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RESUMEN Introducción: Se ha descrito que la infección por COVID-19 se asocia a complicaciones cardiovasculares en pacientes hospitalizados en 7-28%de los casos, con diagnóstico basado en elevación de biomarcadores. La afección cardiaca subclínica post COVID-19 en pacientes ambulatorios representa una preocupación creciente, así como las secuelas cardiovasculares a mediano y largo plazo. El objetivo del presente trabajo fue determinar la utilidad de la detección de compromiso cardiovascular en pacientes post COVID-19 ambulatorios, y su asociación con síntomas y factores de riesgo. Material y métodos: Se incluyeron 668 pacientes de manera prospectiva, >18 años entre septiembre de 2020 y marzo de 2021. Debían tener polimerasa de transcriptasa inversa (PCR) positiva en una muestra del tracto respiratorio positiva para COVID-19, y se les realizó evaluación con examen físico, electrocardiograma (ECG) y eco Doppler cardíaco. A quienes presentaban síntomas de riesgo o anomalías en el ECG o el eco Doppler, se les solicitó resonancia cardíaca (RMC) con contraste endovenoso. Resultados: La edad media fue de 42,9 ± 14,9 años; el 56,9% fueron mujeres. El 12,9% eran hipertensos, el 4,3% diabéticos y el 6,9% obesos. El 57,6% no tenía factores de riesgo cardiovascular y solo el 4,2% contaba con antecedentes cardiovasculares. El 73,2% presentó enfermedad leve, un 16,3% requirió internación y el 1,05% asistencia ventilatoria mecánica. Solo 5 pacientes tuvieron diagnóstico por RMC de miocarditis, y tanto el derrame pericárdico como la presencia de trastornos de la repolarización se asociaron significativamente con la misma (p <0,0001). Conclusiones: La presencia de alteraciones en el ECG o el eco Doppler cardíaco en nuestra cohorte fue infrecuente. Se diagnosticaron 5 casos de miocarditis viral con clínica compatible y confirmación por RMC.
ABSTRACT Introduction: COVID-19 infection has been associated with cardiovascular complications in 7-28% of hospitalized patients, with the diagnosis based on biomarkers elevation. Subclinical cardiac involvement in outpatients recovered from COVID-19 represents a growing concern, as well as mid- or long-term cardiovascular effects. Objective: The aim of the present study was to determine the usefulness of detecting cardiovascular involvement in outpatients recovered from COVID-19, and its association with symptoms and risk factors. Methods: Between September 2020 and March 2021, 668 patients >18 years were prospectively included. All the patients had to have COVID-19 confirmed diagnosis by a positive reverse transcription-polymerase chain reaction (RT-PCR) test in a respiratory tract sample COVID-19. They were evaluated with physical examination, electrocardiogram (ECG) and Doppler echocardiography. Patients with symptoms suggestive of risk or abnormal findings on ECG or echocardiogram underwent cardiac magnetic resonance imaging (CMRI) with gadolinium-based contrast agent. Results: Mean age was 42.9 ± 14.9 years and 56.9% were women; 12.9% were hypertensive, 4.3% were diabetic and 6.9% obese. Overall, 57.6% had no cardiovascular risk factors and only 4.2% had a history of cardiovascular disease. The disease was mild in 73.2%; 16.3% required hospitalization and 1.05% needed mechanical ventilation. Only 5 patients had myocarditis diagnosed by CMRI, and both pericardial effusion and abnormal repolarization were significantly associated with myocarditis (p < 0.0001). Conclusions: Abnormal ECG or echocardiographic findings were uncommon in our cohort. The diagnosis of viral myocarditis was made in 5 cases with clinical signs and symptoms, and was confirmed by CMRI.
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Abstract Objective: To report the computed tomography (CT) features of acute cerebrovascular complications in severely ill patients with confirmed coronavirus disease 2019 (COVID-19) in the intensive care unit. Materials and Methods: We conducted a retrospective analysis of 29 intensive care unit patients with confirmed COVID-19 who underwent CT of the brain. We describe the CT features of the cerebrovascular complications of COVID-19, as well the demographic characteristics and clinical features, together with the results of laboratory tests, such as complete blood cell count, coagulation testing, renal function testing, and C-reactive protein assay. Results: Two patients were excluded because of brain death. Among the remaining 27 patients, CT revealed acute cerebrovascular complications in six (three men and three women; 49-81 years of age), whereas no such complications were seen in 21 (15 men and six women; 36-82 years of age). Conclusion: Radiologists should be aware of the risks of cerebrovascular complications of COVID-19 and the potential underlying etiologies. COVID-19-associated coagulopathy is likely multifactorial and may increase the risk of ischemic and hemorrhagic infarction.
Resumo Objetivo: Relatar as características da tomografia computadorizada (TC) das complicações cerebrovasculares agudas em pacientes com doença do coronavírus 2019 (COVID-19) grave, internados em unidade de terapia intensiva. Materiais e Métodos: Foi realizada análise retrospectiva de 29 pacientes com COVID-19 confirmada, internados em unidade de terapia intensiva, que realizaram TC de crânio. Descrevemos as alterações tomográficas das complicações cerebrovasculares, bem como as características demográficas, clínicas e exames laboratoriais, tais como hemograma completo, teste de coagulação, função renal e proteína C reativa desses pacientes. Resultados: Seis pacientes (três homens e três mulheres; faixa etária de 49-81 anos) apresentaram alterações cerebrovasculares reveladas por TC e 21 pacientes (15 homens e 6 mulheres; faixa etária de 36-82 anos) não apresentaram complicações cerebrovasculares agudas. Dois pacientes foram excluídos por morte encefálica. Conclusão: Os radiologistas devem estar cientes dos riscos de complicações cerebrovasculares da COVID-19 e das possíveis etiologias subjacentes. A coagulopatia relacionada à COVID-19 é provavelmente multifatorial e pode aumentar os riscos de infarto isquêmico e hemorrágico.
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ABSTRACT Coronavirus disease 2019 (COVID-19) is a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has spread globally in pandemic proportions. Accumulative evidence suggests SARS-CoV-2 can be transmitted through the digestive system, the so-called fecal-oral route of transmission, and may induce several gastrointestinal manifestations. MEDLINE® and Embase databases were extensively searched for major clinical manifestations of gastrointestinal involvement in children and adolescents with COVID-19 reported in medical literature, and for nutritional therapy-related data. Findings and recommendations were pragmatically described to facilitate overall pediatric approach. A total of 196 studies addressing gastrointestinal or nutritional aspects associated with the global COVID-19 pandemic were found. Of these, only 17 focused specifically on pediatric patients with regard to aforementioned gastrointestinal or nutritional aspects. Most articles were descriptive and six addressed guidelines, established protocols, or expert opinions. Children and adolescents with gastrointestinal symptoms, such as nausea, vomiting and diarrhea, should be seriously suspected of COVID-19. Gastrointestinal signs and symptoms may occur in 3% to 79% of children, adolescents and adults with COVID-19, and are more common in severe cases. These include diarrhea (2% to 50%), anorexia (40% to 50%), vomiting (4% to 67%), nausea (1% to 30%), abdominal pain (2% to 6%) and gastrointestinal bleeding (4% to 14%). Patients with inflammatory bowel disease or chronic liver disease are not at greater risk of infection by SARS-CoV-2 relative to the general population. Nutritional support plays an important role in treatment of pediatric patients, particularly those with severe or critical forms of the disease. The digestive system may be a potential route of COVID-19 transmission. Further research is needed to determine whether the fecal-oral route may be involved in viral spread. Nutritional therapy is vital to prevent malnutrition and sarcopenia in severe cases.
RESUMO A doença pelo coronavírus 2019 (COVID-19) é causada pelo coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2) e foi amplamente disseminada em todo o mundo em proporções pandêmicas. Evidências crescentes sugerem que o sistema digestivo pode ser uma via potencial para a infecção pelo SARS-CoV-2, para a disseminação do vírus por via fecal-oral, e estar relacionado com vários sintomas gastrintestinais. Realizamos uma extensa revisão da literatura médica utilizando os bancos de dados MEDLINE® e Embase, com o objetivo de identificar as principais manifestações clínicas do envolvimento gastrintestinal e analisar a terapia nutricional em crianças e adolescentes com COVID-19. Os achados e as recomendações foram descritos de maneira pragmática, para facilitar a abordagem do pediatra em geral. Foram analisados 196 estudos relacionados ao envolvimento do trato gastrintestinal ou aspectos nutricionais associados à pandemia de COVID-19 em todo o mundo. Destes estudos, apenas 17 incluíram a população pediátrica exclusivamente com aspectos gastrintestinais ou nutricionais específicos. Os artigos, em sua maioria, foram descritivos, sendo seis relacionados a diretrizes, protocolos instituídos ou opiniões de especialistas. Crianças e adolescentes com sintomas gastrintestinais, como náusea, vômito e diarreia, devem ser avaliados como pacientes suspeitos de COVID-19. Os sinais e sintomas gastrintestinais podem ocorrer em 3% a 79% das crianças, adolescentes e adultos com COVID-19, estando mais frequentemente presentes em casos graves. Incluem diarreia (2% a 50%), anorexia (40% a 50%), vômitos (4% a 67%), náusea (1% a 30%), dor abdominal (2% a 6%) e sangramento gastrintestinal (4% a 14%). Pacientes com doença inflamatória intestinal ou doenças hepáticas crônicas não apresentam maior risco de infecção por SARS-CoV-2 do que a população em geral. O suporte nutricional é parte muito importante do tratamento de pacientes pediátricos, principalmente nas formas graves ou críticas da doença. O trato gastrintestinal pode ser uma via potencial para a infecção por COVID-19. Mais pesquisas são necessárias para determinar a possibilidade da transmissão fecal-oral, importante para a disseminação viral. A terapia nutricional é essencial para prevenir desnutrição e sarcopenia nos casos graves.
Subject(s)
Humans , Child , Adolescent , Pneumonia, Viral/therapy , Coronavirus Infections/therapy , Nutritional Support , Gastrointestinal Diseases/virology , Pneumonia, Viral/complications , Coronavirus Infections/complications , Pandemics , Pediatricians , Betacoronavirus , SARS-CoV-2 , COVID-19ABSTRACT
ABSTRACT The coronavirus disease 2019 (covid-19) pandemic has caused a public health emergency worldwide. Risk, severity and mortality of the disease have been associated with non-communicable chronic diseases, such as diabetes mellitus. Accumulated evidence has caused great concern in countries with high prevalence of this morbidity, such as Brazil. This text shows the picture of diabetes in Brazil, followed by epidemiological data and explanatory hypothesis for the association between diabetes and covid-19. We emphasized how the burden of these two morbidities in a middle-income country has aggravated this pandemic scenario. The comprehension of this association and biological plausibility may help face this pandemic and future challenges.