PERFIL DOS PACIENTES COM DIAGNÓSTICO DE AVC ATENDIDOS EM UM HOSPITAL DE MINAS GERAIS CREDENCIADO NA LINHA DE CUIDADOS

Acidente Vascular Cerebral é um problema de saúdepública em que estudos epidemiológicos evidenciam a importânciada prevenção, promoção e tratamento da doença no Brasil. Objetivo:descrever a distribuição de pacientes com Acidente Vascular Cerebralnos diferentes setores de internação de um hospital da redepública credenciado pelo Ministério da Saúde na linha de cuidados.Métodos: Estudo transversal em que foram avaliados pacientes comAcidente Vascular Cerebral admitidos no Hospital Risoleta TolentinoNeves de Belo Horizonte no período de janeiro a junho de 2015. Dadossócio-demográficos e clínicos foram extraídos dos prontuários e/ou por meio de entrevistas, sendo analisadas as informações: sexo;idade; mecanismo fisiopatológico; tempo de ictus; fatores de riscopara o AVC; setor de internação; tempo de internação e complicaçõesclínicas. Resultados: Dos 223 pacientes internados, 55% eramsexo masculino e idade média de 64,3 anos. Em relação aos setoreshospitalares, 169 foram alocados para a Unidade de Acidente VascularCerebral (82% isquêmico), 24 no Centro de Tratamento Intensivo(79% hemorrágico), 23 no Pronto Atendimento (74% Ataque IsquêmicoTransitório) e sete na Enfermaria Geral. A média do tempo de ictusfoi de 13,2 horas. O tempo médio de internação foi de 12,4 À 9,8 dias,entretanto a Enfermaria Geral e o Centro de Tratamento Intensivoapresentaram maiores tempos de internação e número de complicaçõesclínicas. Conclusão: A linha de cuidado em Acidente VascularCerebral nos hospitais pode reduzir complicações clínicas, mortalidadee tempo de internação, contribuindo para organização de setoresde internação e utilização de recursos hospitalare

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

AVALIAÇÃO DO PERFIL DE CONFORMIDADE DE DIFERENTES LEITES FERMENTADOS COM A LEGISLAÇÃO BRASILEIRA DE ALIMENTOS

Leites fermentados são produtos resultantes da fermentação do leite pasteurizado ou esterilizado, por fermentos lácticos próprios. Entre os parâmetros exigidos, destaca-se a acidez titulável e a contagem de bactérias láticas presentes no produto final. O objetivo deste estudo foi avaliar o perfil de conformidade de diferentes leites fermentados com a legislação brasileira de alimentos com relação aos parâmetros microbiológicos e de acidez. Foram adquiridas amostras de sete marcas de leites fermentados comercializadas em Viçosa, Minas Gerais. Para cada marca, foram adquiridas três amostras em dias aleatórios, e em seguida analisadas. Foram feitas diluições seriadas e plaqueadas em quatro meios: MRS, Rogosa, PDA e PCA. Após o período de incubação, foram feitas contagens e, as colônias com morfologia característica crescidas em MRS e Rogosa foram isoladas e estriadas em agar sólido para confirmação de pureza das colônias, colorações de Gram, morfologia e catalase. Em cada amostra, foram determinadas acidez titulável e pH. Todas as amostras apresentaram valores de pH e acidez de acordo com a legislação. Dentre as sete amostras avaliadas, cinco delas (71,5%) especificam na embalagem a espécie do micro-organismo veiculado, porém apenas uma delas (14,3%) menciona a contagem de micro-organismos esperada na porção do produto. Em relação à contagem de micro-organismos todas as amostras apresentaram conformidade com a legislação vigente. Os leites fermentados comercializados no mercado mineiro local atendem aos critérios de identidade e qualidade preconizados na legislação de leites fermentados

AVALIAÇÃO DO PERFIL DE CONFORMIDADE DE DIFERENTES LEITES FERMENTADOS COM A LEGISLAÇÃO BRASILEIRA DE ALIMENTOS

Fermented milks are products derived from fermentation of pasteurized or sterilized milk by proper lactic ferments. Among the parameters required, titratable acidity and total lactic acid count in the final product can be highlighted. The aim of this study was to evaluate the profile of compliance of different fermented milks with Brazilian food legislation with regard to microbiological and acidity parameters. Samples were obtained from seven brands of fermented milk commercialized in Viçosa, Minas Gerais. For each brand, were acquired three samples on random days, and then analyzed. Serial dilutions were made and plated on four media: mRS, Rogosa, PDA and PCA. After the incubation period was completed, plates were counted, and colonies with characteristic morphology observed in MRS and Rogosa medium were isolated and striated in solid agar to confirm purity of the colonies, Gram staining, morphology and catalase. For each sample, titratable acidity and pH were assessed. All samples showed acidic pH values and in accordance with the law. Among the seven samples, five of them (71.5%) specified the microorganism specie present in their product, however only one (14.3%) mentioned the microorganism counting expected in the product´s portion. In relation to microorganism counting all the samples were in conformity with the current legislation. Thus, fermented milks commercialized in the local market of Viçosa meet the criteria of identity and quality recommended by specific legislation for fermented milk.Leites fermentados são produtos resultantes da fermentação do leite pasteurizado ou esterilizado, por fermentos lácticos próprios. Entre os parâmetros exigidos, destaca-se a acidez titulável e a contagem de bactérias láticas presentes no produto final. O objetivo deste estudo foi avaliar o perfil de conformidade de diferentes leites fermentados com a legislação brasileira de alimentos com relação aos parâmetros microbiológicos e de acidez. Foram adquiridas amostras de sete marcas de leites fermentados comercializadas em Viçosa, Minas Gerais. Para cada marca, foram adquiridas três amostras em dias aleatórios, e em seguida analisadas. Foram feitas diluições seriadas e plaqueadas em quatro meios: MRS, Rogosa, PDA e PCA. Após o período de incubação, foram feitas contagens e, as colônias com morfologia característica crescidas em MRS e Rogosa foram isoladas e estriadas em agar sólido para confirmação de pureza das colônias, colorações de Gram, morfologia e catalase. Em cada amostra, foram determinadas acidez titulável e pH. Todas as amostras apresentaram valores de pH e acidez de acordo com a legislação. Dentre as sete amostras avaliadas, cinco delas (71,5%) especificam na embalagem a espécie do micro-organismo veiculado, porém apenas uma delas (14,3%) menciona a contagem de micro-organismos esperada na porção do produto. Em relação à contagem de micro-organismos todas as amostras apresentaram conformidade com a legislação vigente. Os leites fermentados comercializados no mercado mineiro local atendem aos critérios de identidade e qualidade preconizados na legislação de leites fermentados

Preparation of instant flour from the pulp of breadfruit (Artocarpus altilis)

This work aimed to develop an instant flour using the mesocarp of breadfruit, variety apyrena, and assess its physicochemical composition, as well as to develop a flour based puree and determine its potential sensory acceptance by potential consumers, employing the consumer testing. The in natura breadfruit presented moisture in dry basis, pH, soluble solids and total acidity values of 74.58%, 6.01, 5.6°Brix and 1.64%, respectively, while the instant flour presented moisture, pH, density, alcohol content, soluble acidity and water activity values of 9.4%, 5.55, 0.61 g mL-1, 2.098% and 0.538, respectively. The equation adapted from Brooker, used to adjust the drying behavior, was efficient to describe the process of breadfruit drying. The puree breadfruit presented good acceptability by the consumers, considering the sensorial attributes evaluated, except for color, and most of them declared that they would buy the product.Objetivou-se elaborar uma farinha instantânea utilizando do mesocarpo de fruta-pão, variedade apyrena, e avaliar sua composição físico-química, bem como desenvolver um purê a base da farinha e determinar sua aceitação sensorial por consumidores potenciais utilizando o teste de consumidor. A fruta-pão in natura apresentou valores de umidade em base úmida, pH, teor de sólidos solúveis totais e acidez total titulável aproximadamente 74,58±2,84%, 6,01±0,04, 5,6±0,01Brix e 1,64±0,01%, respectivamente, e a farinha instantânea com umidade, pH, densidade, acidez álcool solúvel e atividade de água de 9,4±0,28%, 5,55±0,2, 0,61±0,01g mL-1, 2,098±0,01% e 0,538±0,14, respectivamente. A equação adaptada de Brooker, usada para ajustar o comportamento da secagem, foi eficiente para descrever o processo de secagem da polpa de fruta-pão cozida. O purê de fruta-pão apresentou boa aceitabilidade pelos consumidores para os atributos sensoriais avaliados, exceto para a cor, sendo que a maioria declarou comprar o produto.1123112

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes

The value of open-source clinical science in pandemic response: lessons from ISARIC

International audienc