COVID-19 is still placing a heavy health and financial burden worldwide. Impairment in patient screening and risk management plays a fundamental role on how governments and authorities are directing ...resources, planning reopening, as well as sanitary countermeasures, especially in regions where poverty is a major component in the equation. An efficient diagnostic method must be highly accurate, while having a cost-effective profile. We combined a machine learning-based algorithm with mass spectrometry to create an expeditious platform that discriminate COVID-19 in plasma samples within minutes, while also providing tools for risk assessment, to assist healthcare professionals in patient management and decision-making. A cross-sectional study enrolled 815 patients (442 COVID-19, 350 controls and 23 COVID-19 suspicious) from three Brazilian epicenters from April to July 2020. We were able to elect and identify 19 molecules related to the disease’s pathophysiology and several discriminating features to patient’s health-related outcomes. The method applied for COVID-19 diagnosis showed specificity >96% and sensitivity >83%, and specificity >80% and sensitivity >85% during risk assessment, both from blinded data. Our method introduced a new approach for COVID-19 screening, providing the indirect detection of infection through metabolites and contextualizing the findings with the disease’s pathophysiology. The pairwise analysis of biomarkers brought robustness to the model developed using machine learning algorithms, transforming this screening approach in a tool with great potential for real-world application.
ABSTRACT Introduction: Low back pain is defined as pain, muscle spasm, or stiffness between the L1 and L5 vertebrae, below the lower margin of the twelfth rib and above the upper gluteal fold, and ...may or may not be associated with pain radiating to the lower limbs. Objective: To determine the prevalence of low back pain in spine surgeons. Method: A non-randomized quantitative cross-sectional clinical study was carried out in a sample of 95 spine surgeons in Brazil, with the application of the Oswestry and visual analog pain scales, in addition to a structured questionnaire for the characterization of the participants. Results: Among the studied population, 69.5% were orthopedists, 30.5% were neurosurgeons, and the mean age of the sample was 46 years (±10.6), with neurosurgeons being older than orthopedists. Regarding BMI, the majority (77.8%) were overweight or obese, and seventy-six percent performed physical activity. The prevalence of low back pain was 58.9%. No relevant differences were found in the time spent weekly in surgeries between those who had low back pain and those who did not (p = 0.364). Mean pain intensity was 2.0 (SD = 2.2), statistically (p = 0.025) higher in orthopedists (2.3) when compared to neurosurgeons (1.3). Regarding the ODI score, 98.2% of the surgeons had a minimal disability (0-20%) for daily activities. Conclusion: The prevalence of low back pain in spine surgeons is high and is associated with mild inability to perform daily activities. Level Of Evidence IV; Non-Randomized Quantitative Cross-Sectional Clinical Study.
RESUMEN Introducción: La lumbalgia se define como dolor, espasmo muscular o rigidez entre las vértebras L1 y L5, por debajo del margen inferior de la duodécima costilla y por encima del pliegue glúteo superior, y puede o no asociarse a dolor irradiado a las extremidades inferiores. Objetivo: Determinar la prevalencia de dolor lumbar en cirujanos de columna. Método: Se realizó un estudio clínico transversal cuantitativo no aleatorizado en una muestra de 95 cirujanos de columna en Brasil, con la aplicación de las escalas de dolor de Oswestry y analógica visual, además de un cuestionario estructurado para la caracterización de los participantes. Resultados: Entre la población estudiada, el 69,5% eran ortopedistas y el 30,5% neurocirujanos y la edad media de la muestra fue de 46 años (±10,6), siendo los neurocirujanos mayores que los ortopedistas. En cuanto al IMC, la mayoría (77,8%) presentaba sobrepeso u obesidad y el setenta y seis por ciento realizaba actividad física. La prevalencia de dolor lumbar fue del 58,9%. No se encontraron diferencias relevantes en el tiempo dedicado semanalmente a las cirugías, entre los que tenían lumbalgia y los que no (p = 0,364). La intensidad media del dolor fue de 2,0 (DP = 2,2), siendo estadísticamente (p = 0,025) mayor en traumatólogos (2,3) que en neurocirujanos (1,3). En cuanto a la puntuación ODI, el 98,2% de los cirujanos tenían incapacidad mínima (0-20%) para las actividades diarias. Conclusión: La prevalencia de lumbalgia en cirujanos de columna es alta y se asocia a incapacidad leve para realizar las actividades cotidianas. Nivel de Evidencia IV; Estudio Clínico Transversal Cuantitativo no Aleatorizado.
RESUMO Introdução: A lombalgia é definida como dor, espasmo muscular ou rigidez entre as vértebras L1 e L5, abaixo da margem inferior da décima segunda costela e acima da prega glútea superior, e pode ou não estar associada à dor que se irradia para os membros inferiores. Objetivo: Determinar a prevalência de lombalgia em cirurgiões de coluna. Método: Foi realizado um estudo clínico transversal quantitativo não randomizado em uma amostra de 95 cirurgiões de coluna do Brasil, com aplicação das escalas Oswestry e visual analógica da dor, além de questionário estruturado para a caracterização dos participantes da pesquisa. Resultados: Dentre a população estudada, 69,5% eram ortopedistas e 30,5% eram neurocirurgiões e a idade média da amostra foi de 46 anos (±10,6), sendo que os neurocirurgiões eram mais velhos que os ortopedistas. Em relação ao IMC a maioria (77,8%) estavam com sobrepeso e obesidade e setenta e seis porcento realizavam atividade física. A prevalência de lombalgia foi de 58,9%. Não foram encontradas diferenças relevantes no tempo gasto semanalmente em cirurgias, entre quem tinha ou não lombalgia (p = 0,364). A intensidade média da dor foi de 2,0 (DP = 2,2), sendo estatisticamente (p = 0,025) maiores em ortopedistas (2,3) quando comparados aos neurocirurgiões (1,3). Em relação ao escore do ODI, 98,2% dos cirurgiões apresentaram incapacidade mínima (0-20%) para as atividades diárias. Conclusão: A prevalência de lombalgia em cirurgiões de coluna é grande e está associada com incapacidade leve para atividades cotidianas. Nível de Evidência IV; Estudo Clínico Transversal Quantitativo não Randomizado.
ABSTRACT Objective To determine the prevalence of low back pain and to establish a correlation with risk factors for the development of low back pain in a teaching hospital in the East Zone of São ...Paulo. Method This is a cross-sectional, observational, analytical study, in which 90 patients from the teaching hospital wards were evaluated. Internationally validated instruments were used to assess clinical, epidemiological and behavioral aspects. Results The prevalence rate obtained was 57.73%, which is considered high compared to the rates in studies conducted outside of the hospital environment. There was predominance in the female sex, at 30.13% (SSD 5.32%). Sleep disturbances, measured indirectly through hours of sleep and the average pain score (p = 0.007), seem to act as a risk factor. The instruments for checking pain seem to be more effective when used together, with an association being observed between the Oswestry questionnaire (ODI) and the visual analog scale (VAS) for pain (p = 0.000). Conclusions There is a prevalence of low back pain among institutionalized individuals, especially those who are hospitalized, compared to rates observed outside the hospital environment. Level of evidence IV; Cross-sectional observational.
RESUMEN Objetivo Determinar la prevalencia de lumbalgia y establecer una correlación con los factores de riesgo para el desarrollo del dolor lumbar en un hospital universitario en la Zona Este de São Paulo. Métodos Este es un estudio analítico observacional de corte transversal, en el que se evaluaron 90 pacientes de las enfermerías del hospital universitario. Se utilizaron instrumentos validados internacionalmente para evaluar aspectos clínicos, epidemiológicos y de comportamiento. Resultados La tasa de prevalencia obtenida fue de 57,73%, considerada alta en comparación con las tasas de los encuestados fuera del ámbito hospitalario. Predominó el sexo femenino, con un 30,13%(SSD 5,32%). Los trastornos del sueño, medidos indirectamente a través de horas de sueño y la puntuación promedio de dolor (p = 0,007), parecen actuar como un factor de riesgo. Los instrumentos para controlar el dolor parecen ser más efectivos cuando se usan juntos, con una asociación entre el cuestionario de Oswestry (ODI) y la escala visual analógica (EVA) del dolor (p = 0,000). Conclusiones Se encontró una mayor tasa de prevalencia de dolor lumbar entre los individuos institucionalizados, especialmente los hospitalizados, en comparación con las tasas observadas fuera del contexto hospitalario. Nivel de Evidencia IV; Estudio Observacional Transversal.
RESUMO Objetivo Determinar a prevalência de lombalgia e estabelecer correlação com fatores de risco para o desenvolvimento de dor lombar em um Hospital Escola da Zona Leste de São Paulo. Métodos Trata-se de um estudo analítico observacional transversal, no qual foram avaliados 90 pacientes provenientes das enfermarias do Hospital Escola. Foram empregados instrumentos internacionalmente validados para avaliar aspectos clínicos, epidemiológicos e comportamentais. Resultados A taxa de prevalência obtida foi de 57,73%, considerada alta em comparação com as taxas das pesquisadas realizadas fora do ambiente hospitalar. Houve predomínio do sexo feminino, com 30,13% (DPa 5,32%). Os distúrbios do sono, medidos indiretamente por meio de horas de sono e a média da graduação de dor (p = 0,007), parecem agir como fator de risco. Os instrumentos para verificação da dor parecem ter maior eficácia quando usados em conjunto, sendo observada uma associação entre o questionário de Oswestry (ODI) e a escala visual analógica (EVA) de dor (p = 0,000). Conclusões Constatou-se maior taxa da prevalência de lombalgia entre os indivíduos institucionalizados, principalmente, os hospitalizados, comparada a taxas observadas fora do contexto hospitalar. Nível de evidência IV; Estudo Observacional Transversal.
Marine aquaculture, particularly in the Mediterranean region, faces the challenge of minimizing growth dispersion, which has a direct impact on the production cycle, market value and sustainability ...of the sector. Conventional grading methods are resource intensive and potentially detrimental to fish health. The current study presented an innovative approach in predicting fish weight dispersion in European seabass (Dicentrarchus labrax) aquaculture. Seabass is one of the two major fish species cultivated on the Mediterranean coast, with a fattening cycle of 18–24 months. During this period, several grading operations are carried out to minimize growth dispersion. The intricate feed-fish-water system, characterized by complex interactions among feeding regimes, fish behavior, individual metabolism and environmental factors, is the focus of the study. The comprehensive, five-step methodology addresses this complexity. The process begins with a Discrete Event System (DES) model that simulates the feed-fish-water dynamics, taking into account individual fish metabolism. This is followed by the development of a surrogate machine learning (ML) regressor model, which is trained on DES simulation data to efficiently predict growth distribution. The model is then calibrated and customized for specific fish stocks and production tanks. The preliminary results from 21 tanks in two trials with European seabass (D. labrax) showed the effectiveness of the method. The results from the simulation models achieved a R2 of 99.9 % and a Mean Absolute Percentage Error (MAPE) of 1.1 % for the prediction of mean final weight and a R2 of 90.3 % with a MAPE of 8.1 % for the standard deviation of final weight. In summary, this study represents a significant advance in the planning and management of seabass aquaculture. Given the lack of effective prediction tools in the aquaculture industry, the proposed methodology has the potential to reduce risks and inefficiencies, thus possibly optimizing aquaculture practices by increasing sustainability and profitability.
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•Aquaculture units are complex and unique systems with biotic and abiotic factors.•Discrete Event System implementation simulates the growth of a seabass fish stock.•Machine Learning model replaces efficiently daily aggregated simulation results.•Final Machine Learning model is customizable for each specific fish stock and tank.•Results demonstrate the application of the methodology to laboratory tank modeling.
ABSTRACT Objective: To evaluate the prevalence of low back pain in nurses at a university hospital in São Paulo and establish a relationship with social aspects. Methods: A cross-sectional study was ...carried out, through the application of a questionnaire containing social questions(weight, age, height, work sector, working hours, physical activity, presence and frequency of low back pain) in addition to the Oswestry questionnaire. Results: One hundred fifty-three nurses participated in the study. Of these, 92.30% of the women and 73.91% of the men presented low back pain, with a third classifying the pain as sporadic. In relation to BMI, pain is lower in those who are underweight (60%) and higher among those who are overweight (96.77%). Most of the sample was sedentary (66%), and of these, 96% had low back pain. There was no difference in the comparison by working hours, in relation to work sector, pain was more present in the following sectors: coordination (100%); children’s ward (92%); adult emergency room (90%) and adult ICU (31%). Thirty nurses worked double shifts, and of these, 90% reported low back pain, while among those who worked only at the university hospital, 89.4% reported pain. In relation to working hours, the longer the working day, the greater the pain. In the function assessment (Oswestry), 99 participants obtained a value of up to 30% disability. Conclusion: Based on the results of this work, it is concluded that there is a high prevalence of low back pain in nurses at the Hospital Universitário; however, it was not possible to determine a direct risk factor associated with this high prevalence. Level of Evidence IV; Cross-sectional study.
Resumo: Objetivo: Avaliar a prevalência de dor lombar em enfermeiros de um hospital universitário da zona leste de São Paulo e estabelecer relação com aspectos sociais. Métodos: Foi realizado um estudo de corte transversal, através da aplicação de um questionário contendo questões sociais (peso, idade, altura, setor de trabalho, carga horária, prática de exercício físico, presença e frequência de dor lombar), além do questionário Oswestry. Resultados: Cento e cinquenta e três enfermeiros participaram do estudo, destes 92,30% das mulheres e 73,91% dos homens apresentaram dor lombar, sendo que um terço classificava a dor como esporádica. Em relação ao IMC, a dor é menor naqueles que estão abaixo do peso (60%) e maior entre aqueles que se apresentam sobrepeso (96,77%). A maioria da amostra era sedentária (66%), sendo que destes, 96% apresentavam dor lombar. Não houve diferença na comparação para período de trabalho, já em relação ao setor de trabalho a dor estava mais presente no setor de coordenação (100%), seguido por enfermaria infantil (92%), pronto socorro adulto (90%) e UTI adulto (31%). Trinta enfermeiros faziam dupla jornada, e destes, 90% relataram dor, já nos que trabalhavam somente no hospital universitário 89,4% relataram dor. Em relação à carga horária, quanto maior a jornada, mais dor. Na avaliação da função (Oswestry), 99 participantes obtiveram um valor de até 30% de incapacidade. Conclusão: A partir dos resultados deste trabalho, conclui-se que existe uma alta prevalência de dor lombar nos enfermeiros do Hospital Universitário, no entanto, não foi possível determinar um fator de risco direto associado à esta alta prevalência. Nível de Evidência IV; Estudo de corte transversal.
Resumen: Objetivo: Evaluar la prevalencia del dolor de la región lumbar en enfermeros y enfermeras de un hospital universitario de la zona este de São Paulo y establecer una relación con los aspectos sociales. Métodos: Se realizó un estudio transversal aplicando un cuestionario que contenía preguntas sociales (peso, edad, altura, sector laboral, carga de trabajo, práctica de ejercicio físico, presencia y frecuencia de dolor en la región lumbar), además del cuestionario de Oswestry. Resultados: Participaron del estudio 153 enfermeros y enfermeras, de los cuales el 92,30% de las mujeres y el 73,91% de los hombres presentaban dolor en la región lumbar, y un tercio clasificaba el dolor como esporádico. En cuanto al IMC, el dolor es menor en los que tienen un peso inferior al normal (60%) y mayor entre los que tienen sobrepeso (96,77%).La mayoría de la muestra era sedentaria (66%), y de ellos, el 96% presentaba lumbalgia. No hubo diferencias en la comparación por período de trabajo, pero en cuanto al sector de trabajo, el dolor estuvo más presente en el sector de: coordinación (100%); seguido de la sala infantil (92%); urgencias de adultos (90%) y UCI de adultos (31%). Treinta enfermeros y enfermeras trabajaban en doble turno, y de ellos, el 90% manifestó dolor, mientras que de los que trabajaban sólo en el hospital universitario, el 89,4% manifestó dolor. En cuanto a la carga de trabajo, cuanto más largo es el turno, más dolor. En la evaluación de la función (Oswestry), 99 participantes obtuvieron un valor de hasta un 30% de incapacidad. Conclusión: A partir de los resultados de este estudio, se concluye que existe una alta prevalencia de dolor de la región lumbar en enfermeros y enfermeras del Hospital Universitario, sin embargo, no fue posible determinar un factor de riesgo directo asociado a esta alta prevalencia. Nivel de Evidencia IV; .Estudio Transversal.
ABSTRACT Objective: To evaluate and correlate the bacterial profile identified in blood cultures, urine cultures and vertebral biopsies in patients at Hospital Santa Marcelina in São Paulo - SP. ...Methods: Cross-sectional study of 20 patients affected by spondylodiscitis. Blood culture, urine culture, and spinal biopsy results were evaluated, in addition to sex and age. Results: The sample consisted of 20 patients, between 32 and 79 years old, predominantly male, diagnosed with spondylodiscitis. Most blood culture and urine culture results were negative, 80% and 65%, respectively. Among the spinal biopsy samples, 60% identified pathogens. When correlating the samples, 50% of the blood culture and biopsy cases presented the same result; however, between urine culture and biopsy, none identified the same germ between the samples. Conclusion: It is concluded that results from blood cultures, urine cultures, and spinal biopsies may frequently differ, making biopsy essential in diagnosing and treating spondylodiscitis. Level of Evidence IV; Cross-Sectional Study.
Resumo: Objetivo: Avaliar e correlacionar o perfil bacteriano identificado em hemoculturas, uroculturas e biópsias da coluna vertebral em pacientes do Hospital Santa Marcelina em São Paulo - SP. Métodos: Estudo transversal de 20 pacientes acometidos por espondilodiscite. Avaliados resultados de hemocultura, urocultura e biopsia vertebral, além de sexo e idade. Resultados: A amostra foi constituída de 20 pacientes, entre 32 e 79 anos, com prevalência do sexo masculino, diagnosticados com espondilodiscite. A maioria dos resultados de hemocultura e urocultura se apresentaram negativos, 80% e 65% respectivamente. Dentre as amostras de biopsia vertebral, 60% identificaram patógenos. Ao se correlacionar as amostras, 50% dos casos de hemocultura e biópsia apresentaram o mesmo resultado, porém entre urocultura e biópsia, nenhum dos casos identificou o mesmo germe entre as amostras. Conclusão: Conclui-se que resultados de hemoculturas, uroculturas e biopsia da coluna vertebral podem divergir com frequência nos resultados, tornando a biopsia essencial no diagnóstico e tratamento da espondilodiscite. Nível de Evidência IV; Estudo Transversal.
Resumen: Objetivo: Evaluar y correlacionar el perfil bacteriano identificado en hemocultivos, urocultivos y biopsias de columna en pacientes del Hospital Santa Marcelina de São Paulo - SP. Métodos: Estudio transversal de 20 pacientes afectados de espondilodiscitis. Se evaluaron los resultados de hemocultivo, urocultivo y biopsia vertebral, además del sexo y la edad. Resultados: Resultados: La muestra estuvo compuesta por 20 pacientes, entre 32 y 79 años, predominantemente masculinos, diagnosticados con espondilodiscitis. La mayoría de los resultados de hemocultivos y urocultivos fueron negativos, 80% y 65% respectivamente. Entre las muestras de biopsia de columna, el 60% identificó patógenos. Al correlacionar las muestras, el 50% de los casos de hemocultivo y biopsia presentaron el mismo resultado, sin embargo, entre urocultivo y biopsia, en ninguno de los casos se identificó el mismo germen entre las muestras. Conclusión: Se concluye que los resultados de los hemocultivos, los urocultivos y la biopsia de columna a menudo pueden diferir en los resultados, lo que hace que la biopsia sea esencial en el diagnóstico y tratamiento de la espondilodiscitis. Nivel de Evidencia IV; Estudio Transversal.
Assess whether the spine surgical approach for degenerative diseases can influence the physical capacity of patients and its correlation with cardiorespiratory function.
A prospective study was ...conducted on 9 patients of both genders, aged between eighteen and sixty, scheduled for spinal surgery for degenerative disease in the lumbar segment. Patients underwent treadmill stress test two times, fifteen days before and sixty days after the surgery. A cardiologist performed the test according to the Bruce protocol with a progressive increase in incline and speed.
There were no statistically significant differences between pre- and postoperative assessments for the parameters evaluated in the treadmill stress test. Forty-four percent of patients needed to interrupt the test postoperatively due to dyspnea (p=0.023).
The improvement obtained with spinal surgery does not have statistically significant relevance in tiredness, pain, and fatigue in the lower limbs and low back pain. Some patients could not complete the examination after surgery due to poor physical conditioning, and it was necessary to interrupt the examination due to dyspnea.
Weight gain is a metabolic disorder that often culminates in the development of obesity and other comorbidities such as diabetes. Obesity is characterized by the development of a chronic, subclinical ...systemic inflammation, and is regarded as a remarkably important factor that contributes to the development of such comorbidities. Therefore, laboratory methods that allow the identification of subjects at higher risk for severe weight-associated morbidity are of utter importance, considering the health, and safety of populations. This contribution analyzed the plasma of 180 Brazilian individuals, equally divided into a eutrophic control group and case group, to assess the presence of biomarkers related to weight gain, aiming at characterizing the phenotype of this population. Samples were analyzed by mass spectrometry and most discriminant features were determined by a machine learning approach using Random Forest algorithm. Five biomarkers related to the pathogenesis and chronicity of inflammation in weight gain were identified. Two metabolites of arachidonic acid were upregulated in the case group, indicating the presence of inflammation, as well as two other molecules related to dysfunctions in the cycle of nitric oxide (NO) and increase in superoxide production. Finally, a fifth case group marker observed in this study may indicate the trigger for diabetes in overweight and obesity individuals. The use of mass spectrometry combined with machine learning analyses to prospect and characterize biomarkers associated with weight gain will pave the way for elucidating potential therapeutic and prognostic targets.
The disease of the aortic arch is traditionally approached by open surgical repair requiring cardiopulmonary bypass and circulatory arrest. This study performed a retrospective analysis comparing ...outcomes through primary hybrid patients submitted to aortic arch surgery without cardiopulmonary bypass with patients submitted to conventional open surgery.
25 patients submitted to the aortic arch surgery were selected in the period 2003-2012 at the Madre Teresa Hospital in the city of Belo Horizonte, Brazil; 13 of these underwent hybrid technique without cardiopulmonary bypass and 12 underwent conventional open surgery.
The mortality rate for the hybrid group was 23% and for the conventional surgery group was 17% (P=0.248). The postoperative complication rate was also similar in both groups, with no significant difference.
Both techniques proved to be similar in mortality and morbidity. However, due to the small sample, more analytical studies with larger samples and long-term follow-up are needed to clarify this issue.
Brazil and many other Latin American countries are areas of endemicity for different neglected diseases, and the fungal infection paracoccidioidomycosis (PCM) is one of them. Among the clinical ...manifestations, pneumopathy associated with skin and mucosal lesions is the most frequent. PCM definitive diagnosis depends on yeast microscopic visualization and immunological tests, but both present ambiguous results and difficulty in differentiating PCM from other fungal infections. This research has employed metabolomics analysis through high-resolution mass spectrometry to identify PCM biomarkers in serum samples in order to improve diagnosis for this debilitating disease. To upgrade the biomarker selection, machine learning approaches, using Random Forest classifiers, were combined with metabolomics data analysis. The proposed combination of these two analytical methods resulted in the identification of a set of 19 PCM biomarkers that show accuracy of 97.1%, specificity of 100%, and sensitivity of 94.1%. The obtained results are promising and present great potential to improve PCM definitive diagnosis and adequate pharmacological treatment, reducing the incidence of PCM sequelae and resulting in a better quality of life.
Paracoccidioidomycosis (PCM) is a fungal infection typically found in Latin American countries, especially in Brazil. The identification of this disease is based on techniques that may fail sometimes. Intending to improve PCM detection in patient samples, this study used the combination of two of the newest technologies, artificial intelligence and metabolomics. This combination allowed PCM detection, independently of disease form, through identification of a set of molecules present in patients' blood. The great difference in this research was the ability to detect disease with better confidence than the routine methods employed today. Another important point is that among the molecules, it was possible to identify some indicators of contamination and other infection that might worsen patients' condition. Thus, the present work shows a great potential to improve PCM diagnosis and even disease management, considering the possibility to identify concomitant harmful factors.
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