Lesão [renal] aguda induzida pela COVID-19 em pacientes críticos: o que diz a literatura? / COVID-19-induced acute kidney injury in critical patients: what does the literature say? / Lesión renal aguda inducida por COVID-19 en pacientes críticos: ¿qué dice la literatura?

Objetivo: identificar por meio da literatura a relação entre lesão renal aguda (LRA) e COVID-19, no paciente crítico. Método: revisão integrativa da literatura, com seleção dos artigos publicados entre 2020 e 2021 nas bases de dados da Biblioteca Virtual da Saúde: LILACS, SCIELO, PUBMED. Por meio dos descritores "Lesão Renal Aguda" AND "Coronavírus-19" AND "Unidade de Terapia Intensiva". Resultados: o estudo foi composto por um recorte de 12 publicações. Os estudos em geral apontam que a LRA no contexto da COVID-19, é de causa multifatorial, entretanto não há consenso sobre essa afirmativa, uma vez que alguns estudos apontam que a COVID-19 contribui diretamente para novos casos de LRA em pacientes críticos devido à cascata de citocinas presente na patologia, o que não foi confirmado por todos os estudos. Conclusão: esta revisão evidenciou que a LRA é uma complicação presente em pacientes críticos com Covid-19. Os estudos encontrados demonstram que o assunto ainda precisa melhor explorado para que a relação entre o COVID-19 e a LRA seja definitivamente esclarecida.

Objective: to identify through the literature the relationship between acute kidney injury (AKI) and COVID-19 in critically ill patients.Method: integrative literature review, with selection of articles published between 2020 and 2021 in the Virtual Health Library databases: LILACS, SCIELO, PUBMED. Through the descriptors "Acute Kidney Injury" AND "Coronavirus-19" AND "Intensive Care Unit". Results: the study consisted of a cut of 12 publications. Studies in general point out that AKI in the context of COVID-19, is of multifactorial cause, however there is no consensus on this statement, since some studies point out that COVID-19 directly contributes to new cases of AKI in critically ill patients due to to the cytokine cascade present in the pathology, which was not confirmed by all studies. Conclusion: this review showed that AKI is a complication present in critically ill patients with Covid-19. The studies found demonstrate that the subject still needs to be further explored so that the relationship between COVID-19 and AKI is definitively clarified.

Objetivo: identificar a través de la literatura la relación entre insuficiencia renal aguda (IRA) y COVID-19 en pacientes críticos.Metodo: revisión integrativa de la literatura, com selección de artículos publicados entre 2020 y 2021 en las bases de datos de la Biblioteca Virtual en Salud: LILACS, SCIELO, PUBMED. A través de los descriptores "Daño Renal Agudo" Y "Coronavirus-19" Y "Unidad de Cuidados Intensivos". Resultados: el estudio constó de un corte de 12 publicaciones. Los estudios en general señalan que el IRA en el contexto del COVID-19, es de causa multifactorial, sin embargo no existe consenso sobre esta afirmación, ya que algunos estudios señalan que el COVID-19 contribuye directamente a nuevos casos de IRA en pacientes críticos por a la cascada de citocinas presente en la patología, que no fue confirmada por todos los estudios. Conclusión: esta revisión mostró que el DRA es una complicación presente en pacientes críticos com Covid-19. Los estudios encontrados demuestran que el tema aún necesita ser más explorado para que la relación entre COVID-19 y AKI se aclare definitivamente.

Analysis of all the adverse events following immunization by CovishieldTM vaccine among healthcare workers at Government Medical College, Jalgaon

Background: The severe acute respiratory syndrome coronavirus 2 (COVID 19) is a global pandemic since December 2019. The subject expert committee of the Central Drugs Standard Control Organization made recommendations for Restricted Emergency Approval of COVID-19 virus vaccine of M/s Serum Institute of India ChAdOx1 nCoV-19 vaccine (AZD1222) COVISHIELD™ which was developed at Oxford University. In India, this vaccine was launched on January 16, 2021, and healthcare workers were included first in this vaccination program. Aim and Objectives: This study aimed to record and analyzes all the adverse events following the immunization (AEFI) in healthcare workers for monitoring the safety and find the correlation if any. Materials and Methods: This was a prospective observational study. After obtaining Institutional Ethics committee approval, we collected the data by phone call to the participants within 3 days after the first and second dose of the vaccine. We collected the data from 100 healthcare workers randomly with their consent. Results: The most common adverse effect found was myalgia followed by local pain at the injection site after the first dose. About 92% of participants did not react to the second dose of the vaccine. Conclusion: There were no serious adverse events after the first as well as the second dose of vaccination. More studies and monitoring are needed to find out any unexpected reactions following COVID-19 vaccination.

Prevalência de hipertensão arterial sistêmica e diabetes mellitus em indivíduos com covid-19: um estudo retrospectivo de óbitos em pernambuco, brasil / Prevalence of systemic arterial hypertension and diabetes mellitus in individuals with covid-19: a retrospective study of deaths in pernambuco, brazil

Resumo Hipertensão arterial sistêmica (HAS) e diabetes mellitus (DM) são dois dos principais fatores de risco para a mortalidade por COVID-19. Descrever a prevalência e o perfil clínico-epidemiológico de óbito por COVID-19 ocorridos em Pernambuco, Brasil, entre 12 de março e 14 de maio de 2020 entre pacientes que possuíam hipertensão arterial sistêmica e/ou diabetes mellitus como doenças prévias. Estudo observacional transversal. Foram analisadas as seguintes variáveis: município de procedência, sexo, faixa etária, tempo entre o início dos sinais/sintomas e o óbito, sinais/sintomas, tipo de comorbidades e hábitos de vida. Variáveis categóricas foram descritas por meio de frequências e variáveis contínuas por meio de medidas de tendência central e de dispersão. Os testes de Mann-Whitney e Kruskal-Wallis foram utilizados. Dos 1.276 registros incluídos no estudo, 410 apresentavam HAS e/ou DM. A prevalência de HAS foi 26,5% (n=338) e de DM foi 19,7% (n=252). Dos registros, 158 (12,4%) eram de pacientes que possuíam somente HAS, 72 (5,6%) somente DM e 180 (14,1%) apresentavam HAS e DM. Dos indivíduos com HAS, 53,3% apresentavam DM e 71,4% dos diabéticos apresentam HAS. A mediana (em dias) do tempo entre o início dos sinais/sintomas e o desfecho óbito foi 8,0 (IIQ 9,0), sem diferença significativa entre os grupos de comorbidades (p=0,633), sexo (p=0,364) e faixa etária (p=0,111). Observou-se maior prevalência de DM e HAS na população masculina (DM — 61,3% eram homens e 38,9% mulheres; HAS — 53,2% eram homens e 46,8% mulheres). Os sinais/sintomas mais frequentes foram dispneia (74,1%; n=304), tosse (72,2%; n=296), febre (68,5%; n=281) e saturação de O2<95% (66,1%; n=271). Dos hipertensos, 73,3% (n=100) apresentavam outras comorbidades/fatores de risco associados, e 54,2% (n=39) dos diabéticos apresentavam outras comorbidades/fatores de risco associados. Destacaramse as cardiopatias (19,5%; n=80), obesidade (8,3%; n=34), doença respiratória prévia (7,3%; n=30) e nefropatia (7,8%; n=32). A prevalência de tabagismo foi 8,8% (n=36) e de etilismo alcançou 3,4% (n=14). O estudo mostrou que a prevalência de HAS foi superior à prevalência de DM nos indivíduos que foram a óbito por COVID-19. Em idosos, a prevalência foi superior à observada em indivíduos não idosos.

Marginalization, Vulnerability and Economic Dynamics in COVID-19

Abstract COVID-19, caused by the coronavirus family SARS-CoV-2 and declared a pandemic in March 2020, continues to spread. Its enormous and unprecedented impact on our society has evidenced the huge social inequity of our modern society, in which the most vulnerable individuals have been pushed into even worse socioeconomic situations, struggling to survive. As the pandemic continues, we witness the huge suffering of the most marginalized populations around the globe, even in developed, high-income latitudes, such as North America and Europe. That is even worse in low-income regions, such as Brazil, where the public healthcare infrastructure had already been struggling before the pandemic. Cities with even more evident social inequity have been impacted the most, leaving the most socioeconomically disadvantaged ones, such as slum residents and black people, continuously inflating the statistics of COVID-19 sufferers. Poverty, marginalization, and inequity have been well-known risk factors for morbidity and mortality from other diseases. However, COVID-19 has deepened our society's wound. It is up to us to heal it up. If we really care for the others and want to survive as a species, we must fight social inequity.

COVID-19 en el paciente pediátrico / COVID-19 in the pediatric patient

Resumen Este documento fue preparado (en junio de 2020) por y para los profesionales médicos (clínicos y proveedores de salud), y está disponible públicamente para propósitos de recomendaciones relacionada con pacientes pediátricos y enfermedad por coronavirus 2019 (COVID-19). Según datos disponibles hasta la fecha, los niños de todas las edades pueden contraer la COVID-19; sin embargo, tienen mejor pronóstico que los adultos, siendo pocos los casos graves reportados, y los casos leves se recuperan en 1-2 semanas después del inicio de la enfermedad. El objetivo de este documento es aportar peculiaridades que consideramos importantes para el diagnóstico y tratamiento. Debido a los cambios en la actual situación epidemiológica se pueden modificar algunos conceptos y acciones, por lo que la información aquí contenida debe ser adaptada a cada paciente, basada en el juicio clínico, necesidades del paciente y recursos disponibles.

Abstract This document was prepared (June 2020) by and for medical professionals (clinicians and health providers), and it is available as a guideline for pediatric patients with coronavirus disease 2019 (COVID-19). So far, according to available data although children of all ages can acquire COVID-19, they have better outcome than adults, with a little proportion of severe disease, and in mild cases they have a 1 to 2-week recovery after the beginning of the infection. The objective of this document is to provide particularities that we consider important for diagnosis and treatment. Owe to the changing epidemiological situation some concepts and actions can change, so this information must be adapted to each specific case, based on the clinical judgement according to patient requirements and available resources.

Experiencia inicial en la atención de pacientes con Covid-19 en un hospital privado de alta complejidad de la Ciudad de Buenos Aires / Initial experience in the attention of patients with COVID-19 in a private third-level hospital in Buenos Aires city

Resumen La infección por COVID-19 tiene presentaciones variadas, siendo aún escasos los datos de evolución de pacientes afectados en Argentina. Este es un estudio retrospectivo, observacional de pacientes con confirmación virológica de coronavirus atendidos entre marzo y mayo 2020 en un hospital privado universitario de tercer nivel de Buenos Aires. Se incluyeron 155 pacientes adultos de los cuales 47 (30.3%) concurrieron solo para realizarse un hisopado; 92 (59.4%) fueron internados en el hospital y 16 (10.3%) tuvieron internación domiciliaria con seguimiento telefónico diario. El 54.2% fueron mujeres con mediana de edad de 35 años (rango intercuartil [RIC] 29 a 50). El 59.4% (92) tenían algún factor de riesgo, incluyendo edad igual o mayor a 65 años, enfermedad crónica predisponente, eran personal de salud o trabajaban/residían en geriátrico. En los 108 que tuvieron seguimiento, el síntoma más frecuente fue fiebre (75.9%), seguido de tos (65.7%), y odinofagia (48.2%). La odinofagia fue más frecuente en mujeres (p = 0.035) y la disnea en hombres (p = 0.014). El 93.5% de los participantes (101) experimentaron síntomas, mientras que 17.6% (19) presentó algún síntoma, pero encontrándose afebriles. En 5 participantes a los que se les realizó una tomografía se observó que la radiografía había sido normal o no diagnóstica. Catorce pacientes requirieron terapia intensiva y 6 de ellos necesitaron ventilación mecánica, falleciendo cuatro. Los 2 pacientes restantes fueron derivados a centros de cuidados crónicos. Ningún paciente con internación domiciliaria requirió ser hospitalizado ni falleció. Si bien esta observación resulta alentadora, deberá ser confirmado en nuevos estudios.

Abstract Infection with the SARS coronavirus type 2 (COVID-19) has a variety of presentations, with little data on the evolution of affected patients in Argentina. This is a retrospective and observational study of patients with virological confirmation of coronavirus treated during the months of March to May in a private third-level university hospital in Buenos Aires. One hundred and fifty-five adult patients were included, of which 30.3% attended only for a swab; 59.4% were admitted to the hospital and 10.3% were hospitalized at home with daily telephone follow-up. Fifty-four point two percent of participants were women and the median age was 35 years (ICQ 29 to 50). About 59.3% of patients had some risk factor, including age (65 years old or more), underlying chronic disease, were health workers or personnel/residents in a nursing home. The most frequent symptom was fever (75.9%), followed by cough (65.7%), and odynophagia (48.2%). Globally, 93.5% experienced some symptoms while 17.6% of the participants presented some symptoms but without fever. Chest tomographies were performed to 5 patients. Their chest radiograph was normal or non-diagnostic. Fourteen patients required intensive therapy and 6 of them required mechanical ventilation, 4 of them died. The remaining 2 patients were referred to chronic care centers. No patient with home hospitalization required admission to hospital or died. While this observation is encouraging, it will need to be confirmed with new studies.

COVID-19: Reestructuración de emergencia e impacto de la pandemia en una Sección de Cirugía Mininvasiva Guiada por Imágenes / Emergency restructuring and impact of the pandemic in an Image-Guided Minimally Invasive Surgery Section

Antecedentes: La enfermedad por coronavirus-19 (COVID-19) ha forzado cambios en todas las facetas de los sistemas de salud. En este artículo se describen las modificaciones realizadas en la Sección de Cirugía Miniinvasiva Guiada por Imágenes (CIGIM) del Hospital Italiano de Buenos Aires, para promover la seguridad y el bienestar del personal manteniendo la capacidad de respuesta a la demanda asistencial y académica. Material y métodos: Las medidas incluyeron la reorganización del personal, el manejo de los procedimientos electivos y de urgencia, las consultas ambulatorias, así como la actividad docente y de investigación. También se analizó comparativamente la variación interanual (2019-2020) de los pacientes atendidos (procedimientos percutáneos y consultas ambulatorias) entre el 20 de marzo y el 10 de mayo de cada año. Resultados: La Sección CIGIM fue reorganizada en rotaciones semanales de 3 actividades, con distanciamiento estricto entre sus miembros, y hasta el momento ninguno resultó afectado. Los pacientes operados y las consultas realizadas durante el período estudiado 2019 vs. 2020 disminuyeron significativamente: 136 vs. 57 operados y 102 vs. 39 consultas; p < 0,0001. Las plataformas virtuales se utilizaron con éxito para mantener la actividad de pregrado, incluyendo cursadas de alumnos de grado de Medicina de dos universidades, el programa de residencia de Cirugía General y reuniones científicas; en dicho período se produjeron 3 trabajos científicos para publicación. Conclusiones: La disminución de la demanda asistencial, la reorganización de los grupos de trabajo y las plataformas virtuales pueden resultar estrategias y herramientas valiosas para afrontar la pandemia por COVID-19.

Background: Coronavirus-19 disease (COVID-19) has forced changes in all facets of health systems. This article describes the modifications made in the Image-Guided Minimally Invasive Surgery Section (CIGIM) of the Hospital Italiano de Buenos Aires, to promote the safety and well being of personnel while maintaining the ability to respond to academic and healthcare demand. Material and methods: Measures included reorganization of staff, management of elective and emergency procedures, outpatient consultations, as well as teaching and research activity. The inter-annual variation (2019-2020) of the patients attended (percutaneous procedures and outpatient consultations) between March 20 and May 10 of each year was also analyzed comparatively. Results: The CIGIM Section was reorganized into weekly rotations of 3 activities, with strict distancing among its members, and so far none have been affected. The operated patients and the consultations made during the analyzed period of 2019 vs. 2020 decreased significantly: 136 vs. 57 operated and 102 vs. 39 consultations; p <0.0001. Virtual platforms were successfully used to maintain undergraduate activity, including courses taken by medical students from two universities, the General Surgery residency program and scientific meetings; In this period, 3 scientific papers were written for publication. Conclusions: Dealing with healthcare demand, reorganizing working groups and virtual platforms can be valuable strategies and tools to confront the COVID-19 pandemic.