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Objetivo: analisar a prevalência da COVID-19 entre os fisioterapeutas brasileiros e os fatores associados segundo características demográficas e ocupacionais. Método: estudo transversal, analítico, segundo inquérito on-line, com a participação de 670 fisioterapeutas de todas as regiões do Brasil. Utilizou-se uma adaptação do método respondent driven sampling ao ambiente virtual para a coleta de dados. Análises bivariadas e de regressão logística múltipla foram utilizadas para identificar associação entre o diagnóstico da COVID-19 e variáveis demográficas e ocupacionais. Considerou-se variáveis estatisticamente significativas com base em um p<0,05. Resultados: a prevalência da COVID-19 foi de 30% (IC95%: 27,8-32,3). Fisioterapeutas da região Sudeste tiveram menores chances de ter diagnóstico da COVID-19. Fisioterapeutas que prestaram assistência em hospital de campanha, que ficaram isolados da família e que tem crianças menores de 12 em casa tiveram chances aumentadas para o diagnóstico da infecção. Conclusão: questões sociodemográficas e ocupacionais impactam no aumento do diagnóstico de Covid-19 entre profissionais fisioterapeutas, o que enfatiza a necessidade de um sistema de saúde de qualidade, igualitário nas diferentes regiões brasileiras.(AU)
Objective: to estimate the prevalence of COVID-19 among Brazilian physiotherapists and its associated factors. Method: cross-sectional study, according to an online survey, with the participation of 670 physiotherapists from all regions of Brazil. An adaptation of the respondent driven sampling method to the virtual environment was used to collect data. Bivariate and multiple logistic regression analyzes were used to identify associations between the diagnosis of COVID-19 and demographic and occupational variables. Variables were considered statistically significant based on p<0.05. Results: the prevalence of COVID-19 was 30% (95%CI: 27.8-32.3). In the Southeast region, physiotherapists were less likely to be diagnosed with COVID-19. Physiotherapists who provided care in a field hospital, who were isolated from their families and who have children under 12 years of age at home had an increased chance of being diagnosed with the infection.Conclusion: sociodemographic and occupational issues impact the increase in COVID-19 diagnoses among physiotherapists, which emphasizes the need for a quality and egalitarian health system in different Brazilian regions.(AU)
Objetivo: evaluar la tasa de prevalencia del COVID-19 en fisioterapeutas de Brasil y analizar sus factores asociados. Método: realizamos un estudio transversal mediante una encuesta on-line, en la que participaron 670 fisioterapeutas de todas las áreas de Brasil. Para la recogida de datos se utilizó una adaptación del método respondent driven sampling al entorno virtual. Se utilizaron análisis bivariados y de regresión logística múltiple para identificar la asociación entre el diagnóstico COVID-19 y variables demográficas y ocupacionales. Las variables se consideraron estadísticamente significativas en función de una p<0,05. Resultados: la prevalencia de COVID-19 fue del 30% (IC 95%: 27,8-32,3). Los fisioterapeutas del sudeste tenían menos probabilidades de ser diagnosticados de COVID-19. Los fisioterapeutas que prestaban asistencia en un hospital de campaña, que estaban aislados de sus familias y que tenían hijos menores de 12 años en casa tenían más probabilidades de que se les diagnosticara la infección. Conclusiones: aspectos sociodemográficos y ocupacionales inciden en el aumento del diagnóstico de COVID-19 entre los fisioterapeutas profesionales, lo que enfatiza la necesidad de un sistema de salud de calidad e igualitario en las diferentes regiones brasileñas.(AU)
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Humans , Male , Female , Occupational Risks , Occupational Health , Physical Therapists , COVID-19/epidemiology , Cross-Sectional Studies , Risk Factors , Sociodemographic FactorsABSTRACT
Introducción: Actualmente los contagios por el virus del SARS-CoV-2 supera los 600 millones de casos en el mundo. Objetivo: Aislar y caracterizar el virus SARS-CoV-2 causante de la COVID-19 a inicios de la pandemia en el Perú. Materiales y métodos: Se realizó el aislamiento viral a partir de 20 muestras de hisopado nasal y faríngeo positivas a SARS-CoV-2 por RT-PCR. El aislamiento se realizó en las líneas celulares Vero ATCC CCL-81 y Vero E6, evaluando el efecto citopático, la presencia del virus por RT-PCR, inmunofluorescencia indirecta (IFI) y posterior identificación por secuenciación genómica. Posteriormente, uno de los aislamientos de mayor circulación fue seleccionado y denominado cepa prototipo (PE/B.1.1/28549/2020), realizándose 10 pasajes sucesivos en células Vero ATCC CCL-81 para evaluar la dinámica de mutaciones. Resultados: Se observaron 11 aislamientos de virus por efecto citopático confirmándose por RT-PCR e IFI, de los cuales 6 fueron secuenciados identificándose los linajes B.1, B.1.1, B.1.1.1 y B.1.205, según el comité Pango de los genomas. La cepa prototipo corresponde a la variante B.1.1 y el análisis de las secuencias de los pasajes sucesivos mostró mutaciones a nivel de la proteína de la espiga (S) del virus, sin variación en la identidad del linaje. Conclusiones: Se aislaron 4 linajes en la línea celular Vero ATCC CCL-81. Los subcultivos en la misma línea celular muestran mutaciones en la proteína de la espiga, lo que indica mayor adaptabilidad a la célula hospedera y variación de la patogenicidad in vitro, comportamiento que le permite tener más éxito de supervivencia.
Introduction: Currently, infections caused by the SARS-CoV-2 virus exceed 600 million cases in the world. Objective: Isolation and characterization of the SARS-CoV-2 virus causing COVID-19 at the beginning of the pandemic in Peru. Materials and methods: Twenty nasal and pharyngeal swab samples were isolated from SARS-CoV-2 using two cell lines, Vero ATCC CCL-81 and Vero E-6; virus identification was performed by RT-PCR and the onset of cytopathic effect (CPE) was evaluated by indirect immunofluorescence and subsequent identification by genomic sequencing. One of the most widely circulating isolates were selected and named the prototype strain (PE/B.1.1/28549/2020). Then 10 successive passages were performed on Vero ATCC CCL-81 cells to assess mutation dynamics. Results: We detected 11 virus isolates by cytopathic effect, and subsequently confirmed by RT-PCR and indirect immunofluorescence. Of these, six were sequenced and identified as the lineages B.1, B.1.1, B.1.1.1, and B.1.205 according to the Pango lineage nomenclature. The prototype strain corresponded to lineage B.1.1. The analysis of the strains from the successive passages showed mutations mainly at in the spike (S) protein of the virus without variation in the identity of the lineage. Conclusions: Four lineages were isolated in the Vero ATCC CCL-81 cell line. Subcultures in the same cell line show mutations in the spike protein indicating greater adaptability to the host cell and variation in pathogenicity in vitro, a behavior that allows it to have more survival success.
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Introdução: Durante a pandemia de COVID-19, tornou-se necessário o uso de estratégias no tratamento dos pacientes que evoluem com insuficiência respiratória aguda. Objetivo: Avaliar o uso de estratégias não invasivas no desfecho de pacientes com insuficiência respiratória aguda ou crônica agudizada por COVID-19. Métodos: Pesquisa de caráter observacional e retrospectivo por meio da coleta de dados em prontuário eletrônico com pacientes submetidos ao uso de cânula nasal de alto fluxo (CNAF) e/ou ventilação mecânica não invasiva (VNI). Resultados: 81 pacientes, sendo 70,4% (57) do sexo masculino, com 56,5 ± 14,6 anos. 49,4% (40) dos indivíduos fizeram uso de CNAF e VNI, 9,9% (8) e 40,7% (33) apenas VNI ou CNAF, respectivamente. O tempo médio de uso da CNAF foi de 4,4 ± 3,7 dias e de VNI foi de 2,7 ± 3,4 dias. Observou-se que 43 (53,1%) dos pacientes pesquisados evoluíram para intubação orotraqueal (IOT) e 40 (49,4%) para óbito. Destes, 22 encontravam-se em IOT. Houve diferença estatística quando comparados idade entre os grupos IOT e não IOT, 60,5 ± 13,9 anos vs 52,1 ± 14,2 anos (p = 0,012), respectivamente. Conclusão: O uso de VNI e/ou CNAF pode ser considerado como alternativa no tratamento de pacientes com COVID-19. Contudo, os diversos fatores intrínsecos e extrínsecos ao paciente ainda contribuem para a alta taxa de IOT e de mortalidade.
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Abstract This study presents a 47-year-old female patient, with a history of diabetes, who contracted SARS-CoV-2 and exhibited cardiovascular complications.
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The WHO COVID-19 Clinical management: living guidance contains the Organization's most up-to-date recommendations for the clinical management of people with COVID-19. Providing guidance that is comprehensive and holistic for the optimal care of COVID-19 patients throughout their entire illness is important. The latest version of this living guideline is available in pdf format (via the 'Download' button) and via an online platform, and is updated regularly as new evidence emerges. No further updates to the previous existing recommendations were made in this latest version. This updated (fifth) version contains 16 new recommendations for the rehabilitation of adults with post COVID-19 condition (see Chapter 24), which includes: strong recommendation that exertional desaturation and cardiac impairment following COVID-19 should be ruled out and managed before consideration of physical exercise training
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Humans , Male , Female , Pregnancy , Child , COVID-19/complications , Palliative Care , Pneumonia, Viral/etiology , Rehabilitation , Respiration, Artificial , Respiratory Distress Syndrome, Newborn/etiology , Shock, Septic , Patient Care Management/organization & administration , Breast Feeding , Pregnancy , Global Health , COVID-19/diagnosis , Hospitalization , MasksABSTRACT
Introduction: The 2019 coronavirus disease (COVID-19) pandemic, should be an opportunity to ensure greater visibility of nursing in health systems and society worldwide. Objective: Review and synthesize the patterns on COVID-19 and nursing research, identifying the main journals, country of origin, language, topics, designs, and area of applicability of the results. Materials and Methods: Systematic review. Searches in PubMed, CINAHL, LILACS, and EMBASE databases (from the inception of the pandemic to May 15, 2020) were performed. Articles of any language related were related to SARS-CoV-2 infection or COVID-19 disease and nursing in any of its roles (care, management, education, among others) and using any epidemiological design or a scientific report were included. Two reviewers independently selected the studies and extracted the data. The main findings from the included studies were summarized through narrative synthesis and descriptive tables. The characteristics of the studies were presented as absolute values and proportions. Results: Three hundred and sixty-five articles were assessed for eligibility. Thirty-eight were included, published in 28 journals. Of those, 53.57% (n=15) were nursing specific. Most articles were "narrative reviews", accounting for 23.68% (n=9). Most studies were conducted in China (n=18, 47.37%), followed by the United Kingdom and the United States. Thirty-four (89.47%) articles were published in English, followed by Portuguese and Chinese. We identified five areas of application of the results, and the most frequent was the "clinical" setting with 47.00% (n=18). Discussion: These findings are crucial to give visibility to nursing work during the emergency of the COVID-19 pandemic. Mental health was the main research topic, while the clinical setting concentrates the major number of articles. This pattern was aligned with the challenges of the initial phase of the pandemic. Conclusion: Future research should explore the current state of evidence in the main topics identified in this review and continue to give visibility to work carried out by nursing in the emergency of the COVID-19 pandemic.
Introducción: La pandemia de la enfermedad de coronavirus 2019 (COVID-19), debería ser una oportunidad para asegurar una mayor visibilidad de la enfermería en los sistemas de salud y la sociedad en todo el mundo. Objetivo: Revisar y sintetizar los patrones de investigación en enfermería y COVID-19, identificando las principales revistas, país de origen, idioma, temas, diseños y área de aplicabilidad de los resultados. Materiales y Metodos: Una revisión sistemática. Se realizaron búsquedas en las bases de datos PubMed, CINAHL, LILACS y EMBASE (desde el inicio de la pandemia hasta el 15 de mayo de 2020). Se incluyeron artículos de cualquier idioma relacionados con la infección por SARS-CoV-2 o COVID-19 y enfermería en cualquiera de sus roles (cuidado, administración, educación, entre otros) que utilizaron cualquier diseño epidemiológico o informe científico. Dos revisores seleccionaron de forma independiente los estudios y extrajeron los datos. Los principales hallazgos de los estudios incluidos se resumieron mediante una síntesis narrativa y tablas descriptivas. Las características de los estudios se presentaron como valores absolutos y proporciones. Resultados: En 325 artículos se evaluaron los criterios de elegibilidad y se incluyeron 38 publicados en 28 revistas. De ellos, el 53,57% (n=15) eran específicos de enfermería. La mayoría de los artículos fueron "revisiones narrativas", que representan el 23,68% (n=9). La mayoría de los estudios se realizaron en China (n=18, 47,37%), seguido de Reino Unido y Estados Unidos. Treinta y cuatro (89,47%) artículos se publicaron en inglés, seguidos de portugués y chino. Identificamos cinco áreas de aplicación de los resultados y la más frecuente fue el ámbito "clínico" con un 47,00% (n=18). Discusión: Estos hallazgos son cruciales para dar visibilidad al trabajo de enfermería en la emergencia de la pandemia COVID-19. Se destaca que la salud mental fue el principal tópico de investigación mientras que el escenario clínico concentró el mayor número de artículo. Este patrón estuvo alineado con los desafíos impuestos por la fase inicial de la pandemia. Conclusión: Las investigaciones futuras deberán explorar el estado actual de la evidencia en los principales temas identificados en esta revisión y continuar dando visibilidad al trabajo realizado por enfermería en la emergencia de la pandemia por COVID-19.
Introdução: A pandemia da doença coronavírus (COVID-19) de 2019 deve ser uma oportu-nidade para garantir maior visibilidade da enfermagem nos sistemas de saúde e na sociedade em todo o mundo. Objetivo: Revisar e sintetizar os padrões de pesquisa em enfermagem e COVID-19, identificando as principais revistas, país de origem, língua, tópicos, desenhos e área de aplicabilidade dos resultados. Materiais e Métodos: Uma revisão sistemática. As ba-ses de dados PubMed, CINAHL, LILACS e EMBASE foram pesquisadas (Do início da pan-demia até 15 de maio de 2020). Artigos de qualquer língua relacionados à infecção por SARS-CoV-2 ou COVID-19 e enfermagem foram incluídos em qualquer das suas funções (assistên-cia, administração, educação, entre outras) que utilizassem qualquer desenho epidemiológico ou relatório científico. Dois revisores selecionaram independentemente estudos e extraíram os dados. As principais conclusões dos estudos incluídos foram resumidas através de uma síntese narrativa e tabelas descritivas. As características dos estudos foram apresentadas em valores absolutos e proporções. Resultados: Em 325 artigos foram avaliados os critérios de elegibili-dade e incluídos 38 publicados em 28 revistas. Destes, 53,57% (n=15) eram específicos da enfermagem. A maioria dos artigos eram "revisões narrativas", representando 23,68% (n=9). A maioria dos estudos foi realizada na China (n=18, 47,37%), seguida do Reino Unido e dos Estados Unidos. Trinta e quatro (89,47%) artigos foram publicados em inglês, seguidos de português e chinês. Identificamos cinco áreas de aplicação dos resultados e a mais frequente foi a área "clínica" com 47,00% (n=18). Discussão: Estas conclusões são cruciais para dar vi-sibilidade ao trabalho de enfermagem durante a emergência da pandemia da COVID-19. A saúde mental foi o principal tema de investigação, enquanto que o cenário clínico concentra o maior número de artigos. Este padrão foi alinhado com os desafios da fase inicial da pande-mia. Conclusão: A investigação futura deve explorar o estado atual das provas nos principais tópicos identificados nesta revisão e continuar a dar visibilidade ao trabalho realizado pela enfermagem na emergência da pandemia da COVID-19.
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Coronavirus Infections , Pandemics , Betacoronavirus , Systematic Review , Nursing CareABSTRACT
RESUMO Objetivo: Avaliar a qualidade de vida relacionada com a saúde e a incapacidade no primeiro mês após a alta para domicílio de todos os sobreviventes de COVID-19 grave internados por mais de 24 horas no Serviço de Medicina Intensiva. Metódos: Estudo realizado no Serviço de Medicina Intensiva do Centro Hospitalar Universitário São João, entre 8 de outubro de 2020 e 16 de fevereiro de 2021. Aproximadamente 1 mês após a alta para domicílio, uma enfermeira com experiência em medicina intensiva realizou uma consulta telefônica a 99 sobreviventes, aplicando os questionários EuroQol Five-Dimensional Five-Level e World Health Disability Assessment Schedule 2.0 - 12 itens. Resultados: A média de idade da população estudada foi de 63 ± 12 anos, e 32,5% foram submetidos à ventilação mecânica invasiva. O Simplified Acute Physiology Score médio foi de 35 ± 14, e o Índice de Comorbilidades de Charlson foi de 3 ± 2. O tempo de internamento em medicina intensiva e no hospital foi de 13 ± 22 e 22 ± 25 dias, respectivamente. A média da Escala Visual Analógica da EuroQol foi de 65% (± 21), sendo que apenas 35,3% dos sobreviventes não apresentaram ou tiveram problemas ligeiros para realizar suas atividades habituais, a maioria com algum grau de dor/desconforto e ansiedade/depressão. O World Health Disability Assessment Schedule 2.0 - 12 itens, mostrou incapacidade marcada em retomar o trabalho habitual ou atividades comunitárias e na mobilidade. O uso de ambas as ferramentas sugeriu que o estado de saúde dos sobreviventes seria pior do que a sua percepção. Conclusão: A identificação precoce de sequelas pode ajudar a definir fluxos e prioridades para a reabilitação e reinserção após a COVID-19 grave.
ABSTRACT Objective: To assess early postdischarge health-related quality of life and disability of all survivors of critical COVID-19 admitted for more than 24 hours to na intensive care unit.. Methods: Study carried out at the Intensive Care Medicine Department of Centro Hospitalar Universitário São João from 8th October 2020 to 16th February 2021. Approximately 1 month after hospital discharge, an intensive care-trained nurse performed a telephone consultation with 99 survivors already at home applying the EuroQol Five-Dimensional Five-Level questionnaire and the 12-item World Health Organization Disability Assessment Schedule 2.0. Results: The mean age of the population studied was 63 ± 12 years, and 32.5% were submitted to invasive mechanical ventilation. Their mean Simplified Acute Physiologic Score was 35 ± 14, and the Charlson Comorbidity Index was 3 ± 2. Intensive care medicine and hospital lengths of stay were 13 ± 22 and 22 ± 25 days, respectively. The mean EuroQol Visual Analog Scale was 65% (± 21), and only 35.3% had no or slight problems performing their usual activities, most having some degree of pain/discomfort and anxiety/depression. The 12-item World Health Organization Disability Assessment Schedule 2.0 showed marked impairments in terms of reassuring usual work or community activities and mobility. The use of both tools suggested that their health status was worse than their perception of it. Conclusion: This early identification of sequelae may help define flows and priorities for rehabilitation and reinsertion after critical COVID-19.
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RESUMEN Las células T helper-17 (Th17) y la interleuquina (IL) IL-17 desempeñan funciones biológicas relacionadas con la protección contra infecciones por bacterias extracelulares y hongos. En algunas enfermedades inflamatorias y autoinmunes hay una secreción persistente y estas participan en su patogénesis. Recientemente, se ha postulado la participación de las respuestas IL-17/Th17 en la patogénesis de la enfermedad por coronavirus 2019 (COVID-19). El objetivo de esta revisión es resumir la evidencia del papel de la IL-17/Th17 en la inmunopatogénesis del COVID-19, como sustento de la possible utilización de los inhibidores de IL-17 en el manejo terapéutico de esta infección.
SUMMARY Interleukin 17 (IL-17)-producing helper T cells (Th17) and IL-17 play an important role in the defense against extracellular bacteria and fungi; however, persistent secretion of IL-17 is also an important component in the pathogenesis of many inflammatory and autoimmune diseases. Recent evidence suggests that Th17 cells and IL-17 are also involved in the immunopathogenesis of COVID-19. This review summarizes the evidence related with the role of Th17/IL-17 in severe COVID-19, which support the possible use of IL-17/IL-17R inhibitors in the treatment of this infection.
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Abstract Background The COVID-19 pandemic has imposed measures of social distancing and, during this time, there has been an elevation in cardiovascular mortality rates and a decrease in the number of emergency visits. Objectives To assess and compare in-hospital mortality for cardiovascular diseases and emergency department visits during the COVID-19 pandemic and the same period in 2019. Methods Retrospective, single-center study that evaluated emergency visits and in-hospital deaths between March 16, 2020 and June 16, 2020, when the steepest fall in the number of emergency admissions for COVID-19 was registered. These data were compared with the emergency visits and in-hospital deaths between March 16 and June 16, 2019. We analyzed the total number of deaths, and cardiovascular deaths. The level of significance was set at p < 0.05. Results There was a 35% decrease in the number of emergency visits and an increase in the ratio of the number of deaths to the number of emergency visits in 2020. The increase in the ratio of the number of all-cause deaths to the number of emergency visits was 45.6% and the increase in the ratio of the number of cardiovascular deaths to the number of emergency visits was 62.1%. None of the patients who died in the study period in 2020 tested positive for COVID-19. Conclusion In-hospital mortality for cardiovascular diseases increased proportionally to the number of emergency visits during the COVID-19-imposed social distancing compared with the same period in 2019. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)
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Humans , Male , Female , Cardiovascular Diseases/mortality , Hospital Mortality , Emergency Service, Hospital , Cardiovascular Diseases/epidemiology , Emergency Treatment/statistics & numerical data , Physical Distancing , COVID-19/complications , HospitalizationABSTRACT
Abstract Background: The risk of sports-related sudden cardiac arrest after COVID-19 infection can be a serious problem. There is an urgent need for evidence-based criteria to ensure patient safety before resuming exercise. Objective: To estimate the pooled prevalence of acute myocardial injury caused by COVID-19 and to provide an easy-to-use cardiovascular risk assessment toolkit prior to resuming sports activities after COVID-19 infection. Methods: We searched the Medline and Cochrane databases for articles on the prevalence of acute myocardial injury associated with COVID-19 infection. The pooled prevalence of acute myocardial injury was calculated for hospitalized patients treated in different settings (non-intensive care unit [ICU], ICU, overall hospitalization, and non-survivors). Statistical significance was accepted for p values <0.05. We propose a practical flowchart to assess the cardiovascular risk of individuals who recovered from COVID-19 before resuming sports activities. Results: A total of 20 studies (6,573 patients) were included. The overall pooled prevalence of acute myocardial injury in hospitalized patients was 21.7% (95% CI 17.3-26.5%). The non-ICU setting had the lowest prevalence (9.5%, 95% CI 1.5-23.4%), followed by the ICU setting (44.9%, 95% CI 27.7-62.8%), and the cohort of non-survivors (57.7% with 95% CI 38.5-75.7%). We provide an approach to assess cardiovascular risk based on the prevalence of acute myocardial injury in each setting. Conclusions: Acute myocardial injury is frequent and associated with more severe disease and hospital admissions. Cardiac involvement could be a potential trigger for exercise-induced clinical complications after COVID-19 infection. We created a toolkit to assist with clinical decision-making prior to resuming sports activities after COVID-19 infection.
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Sports , Heart Disease Risk Factors , COVID-19/complications , Myocarditis/complications , Death, Sudden, Cardiac , Risk Assessment/methods , Evidence-Based Practice/methods , AthletesABSTRACT
ABSTRACT Objective Adhesive capsulitis is an inflammatory disease of the joint capsule, clinically manifested as pain, stiffness, and dysfunction of the shoulder. We subjectively observed an increased incidence of adhesive capsulitis, and raised the hypothesis that adhesive capsulitis was more frequent in magnetic resonance imaging examinations performed during the COVID-19 pandemic as compared with examinations prior to this period. Methods Data from medical records and magnetic resonance imaging of the shoulder presenting typical imaging findings of adhesive capsulitis, performed in our organization from March to June 2020, were evaluated and compared with data and imaging from the same period of the previous year. To this end, an organizational business intelligence tool called "search reports" was used, searching for the term "adhesive capsulitis" in the radiological report, results were tabulated, and corresponding magnetic resonance imaging exams were analyzed. Results Our search found a total of 240 and 1,373 cases of adhesive capsulitis in the 2020 and 2019 periods, respectively. The mean age of patients was 53.9 years in the 2020 group and 49.9 years in 2019 (p<0.001). Magnetic resonance imaging findings were positive for adhesive capsulitis in 40 out of 240 shoulders (16.7%) in the 2020 group versus 127 out of 1,373 shoulders (9.2%) in the 2019 group. This difference was statistically significant (p=0.001). Conclusion Our study findings suggest a relative increase in the proportion of magnetic resonance imaging findings suggestive of adhesive capsulitis cases during COVID-19 pandemics based on data from our organization.
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ABSTRACT Objective: To describe the indications and endoscopic findings of bronchoscopy performed at a reference university hospital for inpatients diagnosed with COVID-19 during the first outbreak of the disease in Brazil. Methods: A retrospective analysis of medical records of adult patients diagnosed with COVID-19 who underwent bronchoscopy at the intensive care units of Instituto do Coração and Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, from March to August 2020. Results: A total of 132 bronchoscopies were performed in 103 patients diagnosed with COVID-19. Mean age was 56.1±14.5 years, and distribution was similar in both sexes. More than one test was performed in 16 patients. The most frequent indications were diagnostic endoscopic evaluation and therapeutic procedures in 78.6% of cases (n=81) and material collection in 21.4% of cases (n=22). The most frequent endoscopic findings were presence of secretion or clots in 34% of cases, the presence of acute inflammatory changes in 22.3%, and tracheal wall laceration in 20.4%. In 27.2% of patients, no relevant bronchoscopic findings were observed. In three patients, bronchoscopy was indicated to assess hemoptysis, but there was only one case of active bleeding. Procedure-related complications were not observed in this group of patients. Conclusion: Bronchoscopy proved to be a safe and effective procedure to assist in treatment of COVID-19 patients, and the most frequent indications were related to investigation of airway involvement or to evaluate infectious and inflammatory pulmonary processes.
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ABSTRACT Objective To evaluate the impact of COVID-19 pandemic on the care delivered to hospitalized cancer patients in end-of-life. Methods A retrospective analysis of data of hospitalized patients with advanced solid tumors, who died under exclusive palliative care during first wave (March 2020 to July 2020) compared with the period previous pandemic (January 2018 to February 2020). Results A total of 190 oncologic patients were included, 161 patients before the pandemic, and 29 in the period from March 2020 to July 2020. The average hospitalization was 497.2 patients per month, before the pandemic, and dropped to an average of 46.5 in the pandemic, whereas the death rate decreased from an average of 6.3 patients per month to 4.8. Considering the benchmarks for quality of care during end-of-life care, preferences on life assistance were discussed prior to hospitalization for 34.4%, before the pandemic, and 13.8% during the pandemic (p=0.0298); 9.3% received chemotherapy 15 days prior to the date of death, before the pandemic, and 20.7%, in the pandemic (p=0.1012). Conclusion Based on the present results, despite the decrease in oncology admissions, the advanced-stage cancer patients continued to seek hospital for end-of-life care. However, we could observe in our benchmarking analyses for palliative quality of care that talks about prognosis occurred less often during the pandemic.
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ABSTRACT Objective Depression is a mental problem that affects the well-being of healthcare workers, impacting the quality of care and even leading to commit suicide. We aim to the levels of depression in frontline healthcare workers during the first severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in Peru. Methods A prospective cohort study was designed in the coronavirus disease 2019 (COVID-19) Care and Isolation Center - Villa Panamericana in eastern Lima. Care and Isolation Center-Villa Panamericana houses about 150 healthcare workers and COVID-19 patients. The Montgomery-Asberg Depression Rating scale was used for depression assessment. Results A total of 96 participants (30±5.6 years) were analyzed: 15 (15.6%) physicians, 39 (40.6%) nurses, 14 (14.6%) medical technologists, and 28 (29.2%) nurse technicians. Mild, moderate, and severe depression were present in 35 (36.5%), 44 (45.8%), and 9 (9.4%) of the cases, respectively. The physicians and nurses reported more severe levels of depression: 8 (53.3%) physicians and 18 (46.2%) nurses presented moderate depression; and 2 (13.3%) physicians and 3 (7.7%) nurses presented severe depression (p=0.005). This study determined greater symptoms of depression according to years of work (p=0.001). Thirty-two healthcare workers had COVID-19, 4 (12.5%) physicians, 9 (28.1%) nurses, 7 (21.9%) medical technologists, and 12 (37.5%) nurse technicians. Twenty-four (75%) participants showed symptoms of COVID-19 and developed moderate (12 [37.5%]) and severe (3 [9.4%]) symptoms of depression (p=0.041). Conclusion This study clearly demonstrated a high prevalence of depression in the Care and Isolation Center-Villa Panamericana frontline healthcare workers during the COVID-19 pandemic in Peru.
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Resumo Introdução a pandemia da Covid-19 e medidas de controle da sua expansão impactaram diferentes segmentos da economia, dentre eles os profissionais da Odontologia. Objetivo este trabalho analisou o impacto financeiro gerado pela pandemia da Covid-19 aos técnicos de prótese dentária (TPDs) no Brasil. Material e método por meio de um estudo transversal descritivo, aplicou-se aos TPDs do Brasil um questionário relacionado ao perfil sociodemográfico e profissional, impacto financeiro e medidas adotadas para minimizar seus efeitos. O questionário foi aplicado de forma on-line em redes sociais entre 27 de janeiro e 15 de fevereiro de 2021. Resultado demonstrou-se que 59,8% dos participantes eram do sexo masculino; 47,5% até 30 anos de idade e 57,3% com menos de 10 anos de prática. As medidas para contenção da propagação do coronavírus impactaram financeiramente 89,6% dos participantes; 72,0% interromperam totalmente seus trabalhos; 97,7% tiveram redução no faturamento; 98,2% tiveram mudança na rotina de trabalho; 94,8% tiveram aumento das despesas do laboratório no período; houve queda do faturamento para 41,2% entre 0% e 25,0% e para 36,3% entre 25,0% e 50,0%; 66,6% continuaram trabalhando durante a pandemia devido à sua situação financeira. Não pensaram em fechar seu laboratório de forma definitiva 71,8% dos participantes; 92,2% seguiram rotineiramente os cuidados de higienização e 21,6% fizeram uso das reservas financeiras. Conclusão os TPDs tiveram impacto financeiro durante o período da pandemia da Covid-19 causado principalmente pela diminuição da carga horária de trabalho, redução do faturamento e aumento do custo operacional devido à mudança na rotina de biossegurança.
Abstract Introduction the COVID-19 pandemic and measures to control its expansion impacted different segments of the economy, including dentistry professionals. Objective this study analyzed the financial impact of the COVID-19 pandemic on dental technicians in Brazil. Material and method this is a descriptive cross-sectional study with the application of a questionnaire of sociodemographic and professional profile, financial impact, and effect containment measures to dental technicians in Brazil. The questionnaire was applied online on social networks between January 27 and February 15, 2021. Result 59.8% of the participants were male, with 47.5% aged up to 30 years, and 57.3% with less than 10 years of practice. The measures to contain the spread of the coronavirus had a financial impact on 89.6% of the participants: 72.0% had their work completely interrupted, 97.7% had their billing reduced, 98.2% changed their work routine, and 94.8% had higher laboratory expenses in the period. Revenue decreased between 0% and 25.0% for 41.2% and between 25.0% and 50.0% for 36.3%. In addition, 66.6% continued working during the pandemic due to their financial situation. 71.8% of the participants did not consider closing their laboratory permanently, whereas 92.2% followed hygiene protocols routinely and 21.6% made use of their financial reserves. Conclusion dental technicians were financially impacted by the COVID-19 pandemic, mainly caused by fewer working hours, revenue reduction, and higher operating costs due to the change in the biosafety routine.
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Surveys and Questionnaires , Dental Technicians , Remuneration , COVID-19ABSTRACT
ABSTRACT The COVID-19 pandemic imposed restrictive measures on dentistry in different regions of the world, ranging from stoppage of care to only permission for urgent and emergency dental services. Thus, new biosafety guidelines for resuming activities, whether in single dental offices, large clinics or dental education activities, are urgently required. In this sense, herein, guidelines that incorporate common points of the main protocols found in the literature for the resumption of dental activities at their different levels, whether in the scope of care or education, are presented. Furthermore, we present the incorporation of measures that allow an increase in the level of biosafety, such as the control of the dental team, the inclusion in the history of conjunctivitis as a possible alert for COVID-19, and the use of the pulse oximeter to assess the risk of silent hypoxemia, which may indicate a complication of COVID-19. In addition, new perspectives for directing research and innovation for biosafety in dentistry are discussed.