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Background: Although dementia has emerged as an important risk factor for severe SARS-CoV-2 infection, results on COVID-19-related complications and mortality are not consistent. We examined the clinical presentations and outcomes of COVID-19 in a multicentre cohort of in-hospital patients, comparing those with and without dementia., Methods: This retrospective observational study comprises COVID-19 laboratory-confirmed patients aged ≥ 60 years admitted to 38 hospitals from 19 cities in Brazil. Data were obtained from electronic hospital records. A propensity score analysis was used to match patients with and without dementia (up to 3:1) according to age, sex, comorbidities, year, and hospital of admission. Our primary outcome was in-hospital mortality. We also assessed admission to the intensive care unit (ICU), invasive mechanical ventilation (IMV), kidney replacement therapy (KRT), sepsis, nosocomial infection, and thromboembolic events., Results: Among 1,556 patients included in the study, 405 (4.5%) had a diagnosis of dementia and 1,151 were matched controls. When compared to matched controls, patients with dementia had a lower frequency of dyspnoea, cough, myalgia, headache, ageusia, and anosmia; and higher frequency of fever and delirium. They also had a lower frequency of ICU admission (32.7% vs. 47.1%, p < 0.001) and shorter ICU length of stay (7 vs. 9 days, p < 0.026), and a lower frequency of sepsis (17% vs. 24%, p = 0.005), KRT (6.4% vs. 13%, p < 0.001), and IVM (4.6% vs. 9.8%, p = 0.002). There were no differences in hospital mortality between groups., Conclusion: Clinical manifestations of COVID-19 differ between older inpatients with and without dementia. We observed that dementia alone could not explain the higher short-term mortality following severe COVID-19. Therefore, clinicians should consider other risk factors such as acute morbidity severity and baseline frailty when evaluating the prognosis of older adults with dementia hospitalised with COVID-19., (© 2024. The Author(s).)

Background: Acute kidney injury has been described as a common complication in patients hospitalized with COVID-19, which may lead to the need for kidney replacement therapy (KRT) in its most severe forms. Our group developed and validated the MMCD score in Brazilian COVID-19 patients to predict KRT, which showed excellent performance using data from 2020. This study aimed to validate the MMCD score in a large cohort of patients hospitalized with COVID-19 in a different pandemic phase and assess its performance to predict in-hospital mortality., Methods: This study is part of the "Brazilian COVID-19 Registry", a retrospective observational cohort of consecutive patients hospitalized for laboratory-confirmed COVID-19 in 25 Brazilian hospitals between March 2021 and August 2022. The primary outcome was KRT during hospitalization and the secondary was in-hospital mortality. We also searched literature for other prediction models for KRT, to assess the results in our database. Performance was assessed using area under the receiving operator characteristic curve (AUROC) and the Brier score., Results: A total of 9422 patients were included, 53.8% were men, with a median age of 59 (IQR 48-70) years old. The incidence of KRT was 8.8% and in-hospital mortality was 18.1%. The MMCD score had excellent discrimination and overall performance to predict KRT (AUROC: 0.916 [95% CI 0.909-0.924]; Brier score = 0.057). Despite the excellent discrimination and overall performance (AUROC: 0.922 [95% CI 0.914-0.929]; Brier score = 0.100), the calibration was not satisfactory concerning in-hospital mortality. A random forest model was applied in the database, with inferior performance to predict KRT requirement (AUROC: 0.71 [95% CI 0.69-0.73])., Conclusion: The MMCD score is not appropriate for in-hospital mortality but demonstrates an excellent predictive ability to predict KRT in COVID-19 patients. The instrument is low cost, objective, fast and accurate, and can contribute to supporting clinical decisions in the efficient allocation of assistance resources in patients with COVID-19., (© 2023. BioMed Central Ltd., part of Springer Nature.)

The association between exposure to air pollutants and respiratory diseases is well known. This study aimed to identify the association between this exposure and hospitalizations for COVID-19 in São José dos Campos, SP, a medium-sized city, between April 2020 and April 2021. Hospitalization data, concerning code B34.2, was supplied by DATASUS, and data concerning pollutants and climate variables were supplied by CETESB. Cases were quantified by sex, age, length of hospital stay in days, and type of discharge, whether hospital discharge or death. The negative binomial regression model was chosen. Estimates were produced for the relative risk (RR) of significant exposure to pollutants (P≤0.05) with a 10 µg/m3 increase of pollutant, as well as for excess hospitalizations. There were 1873 hospitalizations, with a daily average of 4.7 (±3.8), ranging from zero to 21: 716 deaths (38.2%) were recorded, 1065 admissions were men, and women were less susceptible (OR=0.82). The average age of women was higher than that of men; in cases of death, men were older than women; discharged patients were younger. All the above variables were significant. The risk of ozone exposure was higher and more significant in Lag 2, and the risk of nitrogen dioxide exposure was high in Lag 3, which was the period of the highest increase in hospitalizations, at 11.3%. The findings of this study, the first conducted in Brazil, corroborate the results of studies conducted in other centers.

RT-qPCR is the gold standard technique available for SARS-CoV-2 detection. However, the long test run time and costs associated with this type of molecular testing are a challenge in a pandemic scenario. Due to high testing demand, especially for monitoring highly vaccinated populations facing the emergence of new SARS-CoV-2 variants, strategies that allow the increase in testing capacity and cost savings are needed. We evaluated a RT-qPCR pooling strategy either as a simplex and multiplex assay, as well as performed in-silico statistical modeling analysis validated with specimen samples obtained from a mass testing program of Industry Federation of the State of Rio de Janeiro (Brazil). Although the sensitivity reduction in samples pooled with 32 individuals in a simplex assay was observed, the high-test sensitivity was maintained even when 16 and 8 samples were pooled. This data was validated with the results obtained in our mass testing program with a cost saving of 51.5% already considering the expenditures with pool sampling that were analyzed individually. We also demonstrated that the pooling approach using 4 or 8 samples tested with a triplex combination in RT-qPCR is feasible to be applied without sensitivity loss, mainly combining Nucleocapsid (N) and Envelope (E) gene targets. Our data shows that the combination of pooling in a RT-qPCR multiplex assay could strongly contribute to mass testing programs with high-cost savings and low-reagent consumption while maintaining test sensitivity. In addition, the test capacity is predicted to be considerably increased which is fundamental for the control of the virus spread in the actual pandemic scenario., (© 2022. The Author(s).)

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces coronavirus-19 disease (COVID-19), has affected many people in Brazil and worldwide. This disease predominantly affects the organs of the respiratory system, but it also damages the brain, liver, kidneys and especially the heart. In the heart, scientific evidence shows that this virus can damage the coronary arteries, generating microvascular dysfunction, favoring acute myocardial infarction. Furthermore, with the increased expression of pro-inflammatory cytokines, it can lead to myocarditis and cardiac fibrosis, inducing changes in the electrical conduction system of the heart, generating cardiac arrhythmias. All these factors mentioned are protagonists in promoting the increase in the mortality outcome. This outcome may be even higher if the individuals are elderly, or if they have other diseases such as type 2 diabetes mellitus or hypertension, because they may already have cardiomyopathy. In this context, this review focused on the impact that COVID-19 can have on the heart and cardiovascular system and the association of this impact with aging, type 2 diabetes mellitus, cardiac arrhythmias and arterial hypertension.