuring health status outcomes. This study allowed us to measure effectiveness and identify opportunities for automating the classification of outcomes of specific tasks related to clinical conditions of stroke victims, and thus ultimately assess the possibility of proactively using these machine learning techniques in real-world situations

Genome mining of endophytic streptomyces wadayamensis reveals high antibiotic production capability

The actinobacteria Streptomyces wadayamensis A23, an endophitic strain, was recently sequenced and previous work showed qualitatively that the strain inhibits the growth of some pathogens. Herein we report the genome analysis of S. wadayamensis which reveals several antibiotic biosynthetic pathways. Using mass spectrometry, we were able to identify desferoxamines, several antimycins and candicidin, as predicted. Additionally, it was possible to confirm that the biosynthetic machinery of the strain when compared to identified known metabolites is far underestimated. As suggested by biochemical qualitative tests, genome encoded information reveals that the strain A23 has high capability to produce antibiotics.The actinobacteria Streptomyces wadayamensis A23, an endophitic strain, was recently sequenced and previous work showed qualitatively that the strain inhibits the growth of some pathogens. Herein we report the genome analysis of S. wadayamensis which reve27814651475FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOCNPQ - CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO2014/12727-5; 2010/51677-2; 2013/12598-8; 2015/01013-4162191/2015-4; 130933/2015-5We gratefully acknowledge FAPESP (project grant 2014/12727-5 to L. G. O. and 2010/51677-2 to M. N. E.), PETROBRAS (grant 4712-0), and the University of Campinas. C. F. F. A. and B. S. P. acknowledges CNPq (studentships 162191/2015-4 and 130933/2015-5). A

Wild dogs at stake: deforestation threatens the only Amazon endemic canid, the short-eared dog (Atelocynus microtis)

The persistent high deforestation rate and fragmentation of the Amazon forests are the main threats to their biodiversity. To anticipate and mitigate these threats, it is important to understand and predict how species respond to the rapidly changing landscape. The short-eared dog Atelocynus microtis is the only Amazon-endemic canid and one of the most understudied wild dogs worldwide. We investigated short-eared dog habitat associations on two spatial scales. First, we used the largest record database ever compiled for short-eared dogs in combination with species distribution models to map species habitat suitability, estimate its distribution range and predict shifts in species distribution in response to predicted deforestation across the entire Amazon (regional scale). Second, we used systematic camera trap surveys and occupancy models to investigate how forest cover and forest fragmentation affect the space use of this species in the Southern Brazilian Amazon (local scale). Species distribution models suggested that the short-eared dog potentially occurs over an extensive and continuous area, through most of the Amazon region south of the Amazon River. However, approximately 30% of the short-eared dog's current distribution is expected to be lost or suffer sharp declines in habitat suitability by 2027 (within three generations) due to forest loss. This proportion might reach 40% of the species distribution in unprotected areas and exceed 60% in some interfluves (i.e. portions of land separated by large rivers) of the Amazon basin. Our local-scale analysis indicated that the presence of forest positively affected short-eared dog space use, while the density of forest edges had a negative effect. Beyond shedding light on the ecology of the short-eared dog and refining its distribution range, our results stress that forest loss poses a serious threat to the conservation of the species in a short time frame. Hence, we propose a re-assessment of the short-eared dog's current IUCN Red List status (Near Threatened) based on findings presented here. Our study exemplifies how data can be integrated across sources and modelling procedures to improve our knowledge of relatively understudied species

Atherosclerosis and Bone Loss in Humans–Results From Deceased Donors and From Patients Submitted to Carotid Endarterectomy

Funding: We wish to thank all the collaborators (administrative staff, nurses, etc.) of the surgery block, as well as the doctors of the vascular surgery and transplantation departments of the Hospital of Santa Maria for the availability and assistance in the collection of the samples. We also thank Sociedade Portuguesa de Reumatologia for funding with two fellowships: Fundo de Apoio à Investigação 2014 and SPR/MSD 2015. DC-F received funding from a PhD grant from Fundação para a Ciência e a Tecnologia (SFRH/BD/80940/2011).Background and Aims: Atherosclerosis and osteoporosis share common risk factors, as well as inflammatory mechanisms. Our aim was to understand how atherosclerotic lesions are related with disturbances in bone. Methods: Gene expression of pro-inflammatory and bone metabolism related proteins (IL-1β, IL-6, IL-17A, TNF, RANKL, OPG, COL1, CTSK, OCL, TRAP, CBFA1, DKK1, SOST, ADIPOQ, and ADIPOR1) were analyzed in arteries and bones from 45 deceased donors and adipose tissue was used as control. Additionally, in 139 patients with advanced atherosclerosis submitted to carotid endarterectomy we compared calcium content (Alizarin red) and plaque inflammatory scores (CD3+, CD68+, and adiponectin) of patients with normal bone mineral density (BMD) with those with low BMD and explored the associations between gene expression in atherosclerotic plaques and BMD. Serum levels of pro-inflammatory and bone related proteins were measured both in donors and patients. Associations were investigated by the Pearson or Spearman correlation tests, and multivariate regression analyzes were performed when justified. Results: Gene expression of bone remodeling and pro-inflammatory proteins correlated positively in bone and aorta, independently of age and sex of donors, but not in adipose tissue. The expression of bone formation genes was significantly higher in atheroma plaques from endarterectomized patients with normal vs. low BMD as well as inflammatory CD68+ scores, regardless of patients' age and sex, but not of body mass index. No relationship was observed between serum levels and gene expression levels of pro-inflammatory or bone remodeling proteins. Conclusions: Our results suggest that the relationship between bones and vessels in the context of atherosclerotic disease and osteoporosis may rely on the intrinsic connection between the tissues involved, independently of disease stage. Serum measurements of pro-inflammatory and bone-remodeling proteins do not accurately translate tissue pathologic processes.publishersversionpublishe