RESUMO
The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use.
Assuntos
COVID-19 , Hospitalização , Humanos , Pandemias , Estudos Prospectivos , SARS-CoV-2Assuntos
Institutos de Câncer/organização & administração , Neoplasias Colorretais/terapia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , COVID-19 , Neoplasias Colorretais/patologia , Infecções por Coronavirus/prevenção & controle , Humanos , Metástase Neoplásica , Estadiamento de Neoplasias , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controleRESUMO
BACKGROUND: Cosmetic tourism has become increasingly popular despite many associated risks. The economic impact of atypical mycobacterial infections in cosmetic tourism is poorly defined in the literature. We sought to investigate the costs and clinical course of patients with these infections. METHODS: A retrospective review of all patients managed by the Plastic Surgery Division at Columbia University Medical Center from 2013 to 2014 with atypical mycobacterial surgical site infections after cosmetic surgery outside the United States was performed. Data including patient demographics, procedure costs, clinical course, impact on daily life, and costs associated with complications were collected using hospital billing information, patient questionnaires, telephone interviews, and clinical charts. Cost analysis was done to identify the personal and societal costs of these complications. RESULTS: Data from 10 patients were collected and analyzed. Management of mycobacterial infections cost an average of $98,835.09 in medical charges. The indirect cost of these infections was $24,401 with a mean return to work time of 6.7 months. Total patient savings from cosmetic tourism was $3419. The total cost of a mycobacterial infection was greater than $123,236.47. Although the incidence of mycobacterial infection abroad is unknown, the potential cost of an infection alone outweighs the financial benefits of cosmetic tourism if the risk exceeds 2.77%. CONCLUSIONS: Atypical mycobacterial infections as a result of cosmetic tourism come at considerable cost to patients and the health care system. When our results are taken into consideration with other risks of cosmetic tourism, the financial risks likely far outweigh the benefits.
Assuntos
Técnicas Cosméticas/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Turismo Médico/economia , Infecções por Mycobacterium não Tuberculosas/economia , Infecção da Ferida Cirúrgica/economia , Adulto , Colômbia , Técnicas Cosméticas/efeitos adversos , Redução de Custos/estatística & dados numéricos , Análise Custo-Benefício , República Dominicana , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/etiologia , Infecções por Mycobacterium não Tuberculosas/terapia , Cidade de Nova Iorque , Estudos Retrospectivos , Risco , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/terapiaRESUMO
This study presents the first information on the reproduction of the recently described tiger pleco Panaqolus tankei, from Lake Bolonha in the north-eastern Amazon Basin. This loricariid has a long reproductive period, fractionated spawning and low fecundity (on average, female gonads contained 37 oocytes), a total length (LT ) at first maturity of 47.4 mm for females and 54.1 mm LT for males. Correlation of the condition factor and gonado-somatic index with environmental variables suggests that turbidity favours P. tankei reproduction in this environment.
Assuntos
Peixes-Gato/fisiologia , Ecossistema , Reprodução , Animais , Brasil , Feminino , Fertilidade , Masculino , Oócitos , Ovário/citologia , Ovário/crescimento & desenvolvimento , Rios , Estações do Ano , Maturidade SexualRESUMO
BACKGROUND: Unplanned rehospitalizations (UR) within 30 days of discharge are common after lung transplantation. It is unknown whether UR represents preventable gaps in care or necessary interventions for complex patients. The objective of this study was to assess the incidence, causes, risk factors, and preventability of UR after initial discharge after lung transplantation. METHODS: This was a single-center prospective cohort study. Subjects completed a modified short physical performance battery to assess frailty at listing and at initial hospital discharge after transplantation and the State-Trait Anxiety Inventory at discharge. For each UR, a study staff member and the patient's admitting or attending clinician used an ordinal scale (0, not; 1, possibly; 2, definitely preventable) to rate readmission preventability. A total sum score of 2 or higher defined a preventable UR. RESULTS: Of the 90 enrolled patients, 30 (33.3%) had an UR. The single most common reasons were infection (7 [23.3%]) and atrial tachyarrhythmia (5 [16.7%]). Among the 30 URs, 9 (30.0%) were deemed preventable. Unplanned rehospitalization that happened before day 30 were more likely to be considered preventable than those between days 30 and 90 (30.0% versus 6.2%, P = 0.04). Discharge frailty, defined as short physical performance battery less than 6, was the only variable associated with UR on multivariable analysis (odds ratio, 3.4; 95% confidence interval, 1.1-11.8; P = 0.04). CONCLUSIONS: Although clinicians do not rate the majority of UR after lung transplant as preventable, discharge frailty is associated with UR. Further research should identify whether modification of discharge frailty can reduce UR.
Assuntos
Fragilidade/economia , Custos Hospitalares , Transplante de Pulmão/economia , Alta do Paciente , Readmissão do Paciente/economia , Complicações Pós-Operatórias/economia , Adulto , Idoso , Ansiedade/diagnóstico , Ansiedade/economia , Ansiedade/epidemiologia , Ansiedade/terapia , Feminino , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Fragilidade/terapia , Nível de Saúde , Humanos , Incidência , Transplante de Pulmão/efeitos adversos , Masculino , Pessoa de Meia-Idade , Philadelphia/epidemiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Estudos Prospectivos , Fatores de Risco , Fatores de TempoRESUMO
OBJECTIVE: Donor blood transfusion has been identified as a potential risk factor for primary graft dysfunction and by extension early mortality. We sought to define the contributing risk of donor transfusion on early mortality for lung transplant. METHODS: Donor and recipient data were abstracted from the Organ Procurement and Transplantation Network database updated through June 30, 2014, which included 86,398 potential donors and 16,255 transplants. Using the United Network for Organ Sharing 4-level designation of transfusion (no blood, 1-5 units, 6-10 units, and >10 units, massive), we analyzed all-cause mortality at 30-days with the use of logistic regression adjusted for confounders (ischemic time, donor age, recipient diagnosis, lung allocation score and recipient age, and recipient body mass index). Secondary analyses assessed 90-day and 1-year mortality and hospital length of stay. RESULTS: Of the 16,255 recipients transplanted, 8835 (54.35%) donors received at least one transfusion. Among those transfused, 1016 (6.25%) received a massive transfusion, defined as >10 units. Those donors with massive transfusion were most commonly young trauma patients. After adjustment for confounding variables, donor massive transfusion was associated significantly with an increased risk in 30-day (P = .03) and 90-day recipient mortality (P = .01) but not 1-year mortality (P = .09). There was no significant difference in recipient length of stay or hospital-free days with respect to donor transfusion. CONCLUSIONS: Massive donor blood transfusion (>10 units) was associated with early recipient mortality after lung transplantation. Conversely, submassive donor transfusion was not associated with increased recipient mortality. The mechanism of increased early mortality in recipients of lungs from massively transfused donors is unclear and needs further study but is consistent with excess mortality seen with primary graft dysfunction in the first 90 days posttransplant.
Assuntos
Transfusão de Sangue/mortalidade , Transplante de Pulmão/mortalidade , Disfunção Primária do Enxerto/mortalidade , Doadores de Tecidos , Adolescente , Adulto , Causas de Morte , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação , Transplante de Pulmão/efeitos adversos , Masculino , Pessoa de Meia-Idade , Disfunção Primária do Enxerto/diagnóstico , Disfunção Primária do Enxerto/etiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Obtenção de Tecidos e Órgãos , Resultado do Tratamento , Estados Unidos , Adulto JovemRESUMO
Rock fragment fields are important habitat for biodiversity maintenance in coastal regions, particularly when located in protected areas dominated by soft sediments. Researches in this habitat have received surprisingly little attention on the Amazon Coast, despite rock fragments provide refuges, nursery grounds and food sources for a variety of benthic species. The present survey describes the mobile macroinvertebrate species composition and richness of the intertidal rocky fragments in Areuá Island within the "Mãe Grande de Curuçá" Marine Extractive Reserve (RESEX) on the Brazilian Amazon Coast. Samples were collected during the dry (August and November 2009) and rainy seasons (March and May 2010) on the upper and lower intertidal zone, using a 625cm2 quadrat. At each season and intertidal zone, macroinvertebrate samples were collected along four transects (20m each) parallel to the waterline, and within each transect two quadrats were randomly sampled. Macroinvertebrates were identified, density determined, and biomass values obtained to characterize benthic diversity from the rocky fragments. The Jackknife procedure was used to estimate species richness from different intertidal zones during the dry and rainy seasons. Macrofaunal community comprised 85 taxa, with 17 "unique" taxa, 40 taxa were common to both intertidal zones and seasons, and 23 taxa have been recorded for the first time on the Brazilian Amazon Coast. Species richness was estimated at 106 +/- 9.7 taxa and results suggest that sampling effort was representative. Polychaeta was the most dominant in species number, followed by Malacostraca and Gastropoda. Regarding frequency of occurrence, Crustacean species Dynamenella tropica, Parhyale sp. and Petrolisthes armatus were the most frequent representing >75% of frequency of occurrence and 39 taxa were least frequent representing <5% of frequency of occurrence. Occurrence of crustaceans and polychaetes were particularly noteworthy in all intertidal zones and seasons, represented by 15 and 13 taxa, respectively. The most representative class in abundance and biomass was Malacostraca that represented more than half of all individuals sampled, and was dominated by Petrolisthes armatus. The latter was one of the most frequent, numerous and higher biomass species in the samples. In general, results indicated greater richness and biomass in the lower zone. Additionally, richness and density increase during the rainy season. Rock fragment fields in Areuá Island are rich in microhabitats and include a diverse array of species in a limited area. Our results underline the importance of rock fragment fields in Areuá Island for the maintenance of biodiversity in the Amazon Coast.
Assuntos
Biodiversidade , Biomassa , Invertebrados/classificação , Animais , Brasil , Ecossistema , Monitoramento Ambiental , Densidade Demográfica , Estações do AnoRESUMO
Rock fragment fields are important habitat for biodiversity maintenance in coastal regions, particularly when located in protected areas dominated by soft sediments. Researches in this habitat have received surprisingly little attention on the Amazon Coast, despite rock fragments provide refuges, nursery grounds and food sources for a variety of benthic species. The present survey describes the mobile macroinvertebrate species composition and richness of the intertidal rocky fragments in Areuá Island within the “Mãe Grande de Curuçá” Marine Extractive Reserve (RESEX) on the Brazilian Amazon Coast. Samples were collected during the dry (August and November 2009) and rainy seasons (March and May 2010) on the upper and lower intertidal zone, using a 625cm² quadrat. At each season and intertidal zone, macroinvertebrate samples were collected along four transects (20m each) parallel to the waterline, and within each transect two quadrats were randomly sampled. Macroinvertebrates were identified, density determined, and biomass values obtained to characterize benthic diversity from the rocky fragments. The Jackknife procedure was used to estimate species richness from different intertidal zones during the dry and rainy seasons. Macrofaunal community comprised 85 taxa, with 17 “unique” taxa, 40 taxa were common to both intertidal zones and seasons, and 23 taxa have been recorded for the first time on the Brazilian Amazon Coast. Species richness was estimated at 106±9.7 taxa and results suggest that sampling effort was representative. Polychaeta was the most dominant in species number, followed by Malacostraca and Gastropoda. Regarding frequency of occurrence, Crustacean species Dynamenella tropica, Parhyale sp. and Petrolisthes armatus were the most frequent representing >75% of frequency of occurrence and 39 taxa were least frequent representing <5% of frequency of occurrence. Occurrence of crustaceans and polychaetes were particularly noteworthy in all intertidal zones and seasons, represented by 15 and 13 taxa, respectively. The most representative class in abundance and biomass was Malacostraca that represented more than half of all individuals sampled, and was dominated by Petrolisthes armatus. The latter was one of the most frequent, numerous and higher biomass species in the samples. In general, results indicated greater richness and biomass in the lower zone. Additionally, richness and density increase during the rainy season. Rock fragment fields in Areuá Island are rich in microhabitats and include a diverse array of species in a limited area. Our results underline the importance of rock fragment fields in Areuá Island for the maintenance of biodiversity in the Amazon Coast.
Los fragmentos rocosos comprenden un hábitat importante para el mantenimiento de la biodiversidad en las regiones costeras, particularmente cuando estos se encuentran en áreas protegidas dominadas por sedimentos blandos. A pesar de que los fragmentos rocosos proporcionan refugio, zonas de crianza y fuentes de alimento para una gran variedad de especies bentónicas, las investigaciones sobre este hábitat en la costa de la Amazonia han recibido poca atención. El presente estudio describe la composición de macroinvertebrados vágiles y la riqueza de especies en los fragmentos rocosos del intermareal de la isla Areuá en la Reserva Marina Extractiva (RESEX) “Mãe Grande de Curuçá”, en la costa brasileña de la Amazonia. Las muestras fueron recolectadas durante la estación seca (agosto y noviembre 2009) y de lluvias (marzo y mayo 2010) en dos zonas del intermareal (superior e inferior), con un cuadrante de 625cm². En cada zona del intermareal y por temporada se tomaron muestras de macroinvertebrados a lo largo de cuatro transectos (20m cada uno) dispuestos paralelamente a la línea de costa. Dos cuadrantes se muestrearon al azar dentro de cada transecto. Los macroinvertebrados recolectados fueron identificados y se determinó la densidad y la biomasa de organismos para caracterizar la diversidad bentónica de los fragmentos rocosos. La riqueza de especies de las dos zonas del intermareal durante las estaciones seca y de lluvias se estimó por el método de Jackknife. La comunidad de macroinvertebrados estuvo compuesta por 85 taxones, con 17 taxones “único”, 40 taxones fueron comunes para ambas zonas del intermareal y temporadas, y 23 taxones se reportaron por primera vez para la costa brasileña de la Amazonia. La riqueza de especies se estimó en 106±9.7 taxones, por lo que los resultados sugieren que el esfuerzo de muestreo fue representativo. La Clase Polychaeta dominó en número de especies, seguida por Malacostraca y Gasteropoda. Los crustaceos Dynamenella tropica, Parhyale sp. y Petrolisthes armatus fueron las más frecuentes, con una frecuencia de presencia >75% mientras que 39 taxones fueron los menos comunes, con una frecuencia de presencia <5%. La presencia de crustáceos y poliquetos fue particularmente notable en las dos zonas y temporadas, incluyeron 15 y 13 taxones, respectivamente. La Clase Malacostraca fue la más conspicua en términos de abundancia y biomasa, representó más de la mitad de todos los individuos recolectados, con dominio de Petrolisthes armatus. Esta especie fue una de las más numerosas, frecuentes y de mayor biomasa en las muestras. En general, los resultados indican que hay una mayor riqueza y biomasa en el intermareal inferior mientras que la riqueza y la densidad aumentan en la estación lluviosa. Los sectores con fragmentos rocosos en la isla Areuá son ricos en microhábitats e incluyen una gran variedad de especies en un área limitada. Nuestros resultados enfatizan la importancia de los sectores con fragmentos rocosos en la isla Areuá para el mantenimiento de la biodiversidad en la costa de la Amazonia.
Assuntos
Animais , Biodiversidade , Biomassa , Invertebrados/classificação , Brasil , Ecossistema , Monitoramento Ambiental , Densidade Demográfica , Estações do AnoRESUMO
BACKGROUND: Idiopathic pulmonary fibrosis (IPF) can lead to the development of pulmonary hypertension, which is associated with an increased risk of death. In pulmonary arterial hypertension, survival is directly related to the capacity of the right ventricle to adapt to elevated pulmonary vascular load. The relative importance of right ventricular function in IPF is not well understood. Our objective was to evaluate right ventricular echocardiographic and hemodynamic predictors of mortality in a cohort of patients with IPF referred for lung transplant evaluation. METHODS: We performed a retrospective cohort study of 135 patients who met 2011 American Thoracic Society/European Respiratory Society criteria for IPF and who were evaluated for lung transplantation at the Hospital of the University of Pennsylvania. RESULTS: Right ventricle:left ventricle diameter ratio (hazard ratio [HR], 4.5; 95% CI, 1.7-11.9), moderate to severe right atrial and right ventricular dilation (HR, 2.9; 95% CI, 1.4-5.9; and HR, 2.7; 95% CI, 1.4-5.4, respectively) and right ventricular dysfunction (HR, 5.5; 95% CI, 2.6-11.5) were associated with an increased risk of death. Higher pulmonary vascular resistance was also associated with increased mortality (HR per 1 Wood unit, 1.3; 95% CI, 1.1-1.5). These risk factors were independent of age, sex, race, height, weight, FVC, and lung transplantation status. Other hemodynamic indices, such as mean pulmonary artery pressure and cardiac index, were not associated with outcome. CONCLUSIONS: Right-sided heart size and right ventricular dysfunction measured by echocardiography and higher pulmonary vascular resistance by invasive hemodynamic assessment predict mortality in patients with IPF evaluated for lung transplantation.