Panoramic snapshot of serum soluble mediator interplay in pregnant women with convalescent COVID-19: an exploratory study

IntroductionSARS-CoV-2 infection during pregnancy can induce changes in the maternal immune response, with effects on pregnancy outcome and offspring. This is a cross-sectional observational study designed to characterize the immunological status of pregnant women with convalescent COVID-19 at distinct pregnancy trimesters. The study focused on providing a clear snapshot of the interplay among serum soluble mediators.MethodsA sample of 141 pregnant women from all prenatal periods (1st, 2nd and 3rd trimesters) comprised patients with convalescent SARS-CoV-2 infection at 3-20 weeks after symptoms onset (COVID, n=89) and a control group of pre-pandemic non-infected pregnant women (HC, n=52). Chemokine, pro-inflammatory/regulatory cytokine and growth factor levels were quantified by a high-throughput microbeads array.ResultsIn the HC group, most serum soluble mediators progressively decreased towards the 2nd and 3rd trimesters of pregnancy, while higher chemokine, cytokine and growth factor levels were observed in the COVID patient group. Serum soluble mediator signatures and heatmap analysis pointed out that the major increase observed in the COVID group related to pro-inflammatory cytokines (IL-6, TNF-α, IL-12, IFN-γ and IL-17). A larger set of biomarkers displayed an increased COVID/HC ratio towards the 2nd (3x increase) and the 3rd (3x to 15x increase) trimesters. Integrative network analysis demonstrated that HC pregnancy evolves with decreasing connectivity between pairs of serum soluble mediators towards the 3rd trimester. Although the COVID group exhibited a similar profile, the number of connections was remarkably lower throughout the pregnancy. Meanwhile, IL-1Ra, IL-10 and GM-CSF presented a preserved number of correlations (≥5 strong correlations in HC and COVID), IL-17, FGF-basic and VEGF lost connectivity throughout the pregnancy. IL-6 and CXCL8 were included in a set of acquired attributes, named COVID-selective (≥5 strong correlations in COVID and <5 in HC) observed at the 3rd pregnancy trimester.Discussion and conclusionFrom an overall perspective, a pronounced increase in serum levels of soluble mediators with decreased network interplay between them demonstrated an imbalanced immune response in convalescent COVID-19 infection during pregnancy that may contribute to the management of, or indeed recovery from, late complications in the post-symptomatic phase of the SARS-CoV-2 infection in pregnant women

Avaliação de cartão de vacina digital na prática de enfermagem em sala de vacinação

Objetivo: desarrollar y evaluar una aplicación de vacuna para dispositivos móviles, con actualización integrada al Sistema de Información del Programa Nacional de Inmunización, para el cuidado en sala de vacunación. Método: investigación metodológica fundamentada en la teoría de ciclo de vida de desarrollo de sistemas de Pressman que fue desarrollada en tres etapas: revisión integrativa de la literatura, desarrollo computacional y evaluación de la aplicación. El producto fue evaluado cuanto a la satisfacción, utilizando un cuestionario validado, y cuanto a la usabilidad por el System Usability Scale. Resultados: las funcionalidades de la aplicación se basaron en la recopilación de innovaciones tecnológicas sobre inmunización, que fueron publicadas en la literatura científica. Exhibe las vacunas del usuario directamente del Sistema de Información del Programa Nacional de Inmunización, notifica próximas vacunas y posibilita la inclusión de tarjeta de vacuna de dependientes. Evaluación con puntuación media de los usuarios fue de 90,5 ± 11,1 y de los profesionales de salud de 84,2 ± 19,4. Conclusión: el uso de la aplicación es una herramienta tecnológica con potencial para mejorar el proceso de trabajo en sala de vacunación y para el alcance de las metas de cobertura de vacunación. Sincroniza datos del Sistema de Información del Programa Nacional de Inmunización posibilitando el mantenimiento del historial de vacunación de las personas.Objective: develop and evaluate a vaccine application for mobile devices, with update integrated with the National Immunization Program Information System, for care in vaccination rooms. Method: methodological research based on the Pressman System Development Life Cycle theory developed in three stages: integrative literature review, computational development, and application evaluation. The product was evaluated as to satisfaction, using a validated questionnaire, and as to usability by the System Usability Scale. Results: the application functionalities were based on the survey of technological Innovations on immunization, published in the scientific literature. It displays user vaccines directly from the National Immunization Program Information System, notifies about upcoming vaccines, and enables the inclusion of vaccine cards of dependents. The evaluation resulted in users’ mean score of 90.5 ± 11.1 and health professionals’ mean score of 84.2 ± 19.4. Conclusion: the application is a technological tool with potential to improve the work process in vaccination rooms and to reach the goals of vaccine coverage. It synchronizes data with the National Immunization Program Information System, thus enabling the maintenance of people’s vaccination history.Objetivo: desenvolver e avaliar um aplicativo de vacina para dispositivos móveis, com atualização integrada ao Sistema de Informação do Programa Nacional de Imunização, para o cuidado em sala de vacinação. Método: pesquisa metodológica fundamentada na teoria ciclo de vida de desenvolvimento de sistemas de Pressman que foi desenvolvida em três etapas: revisão integrativa da literatura, desenvolvimento computacional e avaliação do aplicativo. O produto foi avaliado quanto à satisfação, utilizando um questionário validado, e quanto à usabilidade pelo System Usability Scale. Resultados: as funcionalidades do aplicativo basearam-se no levantamento de inovações tecnológicas sobre imunização, publicadas na literatura científica. Exibe as vacinas do usuário diretamente do Sistema de Informação do Programa Nacional de Imunização, notifica próximas vacinas e possibilita a inclusão de cartão de vacina de dependentes. Avaliação com pontuação média dos usuários foi de 90,5 ± 11,1 e dos profissionais de saúde de 84,2 ± 19,4. Conclusão: o uso do aplicativo é uma ferramenta tecnológica com potencial para melhorar o processo de trabalho em sala de vacinação e para o alcance das metas de cobertura vacinal. Sincroniza dados do Sistema de Informação do Programa Nacional de Imunização possibilitando a manutenção do histórico vacinal das pessoas

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease