Technology enabling the largest free and accessible event worldwide on COVID-19 management: experience report: Tecnologia viabilizando o maior evento gratuito e acessível do mundo sobre gestão da COVID-19: relato de experiência

Introdução: O uso das redes sociais como fonte de informação durante a pandemia de Covid-19 possibilitou o acesso do grande público a informações atualizadas, mas também permitiu uma intensa disseminação de notícias falsas no Brasil e no mundo. Objetivo: Este relatório tem como objetivo apresentar a experiência da tecnologia que possibilita a organização e implantação de um evento científico online gratuito de grande escala sobre a Covid-19, com foco em informações baseadas em evidências, atendimento e gestão do paciente. Métodos: O "Primeiro Congresso Brasileiro de Evidências Clínicas sobre Covid-19" aconteceu entre os dias 03 e 07 de maio de 2021 e foi realizado pela Universidade Federal de Minas Gerais, a principal universidade federal do Brasil. Resultados: Houve 27.102 cadastros. A transmissão teve 29.170 visualizações no primeiro dia. Em 25 de junho de 2021, foram 80.923 visualizações para a versão original em áudio e 10.352 visualizações para a tradução simultânea. Os tópicos compreenderam prevenção da Covid-19, gestão na atenção primária, atendimento pré-hospitalar, assistência hospitalar, unidade de terapia intensiva, longa-COVID-19, vacinas, saúde mental e custos. Minipalestras foram seguidas de discussão e interação com os participantes. Palestrantes e moderadores de todo o Brasil e do exterior foram escolhidos de acordo com sua expertise em temas de Covid-19 e em medicina baseada em evidências. Entre as sessões, foram apresentados depoimentos em vídeo de pessoas que não puderam trabalhar em casa sobre o que tocou seu coração durante a pandemia. A acessibilidade foi garantida por meio de tradução simultânea para a Língua Brasileira de Sinais. A satisfação dos participantes foi avaliada, com 2.228 respondentes, dos quais 97,4% disseram que suas expectativas foram superadas e 86,8% relataram adquirir novos conhecimentos sobre a Covid-19. Final considerations: Essa experiência mostrou que a tecnologia possibilitou a divulgação de evidências científicas acessíveis sobre a Covid-19 para um grande público por meio de um evento online gratuito

COVID-19 outcomes in people living with HIV: Peering through the waves

Objective: To evaluate clinical characteristics and outcomes of COVID-19 patients infected with HIV, and to compare with a paired sample without HIV infection. Methods: This is a substudy of a Brazilian multicentric cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records. Primary outcomes were admission to the intensive care unit, invasive mechanical ventilation, and death. Patients with HIV and controls were matched for age, sex, number of comorbidities, and hospital of origin using the technique of propensity score matching (up to 4:1). They were compared using the Chi-Square or Fisher's Exact tests for categorical variables and the Wilcoxon for numerical variables. Results: Throughout the study, 17,101 COVID-19 patients were hospitalized, and 130 (0.76%) of those were infected with HIV. The median age was 54 (IQR: 43.0;64.0) years in 2020 and 53 (IQR: 46.0;63.5) years in 2021, with a predominance of females in both periods. People Living with HIV (PLHIV) and their controls showed similar prevalence for admission to the ICU and invasive mechanical ventilation requirement in the two periods, with no significant differences. In 2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9% vs. 17.7%; p = 0.049), but there was no difference in mortality between groups in 2021 (25.0% vs. 25.1%; p > 0.999). Conclusions: Our results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in 2021, when the mortality rate is similar to the control group

Clinical characteristics and outcomes of patients hospitalized with COVID-19 in Brazil : results from the Brazilian COVID-19 registry

Objectives: To describe the clinical characteristics, laboratory results, imaging findings, and in-hospital outcomes of COVID-19 patients admitted to Brazilian hospitals. Methods: A cohort study of laboratory-confirmed COVID-19 patients who were hospitalized from March 2020 to September 2020 in 25 hospitals. Data were collected from medical records using Research Electronic Data Capture (REDCap) tools. A multivariate Poisson regression model was used to assess the risk factors for in-hospital mortality. Results: For a total of 2,054 patients (52.6% male; median age of 58 years), the in-hospital mortality was 22.0%; this rose to 47.6% for those treated in the intensive care unit (ICU). Hypertension (52.9%), diabetes (29.2%), and obesity (17.2%) were the most prevalent comorbidities. Overall, 32.5% required invasive mechanical ventilation, and 12.1% required kidney replacement therapy. Septic shock was observed in 15.0%, nosocomial infection in 13.1%, thromboembolism in 4.1%, and acute heart failure in 3.6%. Age >= 65 years, chronic kidney disease, hypertension, C-reactive protein ≥ 100 mg/dL, platelet count < 100 × 109/L, oxygen saturation < 90%, the need for supplemental oxygen, and invasive mechanical ventilation at admission were independently associated with a higher risk of in-hospital mortality. The overall use of antimicrobials was 87.9%. Conclusions: This study reveals the characteristics and in-hospital outcomes of hospitalized patients with confirmed COVID-19 in Brazil. Certain easily assessed parameters at hospital admission were independently associated with a higher risk of death. The high frequency of antibiotic use points to an over-use of antimicrobials in COVID-19 patients

A trypsin inhibitor from Tecoma stans leaves inhibits growth and promotes ATP depletion and lipid peroxidation in Candida albicans and Candida krusei

Tecoma stans (yellow elder) has shown medicinal properties and antimicrobial activity. Previous reports on antifungal activity of T. stans preparations and presence of trypsin inhibitor activity from T. stans leaves stimulated the investigation reported here. In this work, we proceeded to the purification and characterization of a trypsin inhibitor (TesTI), which was investigated for anti-Candida activity. Finally, in order to determine the potential of TesTI as a new natural chemotherapeutic product, its cytotoxicity to human peripheral blood mononuclear cells (PBMCs) was evaluated. TesTI was isolated from saline extract by ammonium sulphate fractionation followed by ion exchange and gel filtration chromatographies. Antifungal activity was evaluated by determining the minimal inhibitory (MIC) and fungicide (MFC) concentrations using fungal cultures containing only yeast form or both yeast and hyphal forms. Candida cells treated with TesTI were evaluated for intracellular ATP levels and lipid peroxidation. Cytotoxicity of TesTI to PBMCs was evaluated by MTT assay. TesTI (39.8 kDa, pI 3.41, Ki 43 nM) inhibited similarly the growth of both C. albicans and C. krusei culture types at MIC of 100 µg/mL. The MFCs were 200 µg/mL for C. albicans and C. krusei. Time-response curves revealed that TesTI (at MIC) was more effective at inhibiting the replication of C. albicans cells. At MIC, TesTI promoted reduction of ATP levels and lipid peroxidation in the Candida cells, being not cytotoxic to PBMCs. In conclusion, TesTI is an antifungal agent against C. albicans and C. krusei, without toxicity to human cells

ESCORE MMCD PARA PREDIÇÃO DE TERAPIA RENAL SUBSTITUTIVA E MORTALIDADE INTRA-HOSPITALAR EM PACIENTES HOSPITALIZADOS COM COVID-19 DE 2020 A 2022

Introdução: A lesão renal aguda (LRA) com necessidade de terapia renal substitutiva (TRS) em suas formas mais graves é uma complicação importante de pacientes com covid-19. O desenvolvimento de um escore de risco para predizer a necessidade de TRS pode ser muito útil, para melhor alocação de recursos de saúde. Assim, este estudo teve como objetivo desenvolver e validar um escore para predição de necessidade de TRS, em pacientes hospitalizados com covid-19, entre 2020 e 2022. Métodos: Trata-se de uma coorte retrospectiva multicêntrica de pacientes consecutivos internados por covid-19, confirmada laboratorialmente, em 40 hospitais brasileiros, entre março de 2020 e julho de 2022. Foram excluídos do estudo pacientes menores de 18 anos, grávidas, em cuidados paliativos ou terapia dialítica à admissão. A seleção de variáveis preditoras foi realizada utilizando modelos aditivos generalizados (GAM). Enquanto, a regressão do operador de seleção e contração mínima absoluta (LASSO) foi usada para derivação de pontuação. O escore foi desenvolvido no período de março a julho de 2020, com validação temporal e geográfica de julho a setembro de 2020 e nova validação temporal no período de março de 2021 a julho de 2022. O desempenho do MMCD foi avaliado pela área sob a curva da característica de operação do receptor (AUROC, com intervalo de confiança de 95%), análise gráfica com teste de intercepto e inclinação e escore de Brier. Resultados: Foram incluídos 3.680 pacientes na amostra de desenvolvimento, 1.532 na validação temporal 2020, 1.378 na validação geográfica e 9.473 na validação temporal 2021-2022. Quatro preditores da necessidade de TRS foram identificados: ventilação mecânica a qualquer momento da internação, sexo masculino, creatinina à admissão e diabetes mellitus. O escore nomeado como MMCD apresentou excelente discriminação, calibração e desempenho geral nas coortes de derivação e validações (desenvolvimento: AUROC: 0.929; IC95%: 0.918–0.939, escore de Brier: 0.057; validação temporal 2020: AUROC 0.927, IC95% 0.911–0.941, escore de Brier 0.056; validação geográfica 2020: AUROC: 0.819, IC95% 0.792–0.845, escore de Brier 0.122; validação temporal 2021/2022: AUROC 0.916, IC95% 0.909-0.924, escore de Brier 0.057). Conclusão: O MMCD apresentou excelente capacidade preditiva para TRS nas diferentes fases da pandemia, o que pode contribuir para subsidiar decisões mais assertivas na alocação de recursos assistenciais

Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients

Abstract Background Acute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement. Methods This study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). Results The median age of the model-derivation cohort was 59 (IQR 47–70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918–0.939) and validation (temporal AUROC 0.927, 95% CI 0.911–0.941; geographic AUROC 0.819, 95% CI 0.792–0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator ( https://www.mmcdscore.com/ ). Conclusions The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation