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Highlights • In-hospital mortality in COVID-19 Brazilian patients from 25 hospitals in 11 cities was 22·0%. • Among those who required invasive mechanical ventilation, mortality was 59.5%. • Easily assessed parameters at admission were associated with a higher risk of death. • Treatment included antibiotics in 87·1%. • Propagation of antimicrobial resistance may be a consequence of the pandemic., Objectives To describe clinical characteristics, laboratory and imaging findings, as well as in-hospital outcomes of COVID-19 patients admitted to Brazilian hospitals. Methods Cohort study of laboratory-confirmed COVID-19 patients hospitalized from March to September 2020 at 25 hospitals. Study data were collected from medical records using Research Electronic Data Capture (REDCap) tools. Multivariate Poisson regression model was used to assess risk factors for in-hospital mortality. Results Of 2054 patients (52.6% male, median age 58 years old), in-hospital mortality was 22.0%, and 47.6% among those treated in the 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% 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-old, chronic kidney disease, hypertension, C-reactive protein ≥100 mg/dL, platelet count

Background: This work aims to identify and validate a risk scale for admission to intensive care units (ICU) in hospitalized patients with coronavirus disease 2019 (COVID-19). Methods: We created a derivation rule and a validation rule for ICU admission using data from a national registry of a cohort of patients with confirmed SARS-CoV-2 infection who were admitted between March and August 2020 (n = 16,298). We analyzed the available demographic, clinical, radiological, and laboratory variables recorded at hospital admission. We evaluated the performance of the risk score by estimating the area under the receiver operating characteristic curve (AUROC). Using the 13 coefficients of the regression model, we developed a score (0 to 100 points) associated with ICU admission. Results: The mean age of the patients was 67 years; 57% were men. A total of 1,420 (8.7%) patients were admitted to the ICU. The variables independently associated with ICU admission were age, dyspnea, Charlson Comorbidity Index score, neutrophil-to-lymphocyte ratio, lactate dehydrogenase levels, and presence of diffuse infiltrates on a chest X-ray. The model showed an AUROC of 0.780 (CI: 0.763-0.797) in the derivation cohort and an AUROC of 0.734 (CI: 0.7080.761) in the validation cohort. A score of greater than 75 points was associated with a more than 30% probability of ICU admission while a score of less than 50 points reduced the likelihood of ICU admission to 15%. Conclusion: A simple prediction score was a useful tool for forecasting the probability of ICU admission with a high degree of precision. (c) 2021 Elsevier Espana, S.L.U. and Sociedad Espanola de Medicina Interna (SEMI). All rights reserved.

BackgroundThe risk of developing Chronic Obstructive Pulmonary Disease (COPD), the associated comorbidities and response to bronchodilators might differ in men and women. The objective of this study was to determine the prevalence of COPD and the clinic-epidemiological characteristics of primary care patients with COPD according to gender.MethodsThis is a cross-sectional study using electronic healthcare records Catalonia (Spain), during the 01/01/2012–31/12/2017 period. Patients from the SIDIAP database (System for the Development of Research in Primary Care) were included (5,800,000 patients registered in 279 primary care health centres). Clinic-demographic characteristics, comorbidities and blood tests results were collected for each patient. Adjusted OR (ORa) with logistic regression methods were used to determine variables associated with men and women.ResultsFrom an initial sample of 800,899 people, 24,135 (3%) were considered COPD patients, and 22.9%were women. The most common risk factors in women were bronchiectasis (ORa = 20.5, SD = 19.5–21.6), age > 71 years (ORa = 18.8; SD = 17.3–20.5), cor pulmonale (ORa = 5.2; SD = 4.3–6.7) and lung cancer (ORa = 3.6, SD = 3.2–4.0). Men and women presented the same comorbidities, though the strength of association was different for each gender.ConclusionsPatients suffering high comorbidity rates. Comorbidities are similar in men and women, although the strength of association varies according to gender. Women are more susceptible to the harmful effects of smoking and present a higher proportion of bronchiectasis and OSAS.

Antecedente: La tuberculosis recurrente ocurre mediante dos mecanismos: reinfección o recaída, que pueden diferenciarse mediante técnicas de genotipificación. Métodos: Revisión sistemática y meta-análisis utilizando como base de datos MEDLINE, Lilacs/Scielo, y Cochrane, de estudios en inglés, francés y español publicados entre el 1 de enero de 1980 hasta el 30 de septiembre de 2020 y que evaluaron las recurrencias tras un tratamiento exitoso y/o diferenciaron recaídas de reinfecciones utilizando genotipificación Se utilizó un metanálisis de modelo de efectos aleatorios para estimar las tasas de incidencia y la proporción de recaídas y reinfecciones. Además, se realizó análisis de subgrupos. Resultados: La tasa de incidencia de tuberculosis recurrente agrupada fue 2.26 por 100 personas-año (95% IC 1.87-2.73; 145 estudios). La heterogeneidad fue alta (I2=98%). La tasa de incidencia de tuberculosis recurrente incrementó de 1.47 (95% IC 0.87-2.46) a 4.10 (95% IC 2.67-6.28) por 100 personas-año entre estudios desarrollados en zonas de baja vs. alta incidencia de tuberculosis. La proporción de recaídas fue del 70% (95% IC 63-77%; I²=85%; 48 estudios). La heterogeneidad estuvo determinada por la incidencia de TB, con una proporción de recaídas del 83% (95% IC 75-89%) vs 59% (95% IC 42-74%) en estudios de baja vs. alta incidencia, respectivamente. Conclusión: El riesgo de recurrencia es sustancial y la recaída es el mecanismo más frecuente de recurrencia. Sin embargo, con el aumento de incidencia de TB, la proporción de reinfecciones incrementa y el predominio de recaídas disminuye. Background A recurrent tuberculosis (TB) episode results from exogenous reinfection or relapse after cure. The use of genotyping allows the distinction between both. Methods We did a systematic review and meta-analysis, using a MEDLINE, Lilacs/Scielo, and Cochrane search for studies in English, French, and Spanish published between January 1, 1980 and September 30, 2020 that assessed recurrences after treatment success and/or differentiated relapses from reinfections using genotyping. We calculated person-years of follow- up and performed random-effects model meta-analysis for estimating pooled recurrent TB incidence rates and proportions of relapses and reinfections. We performed subgroup analysis by clinical-epidemiological factors and by methodological study characteristics. Findings The pooled recurrent TB incidence rate was 2.26 per 100 person-years at risk (95%CI 1.87-2.73; 145 studies). Heterogeneity was high (I2=98%). Stratified pooled recurrence rates increased from 1.47 (95%CI 0.87-2.46) to 4.10 (95%CI 2.67-6.28) per 100 person-years for studies conducted in low vs. high TB incidence settings. Background HIV prevalence, treatment drug regimen, sample size and duration of follow-up contributed too. The pooled proportion of relapses was 70% (95%CI 63- 77%; I²=85%; 48 studies). Heterogeneity was determined by background TB incidence, as demonstrated by pooled proportions of 83% (95%CI 75-89%) vs 59% (95%CI 42- 74%) relapse for studies from settings with low vs. high TB incidence, respectively. Interpretation The risk of recurrent TB is substantial and relapse is consistently the most frequent form of recurrence. Notwithstanding, with increasing background TB incidence the proportion of reinfection increases and the predominance of relapses among recurrences decreases.

Josep Garre-Olmo,1–3 Anna Ponjoan,1,4–5 José Maria Inoriza,6,7Jordi Blanch,4 Inma Sánchez-Pérez,6 Rafel Cubí,4 Rosa de Eugenio,7 Oriol Turró-Garriga,1,2Joan Vilalta-Franch On behalf of the Registry of Dementia of Girona Study Group (ReDeGi Study Group)11Research Group on Ageing, Disability and Health, Girona Biomedical Research Institute (IDIBGI), Catalonia, Spain; 2Registry of Dementia of Girona, Health Assistance Institute, Catalonia, Spain; 3Department of Medical Sciences, School of Medicine, University of Girona, Catalonia, Spain; 4Vascular Health Research Group (ISV-Girona), Foundation University Institute for Primary Health Care Research Jordi Gol I Gurina, Catalonia, Spain; 5Autonomous University of Barcelona, Catalonia, Spain; 6Research Group on Health Services and Health Outcomes (GRESSIRES), Integrated Health Services Baix Empordà (SSIBE), Catalonia, Spain; 7Hospital de Palamós, Integrated Health Services Baix Empordà (SSIBE), Catalonia, SpainBackground: Knowledge on survival after diagnosis is important for all stakeholders. We aimed to estimate the survival and life expectancy after a dementia diagnosis, and to quantify the impact of dementia subtypes on mortality.Methods: Retrospective matched cohort study using a linkage between a dementia-specific registry and two primary care electronic medical records databases. Between 1 January 2007 and 31 December 2015 there were 5,156 subjects aged 60years and over registered by the Registry of Dementia of Girona and matched to 15,468 age-sex and comorbidity individuals without dementia attended by general practitioners in the province of Girona (Catalonia, Spain).Results: The median survival was 5.2years (95% CI 5.0 to 5.4), the median life expectancy was 74.7years (95% CI 71.9 to 76.5), and there were differences by gender. The mortality rate was 127.1 per 1,000 person-years (95% CI 121.6 to 132.7), and the hazard ratio for mortality in persons with dementia ranged between 1.63 (95% CI 1.52 to 1.76) for Alzheimer’s disease and 2.52 (95% CI 1.90 to 3.35) for Parkinson-plus syndromes. There was one death per year attributable to dementia for every 18.6 persons with dementia, and for every 2.4 persons with dementia who die, one death was attributable to dementia.Conclusion: The prognosis after dementia diagnosis is conditioned by demographic and clinical features. Although survival is larger for women, they also experience a higher number of years of life lost. Parkinson-plus syndromes and dementia due to multiple etiologies are among the most malignant subtypes regarding mortality.Keywords: epidemiology, diagnosis, dementia, mortality

Sickle cell anemia (SCA) is characterized by chronic hemolysis, severe vasoocclusive crises (VOCs), and recurrent often severe infections. A cohort of 95 SCA pediatric patients was the background for genotype-to-phenotype association of the patient's infectious disease phenotype and three non-coding polymorphic regions of the TLR2 gene, the -196 to -174 indel, SNP rs4696480, and a (GT)n short tandem repeat. The infectious subphenotypes included (A) recurrent respiratory infections and (B) severe bacterial infection at least once during the patient's follow-up. The absence of the haplotype [Del]-T-[n ≥ 17] (Hap7) in homozygocity protected against subphenotype (B), in a statistically significant association, resisting correction for multiple testing. For the individual loci, the same association tendencies were observed as in the haplotype, including a deleterious association between the SNP rs4696480 T allele and subphenotype (A), whereas the A/A genotype was protective, and a deleterious effect of the A/T genotype with subphenotype (B), as well as including the protective effect of -196 to -174 insert (Ins) and deleterious effect of the deletion (Del) in homozygocity, against subphenotype (B). Moreover, a reduction in the incidence rate of severe bacterial infection was associated to a rise in the hemolytic score, fetal hemoglobin levels (prior to hydroxyurea treatment), and 3.7-kb alpha-thalassemia. Interestingly, differences between the effects of the two latter covariables favoring a reduction in the incidence rate of subphenotype (B) contrast with a resulting increase in relation to subphenotype (A). These results could have practical implications in health care strategies to lower the morbidity and mortality of SCA patients This study was carried out with financial support from FCT/MEC through national funds and cofinanced by FEDER, under the Partnership Agreement PT2020, in the project with reference UIDMULTI/00211/2013, and was partially funded by FCT grants PIC/IC/83084/2007 and the Centro de Investigação em Genética Molecular Humana (CIGMH). info:eu-repo/semantics/publishedVersion

A busca da resposta a uma questão clínica bem construída pode ser realizada em inúmeras fontes de informação científica. Na dependência de onde obtemos a informação, a decisão clínica não será sustentada pelas melhores evidências disponíveis na atualidade, expondo o paciente a um risco desnecessário. A busca pode ser realizada em bases primárias, que disponibilizam os trabalhos originais, cabendo ao leitor o ônus de selecionar e analisar criticamente a validade de seus resultados. A busca pode também ser realizada em bases secundárias, que economizam o tempo do leitor na seleção metodológica e avaliação crítica. Entre as bases primárias, recomendamos o Medline e o SciELO, onde a busca pode ter início com a utilização das palavras-chaves, obtidas na construção da pergunta estruturada segundo o acrônimo P.I.C.O., em seguida, organizadas com a adição dos booleanos AND, OR ou NOT. Entre as bases secundárias que acrescem qualidade científica na seleção das evidências apresentadas, algumas fornecem respostas fundamentadas em trabalhos inviduais, como o ACP Journal Club, o Evidence Based Medicine e o InfoPoems, outras abordam questões clínicas organizadas em forma de livro, como o Clinical Evidence e o UpToDate. A Cochrane Review apresenta evidências de boa qualidade a partir de revisões sistemáticas de ensaios clínicos preferencialmente aleatorizados. A obtenção de estudos que respondem a uma questão clínica faz parte do atendimento que procura integrar a melhor evidência científica às necessidades de atendimento do paciente. Para tanto, conta com recursos tecnológicos, como os PDAs, Palmtops e Notebooks, cada vez mais adaptados para trazer a última informação divulgada pela Internet que auxilia na tomada de decisão clínica à beira do leito. The inadequacy of most of traditional sources for medical information, like textbook and review article, do not sustained the clinical decision based on the best evidence current available, exposing the patient to a unnecessary risk. Although not integrated around clinical problem areas in the convenient way of textbooks, current best evidence from specific studies of clinical problems can be found in an increasing number of Internet and electronic databases. The sources that have already undergone rigorous critical appraisal are classified as secondary information sources, others that provide access to original article or abstract, as primary information source, where the quality assessment of the article rely on the clinician oneself. The most useful primary information source are SciELO, the online collection of Brazilian scientific journals, and Medline, the most comprehensive database of the USA National Library of Medicine, where the search may start with use of keywords, that were obtained at the structured answer construction (P.I.C.O), with the addition of boolean operators «AND», «OR», «NOT». Between the secondary information sources, some of them provide critically appraised articles, like ACP Journal Club, Evidence Based Medicine and InfoPOEMs, others provide evidences organized as online texts, such as «Clinical Evidence» and «UpToDate», and finally, Cochrane Library are composed by systematic reviews of randomized controlled trials. To get studies that could answer the clinical question is part of a mindful practice, that is, becoming quicker and quicker and dynamic with the use of PDAs, Palmtops and Notebooks.

INTRODUCTION Parvovirus B19 (B19V) infection in pregnancy may cause serious damage to the foetus, where infection of placental endothelial cells can lead to hydrops fetalis and/or intrauterine fetal death. In Portugal, B19V female prevalence rates increases with age, reaching about 54.60% between age 20 and 24, 63.8% between age 25 and 29, 64.6% between age 30 an 34 and increasing up to 82.7% in the elder people. After maternal infection, transplacental transmission can occur at different rates depending on gestational ages. The virus is not teratogenic, but congenital infection may be associated to serious birth defects. OBJECTIVES To study suspected cases of B19V infection during pregnancy between May 2009 – May 2012, according to epidemiological, laboratory and clinical data, based on a retrospective study at the National Institute of Health (NIH) in Lisbon. METHODS Thirty-one amniotic fluid samples of 31 pregnant women (median age 29.7 years old) obtained between weeks 13 and 36 of gestation, were analysed at the NIH, according to the clinic indication of maternal cutaneous rash (2 cases), fetal dead (3 cases at 13, 21 and 33 weeks of pregnancy) or fetal ultrasonographic abnormalities (26 cases). B19V-DNA was determined by a ready-to-use commercial real-time PCR system, with a specific amplification of a 76 bp region of the B19V genome. RESULTS B19V DNA were detected in 3/31 amniotic fluid samples (9.7%), all of them with previous clinical diagnosis of hydrops fetalis at 21, 23 e 25 weeks of gestation. From the 26 cases with fetal ultrasonographic abnormalities, 10 cases were not specified, 8 cases had clinical diagnosis of hydrops fetalis and the remaining 8 were other specific abnormalities. One positive case result in fetal death and other positive case result in fetal death after intrauterine blood transfusion. One case resolved after intrauterine blood transfusion, without sequelae. CONCLUSIONS B19V infection is an important health issue since is the most common cause of nonimmune hydrops fetalis and can result in fetal death in 2-6% of cases A total of 3 patients (9.7%) were tested positive for B19V infection in amniotic fluid. According to our results and previous literature, the risk of developing fetal hydrops is high and the risk of fetal dead when maternal infection occurs in the first 20 weeks of pregnancy. Fetal ultrasonography was useful in detecting hydrops and real-time PCR technique in amniotic fluid has been shown to be a good methodology in cases of clinical suspicion of active B19V infection. These results are not representative of all suspected cases of B19V infection during pregnancy in Portugal. Preconceptional screening or prophylactic interventions are not presently recommended. Considering that as many as 36% of women may not be immune to B19V and are susceptible to infection, PCR technologies for DNA detection of B19V in amniotic fluid with increased sensitivity level, are an important diagnostic tool and an aid to confirm clinic B19V diagnostic.

publicado em: ESCV2011-Program Book / European Society of Clinical Virology, p. 73. Disponível em: http://escv.ivdnews.net/public/show_abstract/1126 The incidence of HIV infections in gestational age is an important Public Health issue as are concerns about co-infection with opportunistic viruses, such as CMV/HCV. Several authors refer higher ratios of congenital CMV infection in children born to HIV infected mother than in uninfected. In the case of HCV, perinatal transmission increases in cases of mothers co-infected with HIV. Aims:To study CMV/HCV infection/co-infection in HIV/non-HIV women and their newborns between 2006-2010, according to epidemiological, laboratory and clinical data; to evaluate frequency of CMV/HIV/HCV maternal-fetal transmission and analyse risk factors for infections. Methods:Plasma and/or urine of 137 HIV and 140 non-HIV women, attending a Lisbon Hospital and their 140 newborns were analysed at NIH. HIV-1 and/or HIV-2 proviral DNA nested-PCR was performed on HIV mothers and their newborn’s plasma. Maternal plasma was screened for CMV and HCV antibodies; RNA determination, genotyping and viral load were performed on women with HCV antibodies, their newborn’s plasma was also screened for HCV. Newborn’s urine was inoculated for CMV detection. Data analysis was performed using SPSS 17.0 and Fisher's exact test. Results:HIV1 vertical transmission was diagnosed in 3/140(2.1%) cases. CMV congenital infection was diagnosed in 4(2.9%) newborns from HIV women and no congenital CMV infection was diagnosed in newborns from non-HIV women. 2/137(1.5%) HIV women and 14/140(10.0%) non-HIV women were CMV seronegative. HCV infection was detected in 6(4.4%) HIV women; all had HCV positive viral load; different genotypes were found. One case of HCV perinatal transmission was diagnosed. No HCV antibodies were found in non-HIV women. No children were HIV/HCV or CMV/HCV coinfected but 2 were HIV/CMV coinfected. There is evidence of significant statistical associations with race/ethnicity and time of pregnancy. Conclusion:In this study HIV women had higher CMV/HCV antibody prevalence and frequency of maternal-fetal transmission than non-HIV women. 2/137 HIV seronegative newborns and 2/3 HIV newborns were CMV congenitally infected; this difference should be further studied, as the consequences of CMV/HCV infections may become increasingly serious and complex in the presence of HIV. This specific group is not representative of the Portuguese infected women, nevertheless the significant risk factors found and other risk factors studied without strong associations should be considered in larger studies.

Autosomal recessive spinal muscular atrophy, the leading genetic cause of infant death, is due to loss of functional SMN1 genes, mainly as a result of homozygous deletions. Carrier frequency in the general population varies widely from 1/50 to 1/125 and has significant counseling implications. In a cohort of 210 patients with spinal muscular atrophy confirmed at the molecular level, 91.9% had a homozygous deletion and 14 were compound heterozygotes. Two novel point mutations were detected (c.524delC and c.734dupC) and the 11 bp duplication c.770_780dup was found at a high frequency. We describe the development of a simple and robust method for homozygous deletion detection, which enabled us to simplify the diagnostic workup. Further, carrier frequency in our population was established by direct quantification with the commercially available MLPA kit, following optimization for the use of dried blood spots as sample specimens.

Atualmente ainda há carência de experimentos clínicos em fisioterapia. O objetivo do presente estudo foi conhecer a importância dos artigos originais passíveis de serem encontrados por meio da base de dados LILACS, escritos em língua portuguesa e publicados em revistas, para tomada de decisão terapêutica em fisioterapia. No dia 17 de março de 2000 a LILACS foi acessada por meio da Internet e da BIREME. Foram selecionados os estudos originais sobre tratamento de fisioterapia, escritos em português, e avaliados quanto ao tipo de estudo. Por meio de questionário resumido, inspirado naquele da Universidade McMaster, do Canadá, quanto às qualidades metodológicas, foram feitas, de forma cega, avaliações por dois autores, médicos e pesquisadores, que, posteriormente, buscaram o consenso. Obteve-se, após leitura dos títulos e, quando disponíveis, dos resumos, 135 estudos originais, cujo assunto parecia ser tratamento em fisioterapia. Após leitura do texto integral, classificou-se 32 estudos que pareciam avaliar, prospectivamente, intervenção terapêutica. Como resultado da avaliação desses 32 artigos, após consenso entre os dois médicos, obteve-se três estudos quase-experimentais e 21 ensaios não controlados e excluídos dois não passíveis de classificação e seis séries de casos. Análise estatística foi utilizada em um dos três estudos quase-experimentais e em seis dos 21 ensaios não-controlados. Em nenhum dos 24 estudos foi utilizada qualquer avaliação cega. Conclui-se que os artigos sobre tratamento de fisioterapia, escritos em língua portuguesa, em revistas indexadas na LILACS até a data do presente estudo, não são essenciais para profissionais que desejam encontrar pesquisas relevantes para decisões terapêuticas.

Anna Ponjoan,1–3 Josep Garre-Olmo,2 Jordi Blanch,1 Ester Fages,1 Lia Alves-Cabratosa,1 Ruth Martí-Lluch,1–3 Marc Comas-Cufí,1 Dídac Parramon,1,4 María Garcia-Gil,1 Rafel Ramos1,5 1Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain; 2Girona Biomedical Research Institute (IDIBGI), Girona, Catalonia, Spain; 3Santa Clara Primary Care Health Center, Catalan Health Institute, Girona, Catalonia, Spain; 4Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), Catalonia, Spain; 5Department of Medical Sciences, School of Medicine, Campus Salut, University of Girona, Girona, Catalonia, Spain Purpose: Updated estimates of incidence and prevalence of dementia are crucial to ensure adequate public health policy. However, most of the epidemiological studies in the population in Spain were conducted before 2010. This study assessed the validity of dementia diagnoses recorded in electronic health records contained in a large primary-care database to determine if they could be used for research purposes. Then, to update the epidemiology of dementia in Catalonia (Spain), we estimated crude and standardized prevalence and incidence rates of dementia in Catalonia in 2016. Methods: The System for the Development of Research in Primary Care (SIDIAP) database contains anonymized information for >80% of the Catalan population. Validity of dementia codes in SIDIAP was assessed in patients at least 40 years old by asking general practitioners for additional evidence to support the diagnosis. Crude and standardized incidence and prevalence (95% CI) in people aged ≥65 years were estimated assuming a Poisson distribution. Results: The positive predictive value of dementia diagnoses recorded in SIDIAP was estimated as 91.0% (95% CI 87.5%–94.5%). Age- and sex-standardized incidence and prevalence of dementia were 8.6/1,000 person-years (95% CI 8.0–9.3) and 5.1% (95% CI 4.5%–5.7%), respectively. Conclusion: SIDIAP contains valid dementia records. We observed incidence and prevalence estimations similar to recent face-to-face studies conducted in Spain and higher than studies using electronic health data from other European populations. Keywords: family physician, accuracy, quality, positive predictive value, electronic medical record, real-world data