Inpatient Hospitalizations during the First Wave of COVID-19 in Portugal

The objective of this study was to analyze the impact of the pandemic on inpatient hospital admissions during the first wave in Portugal. Data from hospital admissions in mainland Portugal from 2008 to 2017 were used to forecast inpatient hospital admissions for March to May 2020. The observed number of hospitalizations and their characteristics were compared to forecasted values. Variations were compared by hospital and region. Statistical analysis was used to investigate whether patterns of variations existed according to hospital characteristics. There were 119,315 fewer hospitalizations than expected during March to May 2020 in Portugal, which represented a 57% reduction. Non-COVID-19 hospitalizations had a higher mean length of stay and proportion of inpatient deaths than forecasted values. Differences between observed and forecasted values varied greatly among regions and hospitals. These variations were not associated with COVID-19 hospital admissions, region, forecasted number of hospitalizations, type of hospital, or occupation rate. The impact on inpatient hospital admissions for each hospital was not consistent or proportional to the expected use across Portugal, as indicated by variations between forecasted and observed values. The appropriate planning of future responses may contribute to improving the necessary balance between the level of hospital admissions for usual health needs of the population and the response to COVID-19 patients.

Obstetric Admissions to the Intensive Care Unit: A 18-Year Review in a Portuguese Tertiary Care Centre

INTRODUCTION

Maternal mortality and morbidity are important indicators of the quality of health-care services. Obstetric admissions to an intensive care unit may be considered a marker of maternal morbidity. The aim of this study was to determine the incidence, maternal morbidity and mortality of pregnant and postpartum women who required admission to the intensive care unit.

MATERIAL AND METHODS

Retrospective analysis of all the obstetric patients admitted to the intensive care unit between 2000 and 2017. Results: Ninety-three women required admission to intensive care (0.7 per 1000 deliveries, 0.8% of all adult admissions). Mean age was 30.3 years, mean gestational age was 33.6 weeks, 51 (54.8%) were primiparous, nine (9.7%) were pregnant of twins and five (5.4%) had not been followed during pregnancy. Eighty-four (90.3%) were admitted after immediate delivery. The most common reasons for admission were hypertensive disorders of pregnancy (35.5%) and obstetric haemorrhage (24.7%). Median length of stay was five days. Transfusion of blood products was needed in 23 (57.0%), artificial ventilation in 50 (53.8%) and use of vasopressors in 21 (22.6%). We observed four maternal deaths (4.3%). Most patients (95.7%) successfully recovered and were transferred to other departments. Sequential Organ Failure Assessment score was significantly associated with maternal mortality.

DISCUSSION

Our results are comparable to those obtained in other studies. Maternal mortality was comparable to maternal mortality in developed countries.

CONCLUSION

The incidence of obstetric admissions to the intensive care unit was 0.8% and 0.7 per 1000 deliveries. Hypertensive disorders of pregnancy were the main causes of admission. Maternal mortality was 4.3%. Studies of maternal morbidity are important and can help to improve the quality of health care services.

Identification of a novel group of bacteria in sludge from a deteriorated biological phosphorus removal reactor

The microbial diversity of a deteriorated biological phosphorus removal reactor was investigated by methods not requiring direct cultivation. The reactor was fed with media containing acetate and high levels of phosphate (P/C weight ratio, 8:100) but failed to completely remove phosphate in the effluent and showed very limited biological phosphorus removal activity. Denaturing gradient gel electrophoresis (DGGE) of PCR-amplified 16S ribosomal DNA was used to investigate the bacterial diversity. Up to 11 DGGE bands representing at least 11 different sequence types were observed; DNA from the 6 most dominant of these bands was further isolated and sequenced. Comparative phylogenetic analysis of the partial 16S rRNA sequences suggested that one sequence type was affiliated with the alpha subclass of the Proteobacteria, one was associated with the Legionella group of the gamma subclass of the Proteobacteria, and the remaining four formed a novel group of the gamma subclass of the Proteobacteria with no close relationship to any previously described species. The novel group represented approximately 75% of the PCR-amplified DNA, based on the DGGE band intensities. Two oligonucleotide rRNA probes for this novel group were designed and used in a whole-cell hybridization analysis to investigate the abundance of this novel group in situ. The bacteria were coccoid and 3 to 4 microm in diameter and represented approximately 35% of the total population, suggesting a relatively close agreement with the results obtained by the PCR-based DGGE method. Further, based on electron microscopy and standard staining microscopic analysis, this novel group was able to accumulate granule inclusions, possibly consisting of polyhydroxyalkanoate, inside the cells.