SARS-CoV-2 introductions and early dynamics of the epidemic in Portugal

Genomic surveillance of SARS-CoV-2 in Portugal was rapidly implemented by the National Institute of Health in the early stages of the COVID-19 epidemic, in collaboration with more than 50 laboratories distributed nationwide. Methods By applying recent phylodynamic models that allow integration of individual-based travel history, we reconstructed and characterized the spatio-temporal dynamics of SARSCoV-2 introductions and early dissemination in Portugal. Results We detected at least 277 independent SARS-CoV-2 introductions, mostly from European countries (namely the United Kingdom, Spain, France, Italy, and Switzerland), which were consistent with the countries with the highest connectivity with Portugal. Although most introductions were estimated to have occurred during early March 2020, it is likely that SARS-CoV-2 was silently circulating in Portugal throughout February, before the first cases were confirmed. Conclusions Here we conclude that the earlier implementation of measures could have minimized the number of introductions and subsequent virus expansion in Portugal. This study lays the foundation for genomic epidemiology of SARS-CoV-2 in Portugal, and highlights the need for systematic and geographically-representative genomic surveillance.We gratefully acknowledge to Sara Hill and Nuno Faria (University of Oxford) and Joshua Quick and Nick Loman (University of Birmingham) for kindly providing us with the initial sets of Artic Network primers for NGS; Rafael Mamede (MRamirez team, IMM, Lisbon) for developing and sharing a bioinformatics script for sequence curation (https://github.com/rfm-targa/BioinfUtils); Philippe Lemey (KU Leuven) for providing guidance on the implementation of the phylodynamic models; Joshua L. Cherry (National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health) for providing guidance with the subsampling strategies; and all authors, originating and submitting laboratories who have contributed genome data on GISAID (https://www.gisaid.org/) on which part of this research is based. The opinions expressed in this article are those of the authors and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government. This study is co-funded by Fundação para a Ciência e Tecnologia and Agência de Investigação Clínica e Inovação Biomédica (234_596874175) on behalf of the Research 4 COVID-19 call. Some infrastructural resources used in this study come from the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 - Operational Programme for Competitiveness and Internationalisation (POCI), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and by Fundação para a Ciência e a Tecnologia (FCT).info:eu-repo/semantics/publishedVersio

Condutância da pele como indicador de dor aguda no recém-nascido : estudo comparativo com frequência cardíaca, saturação de oxigênio e escalas comportamentais de dor

Tese (doutorado)—Universidade de Brasília, Programa de Pós-Graduação em Ciências Médicas, 2011.Objetivos: Comparar os escores da atividade de condutância da pele (ACP), da frequência cardíaca (FC) máxima, da saturação de oxigênio (SATO2) mínima, e das escalas comportamentais de dor Neonatal Facial Coding System (NFCS), Neonatal Infant Pain Scale (NIPS) e COMFORT modificada frente a um estímulo doloroso agudo, e se eles preenchem os parâmetros psicofísicos de um marcador de dor (intensidade, reatividade, direção, regulação e inclinação). Método: Estudo longitudinal prospectivo com 41 recém-nascidos de termo saudáveis. As medidas estudadas foram: FC máxima e SATO2 mínima; variáveis da ACP: número de ondas por segundo (NOps) e área sob a curva das ondas (ASC); escores das escalas comportamentais de dor acima citadas. Os escores foram obtidos em períodos rotulados como antes, durante e após uma punção do calcanhar. Resultados: A intensidade entre os períodos foi significante para o NOps (p<0,01), ASC (p<0,05), FC máxima (p<0,01), SATO2 mínima (p<0,01), NFCS (p<0,01), NIPS (p<0,01) e COMFORT modificada (p0,05). O parâmetro regulação foi significante para as variáveis NOps (p<0,01), ASC (p<0.05), FC máxima (p<0,01), SATO2 mínima (p<0,01) e para todas as escalas comportamentais de dor (p<0,01). A inclinação foi significativamente estatística para a SATO2 mínima e as escalas comportamentais de dor NIPS e COMFORT modificada (p<0,05). Não foi encontrada correlação entre os níveis de ACP e os escores das demais variáveis estudadas. Conclusões: As respostas da ACP, da FC máxima, da SATO2 mínima e das escalas comportamentais de dor NFCS, NIPS e COMFORT modificada são similares em eventos dolorosos em recém-nascidos. Todas as variáveis estudadas preenchem os parâmetros psicofísicos de um marcador de dor e servem como medidas válidas para o seu diagnóstico, devendo ser usadas de acordo com as necessidades do contexto. ______________________________________________________________________________ ABSTRACTObjectives: To compare the scores of the skin conductance activity (SCA), maximum heart rate (HR), minimum oxygen saturation (OS), and Neonatal Facial Coding System (NFCS), Neonatal Infant Pain Scale (NIPS) and modified COMFORT behavioral pain scales front to painful stimulus, and if they fit the psychophysical parameters to a pain marker (intensity, reactivity, direction, regulation and slope). Method: Observational prospective study including 41 healthy full term newborns. The measurements studied were: the maximum HR and the minimum OS; the SCA variables: number of waves per second (NWps) and relative area under the curve of waves (AUC); the scores of behavioral pain scales cited above. The measurements were performed in periods labeled before, during, and after a heel prick. Results: The values measured for intensity between periods was significant for the NWps (p0.05). The regulation parameter was significant for the variables NWps (p<0.01), AUC (p<0.05), maximum HR (p<0.01), minimum OS (p<0.01), and to all behavioral pain scales (p<0.01). The slope was statistically significant for the minimum OS, and to NIPS and modified COMFORT scales (p<0.05). There was not significantly correlation among the SCA scores and the scores of all others variables. Conclusions: It was concluded that the responses of the SCA, maximum HR, minimum OS, and NFCS, NIPS and modified COMFORT behavioral pain scales are similarly in painful events, that they fit the psychophysical parameters of a pain marker and serve as valuable measures for pain diagnostic working the use in accordance with the needs of the context

Sleep deprivation, pain and prematurity: a review study

The aim was to describe current reports in the scientific literature on sleep in the intensive care environment and sleep deprivation associated with painful experiences in premature infant. A systematic search was conducted for studies on sleep, pain, premature birth and care of the newborn. Web of Knowledge, MEDLINE, LILACS, Cochrane Library, PubMed, EMBASE, Scopus, VHL and SciELO databases were consulted. The association between sleep deprivation and pain generates effects that are observed in the brain and the behavioral and physiological activity of preterm infants. Polysomnography in intensive care units and pain management in neonates allow comparison with the first year of life and term infants. We have found few references and evidence that neonatal care programs can influence sleep development and reduce the negative impact of the environment. This evidence is discussed from the perspective of how hospital intervention can improve the development of premature infants

Pregnancy outcomes and child development effects of SARS-CoV-2 Infection (PROUDEST Trial) : protocol for a multicenter, prospective cohort study

Background: A growing body of evidence suggests that SARS-COV-2 infection during pregnancy may affect maternal-fetal outcomes and possibly result in implications for the long-term development of SARSCoV-2–exposed children. Objective: The PROUDEST (Pregnancy Outcomes and Child Development Effects of SARS-CoV-2 Infection Study) is a multicenter, prospective cohort study designed to elucidate the repercussions of COVID19 for the global health of mothers and their children. Methods: The PROUDEST trial comprises 2 prospective, sequential substudies. The PREGNANT substudy will clinically assess the effects of SARS-CoV-2 infection on pregnancy, childbirth, and puerperium from a mechanistic standpoint to elucidate the pregnancy-related inflammatory and immunological phenomena underlying COVID-19. Pregnant women aged 18-40 years who have been exposed (proven with laboratory tests) to SARS-CoV-2 (group A; n=300) will be compared to control subjects with no laboratory evidence of in-pregnancy exposure to the virus (group B; n=300). Subjects exposed to other infections during pregnancy will be excluded. The BORN substudy is a long-term follow-up study that will assess the offspring of women who enrolled in the prior substudy. It will describe the effects of SARS-CoV-2 exposure during pregnancy on children’s growth, neurodevelopment, and metabolism from birth up to 5 years of age. It includes two comparison groups; group A (exposed; n=300) comprises children born from SARS-CoV-2– exposed pregnancies, and group B (controls; n=300) comprises children born from nonexposed mothers. Results: Recruitment began in July 2020, and as of January 2021, 260 pregnant women who were infected with SARS-CoV-2 during pregnancy and 160 newborns have been included in the study. Data analysis is scheduled to start after all data are collected. Conclusions: Upon completion of the study, we expect to have comprehensive data that will provide a better understanding of the effects of SARS-CoV-2 infection and related inflammatory and immunological processes on pregnancy, puerperium, and infancy. Our findings will inform clinical decisions regarding the care of SARS-CoV-2–exposed mothers and children and support the development of evidence-based public health policies.Faculdade de Medicina (FMD)Faculdade UnB Ceilândia (FCE

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)