Consideraciones médico-legales laborales de la fórmula de Balthazard / Occupational medical-legal considerations of the Balthazard formula

La determinación del porcentaje de pérdida en pacientes lesionados con múltiples secuelas por riesgos de trabajo resulta un verdadero reto para el perito, esto adquiere mayor relevancia cuando en el fuero judicial se pueden presentar discrepancias en los criterios para el uso o no de fórmulas matemáticas para el cálculo. La fórmula de suma combinada, creada por el Médico Forense Víctor Balthazard, no es más que un ordenamiento de una regla de tres que ordena los porcentajes otorgados a cada secuela de mayor a menor para evitar que el porcentaje final sobrepase el 100%, o bien que resulte en un porcentaje mayor que una secuela única puntuada en el baremo y que por gravedad en la intensidad de la misma resulte con un porcentaje menor al calculado por la secuela múltiple y que se ha utilizado en fueros laborales y de seguridad social alrededor del mundo. El Baremo contenido en el Código de Trabajo no establece explícitamente la forma en que se calcula el porcentaje de pérdida por secuelas múltiples, lo cual brinda libertad al perito para utilizar fórmulas, como lo es la fórmula de suma combinada, que permite calcular de forma congruente las pérdidas sucesivas sin sobrepasar a la persona más allá de su capacidad general total del 100% o de otorgar porcentajes mayores a secuelas de mayor gravedad que la suma de las pérdidas por el evento que se está valorando.

The determination of the percentage of loss in injured patients with multiple sequelae due to occupational hazards is a real challenge for the expert, this becomes even more relevant when in the judicial system there may be discrepancies in the criteria for the use or not of mathematical formulas for the calculation. The combined sum formula, created by the Forensic Physician Victor Balthazard, is nothing more than an arrangement of a rule of three that orders the percentages given to each sequel from highest to lowest to avoid that the final percentage exceeds 100%, or that it results in a higher percentage than a single sequel scored in the scale and that due to the severity in the intensity of the same results in a lower percentage than that calculated for the multiple sequel and that has been used in labor and social security courts around the world. The Schedule contained in the Labor Code does not explicitly establish the way in which the percentage of loss for multiple sequelae is calculated, which gives the expert the freedom to use formulas, such as the combined sum formula, which allows a congruent calculation of the successive losses without exceeding the person's total general capacity of 100% or to grant higher percentages to sequelae of greater severity than the sum of the losses for the event being valued.

Secuelas respiratorias clínicas, funcionales y tomográficas de pacientes hospitalizados por Covid-19 al año del diagnóstico: ESTUDIO SECUELAR-19 / Clinical, functional and tomographic respiratory sequels of patients hospitalized for COVID-19 at one year of diag nosis: SECUELAR-19 TRIAL

Resumen Introducción : Hay información escasa sobre evolución a largo plazo de pacientes hospitalizados por neumo nía COVID-19 moderada (NM) y grave (NG). El objetivo del estudio fue determinar impacto clínico, funcional respiratorio y tomográfico (TACAR) luego del alta a 12 meses del diagnóstico. Métodos : análisis según grupos NM y NG, desatura dores (PD) en prueba de caminata 6 min (PC6M) y patrón tomográfico símil fibrótico (SF). Comparamos resultados a 3 y 12 meses de seguimiento. Resultados : 194 pacientes enrolados, evaluados al año: 103 (53% ): masculinos (62.4%), edad 57.7 ± 10.9 años, comorbilidades (hipertensión arterial 38.8%, dia betes 29.6%, antecedentes respiratorios-AR- 18.4%). Com paramos variables a los 3 y 12 meses (media/DE): CVF 84%(19) a 88(19) (p = 0.01); 27% tuvo CVF<80% al año. En PC6M: 426 metros (108) a 447(92) (p = < 0.01). El 12.8% fue PD al año. NG tuvo mayor SF (40% vs. 27.9% p = 0.021). SF se relacionó con CVF <80% (p = 0.004) en toda la co horte, y NG (p < 0.001). Al año en análisis multivariado se asoció a CVF <80%, AR (OR 4.32, 1.15-16.25), diabetes (OR 2.96, 1.02-8.57) y patrón SF (OR 3.51, 1.25-9.88). PD se asoció a AR (OR 12.2, 2.41-61.85). Discusión : Se observó mejoría en todas las variables al año. Pero al año persisten alteraciones funcionales y tomográficas en <50% de los pacientes. El subgrupo de PD se relacionó a AR. Es importante el seguimiento protocolizado de los pacientes hospitalizados, especial mente los grupos NG, PD y SF.

Abstract Introduction : There is scarce information on longterm evolution of hospitalized patients with moderate (MP) and severe (SP) COVID-19 pneumonia. Objective: to de termine clinical, respiratory function, and tomographic (HRCT) impact after being discharged 12 months after diagnosis. Methods : Analysis according to MP and SP, desatura tor patients (DP) in 6-minute walking test (6MWT) and HRCT fibrotic-like pattern (FLP). Results compared at 3 and 12 months of follow-up. Results : 194 patients enrolled and one year later 103 (53%) were evaluated: gender male (62.4%), age 57.7 ± 10.9 years, comorbidities (arterial hypertension 38.8%, diabetes 29.6%, and respiratory diseases-RD-18.4%). Variables compared 3 months to 12 months (mean/SD): FVC: 84%( 19) to 88%( 19) (p= 0.01). A 27% of patients had FVC<80% at one year. In 6MWT:426 (108) to 447 (92) (p = <0.01). 12.8% are DP in one year. SP had a greater FLP than MP (40% vs. 27.9%, p = 0.021). The FLP group was related to FVC < 80% (p = 0.004) in all patients but only in SP (p < 0.001). After one year, in multivariate analysis, FVC < 80% was associated with RD (OR 4.32, 1.15-16.25), diabetes (OR 2.96, 1.02-8.57) and FLP (OR 3.51, 1.25-9.88). DP were associated with RD (OR 12.2, 2.41-61.85). Discussion : Improvement was observed in all vari ables when comparing 3 to 12 months. However, after one year, functional and tomographic alterations persist in less than 50% of patients. DP subgroup was related to RD. Protocolled follow-up of hospitalized patients is important, especially in SP, DP, and FLP groups.

Perfil Neurocognitivo de una cohorte de menores de edad con vivencias de maltrato infantil / Neuropsychological profile of a cohort of children victims of child abuse

El maltrato infantil (MI) es un problema multidimensional. El estrés crónico producido por dicho fenómeno afecta el desarrollo cerebral de niños, niñas y adolescentes (NNA), incidiendo negativamente en la evolución de diversos aspectos del desarrollo, condicionando su vida futura. El objetivo de este estudio es analizar el desempeño sociocognitivo de NNA que han vivenciado MI, mediante el análisis de las funciones del neurodesarrollo, evaluado con subpruebas de la NEPSY II. Se analizan funciones ejecutivas y percepción social, bases del razonamiento y adaptación social. Se estudia el desempeño de 14 de NNA pertenecientes a un Programa de la Fundación Súmate, cuya Misión es la recuperación de la escolaridad NNA que han visto alterado el curso de su desarrollo por MI. Los resultados dan cuenta de alteraciones cerebrales asociadas al MI, las que se evidencian en un deficitario desarrollo funcional de las variables estudiadas. Existe grave descenso en los procesos y subprocesos del funcionamiento ejecutivo. En relación con la percepción social, la muestra estudiada presenta un mejor desarrollo, el que desciende a medida que aumenta la edad. Las funciones estudiadas tienen directa relación con el razonamiento cognitivo y desarrollo socio adaptativo, bases sobre las que se estructura el desarrollo académico. Los hallazgos, refuerzan la urgencia de abordar esta sensible realidad desde la práctica médica en la atención primaria y especializada. Los resultados también son de utilidad para orientar el desarrollo de políticas públicas que efectivamente contribuyan al progreso de nuestro país.

Abstract. Child maltreatment (MI) is a multidimensional problem. The chronic stress produced by this phenomenon affects the brain development of children and adolescents (NNA), negatively affecting the evolution of various aspects of development, conditioning their future life. The objective of this study is to analyze the sociocognitive performance of children and adolescents who have experienced IM, through the analysis of the performance of neurodevelopmental functions, evaluated through subtests of the NEPSY II. Executive functions and social perception, reasoning bases and social adaptation are studied. The performance of 14 NNA belonging to a Fundación Súmate Program is studied, whose mission is the recovery of NNA schooling that has seen the course of their development altered by IM. The results show brain alterations associated with MI, evidenced in a deficient functional development of the variables studied. There is a serious decline in the processes and threads of executive functioning. In relation to social perception, the studied sample presents a better development, which decreases as age increases. The functions studied are directly related to cognitive reasoning and socio-adaptive development, based on which academic development is structured. The findings reinforce the urgency of addressing this sensitive reality from medical practice in primary and specialized care. The results are also useful to guide the development of public policies that effectively contribute to the progress of our country.

Post-COVID-19 Sequelae in Children

Coronavirus disease 19 (COVID-19), caused by the severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), has been implicated in having post-COVID-19 sequelae in both adults and children. There is a lack of good data on the prevalence and risk factors for post-COVID-19 sequelae in children. The authors aimed to review the current literature on post-COVID sequelae. The prevalence of post-COVID sequelae in children is highly variable among studies, with an average of 25%. The sequelae may affect many organ systems, though mood symptoms, fatigue, cough, dyspnea, and sleep problems are common. In many studies, it is difficult to establish a causal association due to the lack of a control group. Furthermore, it is difficult to differentiate whether the neuropsychiatric symptoms in children after COVID-19 are due to infection or a result of lockdowns and social restrictions imposed by the pandemic. Children with COVID-19 should be followed by a multidisciplinary team and screened for symptoms, followed by focused laboratory evaluations as needed. There is no specific treatment for the sequelae. Only symptomatic and supportive treatment is required in most cases. More research is necessary to standardize the definitions of sequelae, establish a causal association, assess various treatment options, and the effects of different virus variants, and finally, see the impact of vaccination on the sequelae.

Risk factors for clinically significant diffuse parenchymal lung abnormalities persisting after severe COVID-19 pneumonia

Background & objectives: The risk factors for clinically significant diffuse parenchymal lung abnormalities (CS-DPLA) persisting after severe coronavirus disease 2019 (COVID-19) pneumonia remain unclear. The present study was conducted to assess whether COVID-19 severity and other parameters are associated with CS-DPLA. Methods: The study participants included patients who recovered after acute severe COVID-19 and presented with CS-DPLA at two or six month follow up and control group (without CS-DPLA). Adults volunteers without any acute illness, chronic respiratory illness and without a history of severe COVID-19 were included as healthy controls for the biomarker study. The CS-DPLA was identified as a multidimensional entity involving clinical, radiological and physiological pulmonary abnormalities. The primary exposure was the neutrophil-lymphocyte ratio (NLR). Recorded confounders included age, sex, peak lactate dehydrogenase (LDH), advanced respiratory support (ARS), length of hospital stay (LOS) and others; associations were analyzed using logistic regression. The baseline serum levels of surfactant protein D, cancer antigen 15-3 and transforming growth factor-? (TGF-?) were also compared among cases, controls and healthy volunteers. Results: We identified 91/160 (56.9%) and 42/144 (29.2%) participants with CS-DPLA at two and six months, respectively. Univariate analyses revealed associations of NLR, peak LDH, ARS and LOS with CS-DPLA at two months and of NLR and LOS at six months. The NLR was not independently associated with CS-DPLA at either visit. Only LOS independently predicted CS-DPLA at two months [adjusted odds ratios (aOR) (95% confidence interval [CI]), 1.16 (1.07-1.25); P<0.001] and six months [aOR (95% CI) and 1.07 (1.01-1.12); P=0.01]. Participants with CS-DPLA at six months had higher baseline serum TGF-? levels than healthy volunteers. Interpretation and conclusions: Longer hospital stay was observed to be the only independent predictor of CS-DPLA six months after severe COVID-19. Serum TGF-? should be evaluated further as a biomarker.

Caracterización clínico-epidemiológica de niños convalecientes de COVID-19 / Clinical-Epidemiological Characterization of Children Convalescent of COVID-19

Introducción: Las secuelas de la enfermedad viral COVID-19 resultan múltiples y más frecuentes en la edad adulta, pero también pueden aparecer en niños y adolescentes. Objetivo: Determinar las características clínicas y epidemiológicas de pacientes pediátricos convalecientes de COVID-19. Métodos: Estudio descriptivo, observacional, de corte transversal en pacientes menores de 19 años convalecientes de COVID-19, que asistieron a la consulta poscovid-19 del policlínico docente "Mario Escalona Reguera" del municipio Habana del Este. El período del estudio comprendió desde el 1 de enero hasta el 31 de octubre de 2021. Se estudiaron las variables: edad, sexo, historia epidemiológica, comorbilidades, estado durante su ingreso y secuelas en diferentes sistemas. Resultados: Se caracterizaron 474 niños y adolescentes convalecientes de COVID-19. Los mayores de 10 años constituyeron el grupo de edad más afectado, con discreto predominio del sexo masculino. La fuente de infección quedó definida en la mayoría de los pacientes, por contacto autóctono e intradomiciliario. Las comorbilidades más identificadas resultaron el asma bronquial y las sibilancias recurrentes. Durante su ingreso casi la totalidad de los casos se reportaron de cuidado. La tercera parte de los convalecientes presentaron algún tipo de secuelas. Conclusiones: La mayor incidencia de la COVID-19 durante la etapa de la convalecencia se presentaba en niños de 10 años o más, con predominio ligero del sexo masculino. La tercera parte de los pacientes manifestaba algún tipo de secuelas con predominio de las psicológicas, seguidas de las neurológicas.

Introduction: The sequelae of COVID-19 viral disease are multiple and more frequent in adulthood, but can also appear in children and adolescents. Objective: To determine the clinical and epidemiological characteristics of pediatric patients convalescing from COVID-19. Methods: Descriptive, observational, cross-sectional study in patients under 19 years old convalescing from COVID-19, who attended the post-COVID-19 consultation at "Mario Escalona Reguera" Teaching Polyclinic in Habana del Este municipality. The study period covered from January 1 to October 31, 2021. The following variables were studied: age, sex, epidemiological history, comorbidities, condition during admission and sequelae in different systems. Results: 474 children and adolescents convalescing from COVID-19 were characterized. Children older than 10 years were the most affected age group, with a slight predominance of the male sex. The source of infection was defined in most patients as autochthonous and intra-home contact. The most identified comorbidities were bronchial asthma and recurrent wheezing. During their admission, almost all cases were reported as seriously ill. One third of convalescents presented some type of sequelae. Conclusions: The highest incidence of COVID-19 during the convalescence stage was in children aged 10 years or older, with a slight predominance of the male sex. One third of the patients showed some type of sequelae, with a predominance of psychological sequelae, followed by neurological sequelae.

Presença de risco de transtorno do estresse pós-traumático em policiais militares feridos por arma de fogo / Presence of risk of posttraumatic stress disorder in military police officers wounded by firearms / Presencia de riesgo de trastorno de estrés postraumático en policías militares heridos por armamiento de fuego

Este estudo teve como objetivo identificar o risco de desenvolvimento de transtorno de estresse pós-traumático (TEPT), bem como sua associação com pensamentos ou tentativas suicidas e a saúde mental de policiais militares feridos por arma de fogo, na Região Metropolitana de Belém (RMB), nos anos de 2017 a 2019. A pesquisa contou com a participação de 30 entrevistados, que responderam o Inventário Demográfico e a Lista de verificação de TEPT para o DSM-5 (PCL-5). Para análise dos dados, utilizou-se a técnica estatística Análise Exploratória de Dados e a técnica multivariada Análise de Correspondência. Os resultados revelaram a existência de risco de desenvolvimento do transtorno de forma parcial ou total em uma expressiva parcela da população entrevistada, tendo homens como maioria dos sintomáticos, com média de 38 anos, exercendo atividades operacionais e vitimados em via pública quando estavam de folga do serviço. O ferimento deixou a maioria com sequelas, com destaque para dores crônicas, limitações de locomoção e/ou mobilidade e perda parcial de um membro. E, ainda, policiais sintomáticos apresentaram comportamentos suicidas, relatando já terem pensado ou tentado tirar a própria vida. Desta forma, conclui-se que policiais militares são expostos constantemente a traumas inerentes a sua profissão. Quando há ameaça de vida, como nos casos de ferimentos por arma de fogo, são suscetíveis a sequelas físicas decorrente do ferimento, somadas a sequelas mentais tardias, como o surgimento de sintomatologias de TEPT e ideação suicida.(AU)

This study aimed to identify the risk of developing post-traumatic stress disorder (PTSD) and its associations around suicidal thoughts or attempts and mental health in military police officers injured by firearms, in the Metropolitan Region of Belem (RMB), from 2017 to 2019. The research had the participation of 30 respondents who answered the Demographic Inventory and the PTSD checklist for DSM-5 (PCL-5). For data analysis, we used the statistical technique Exploratory Data Analysis and the multivariate technique Correspondence Analysis. The results revealed the existence of risk of developing partial or total disorder in a significant portion of the interviewed population, with men as most of the symptomatic individuals, with mean age of 38 years, developing operational activities and victimized on public roads when they were off duty. The injuries left most of them with sequelae, especially chronic pain, limited locomotion and/or mobility, and partial loss of a limb. In addition, symptomatic officers showed suicidal behavior, such as reporting they had thought about or tried to take their own lives. Thus, we conclude that military policemen are constantly exposed to traumas inherent to their profession. When their lives are threatened, as in the case of firearm wounds, they are susceptible to physical sequelae resulting from the injury, in addition to late mental sequelae, such as the appearance of PTSD symptoms and suicidal ideation.(AU)

Este estudio tuvo como objetivo identificar el riesgo de desarrollo de trastorno de estrés postraumático (TEPT) y sus asociaciones con pensamientos o tentativas suicidas y la salud mental en policías militares heridos por armamiento de fuego, en la Región Metropolitana de Belém (Brasil), en el período entre 2017 y 2019. En el estudio participaron 30 entrevistados que respondieron el Inventario Demográfico y la Lista de verificación de TEPT para el DSM-5 (PCL-5). Para el análisis de datos se utilizaron la técnica estadística Análisis Exploratoria de Datos y la técnica multivariada Análisis de Correspondencia. Los resultados revelaron que existen riesgos de desarrollo de trastorno de estrés postraumático de forma parcial o total en una expresiva parcela de la población de policías entrevistados, cuya mayoría de sintomáticos eran hombres, de 38 años en media, que ejercen actividades operacionales y fueron victimados en vía pública cuándo estaban de día libre del servicio. La lesión dejó la mayoría con secuelas, especialmente con dolores crónicos, limitaciones de locomoción y/o movilidad y la pierda parcial de un miembro. Aún los policías sintomáticos presentaran comportamiento suicida, tales como relataran qué ya pensaron o tentaron quitar la propia vida. Se concluye que los policías militaran se exponen constantemente a los traumas inherentes a su profesión. Cuando existe amenaza de vida, como en los casos de heridas por armamiento de fuego, son expuestos a secuelas físicas transcurridas de la herida, sumado a secuelas mentales tardías, como el surgimiento de sintomatologías de TEPT y la ideación suicida.(AU)

Long COVID: An approach to clinical assessment and management in primary care

Long COVID is an emerging public health threat, following swiftly behind the surges of acute infection over the course of the COVID-19 pandemic. It is estimated that there are already approximately 100 million people suffering from Long COVID globally, 0.5 million of whom are South African, and for whom our incomplete understanding of the condition has forestalled appropriate diagnosis and clinical care. There are several leading postulates for the complex, multi-mechanistic pathogenesis of Long COVID. Patients with Long COVID may present with a diversity of clinical phenotypes, often with significant overlap, which may exhibit temporal heterogeneity and evolution. Post-acute care follow-up, targeted screening, diagnosis, a broad initial assessment and more directed subsequent assessments are necessary at the primary care level. Symptomatic treatment, self-management and rehabilitation are the mainstays of clinical care for Long COVID. However, evidence-based pharmacological interventions for the prevention and treatment of Long COVID are beginning to emerge. This article presents a rational approach for assessing and managing patients with Long COVID in the primary care setting.

ZHANG Zhiyuan's Experience in Treating Stroke Sequela with Focus on Regulating Qi and Blood / 中医杂志

This parer summarized the clinical experience of Professor ZHANG Zhiyuan in treating stroke sequelae from the perspective of regulating qi and blood. It is believed that the basic pathogenesis of stroke sequelae is disharmony of qi and blood， and it is advocated that the basic treatment method is to regulate qi and blood. For the three major symptoms of stroke sequelae， including hemiplegia， cognitive dysfunction， and sluggish speech， the effective formulas have been summarized. Hemiplegia is often treated with Chongsu Qiju Decoction （重塑起居汤） to tonify the center and replenish qi， activate blood and dredge collaterals. Cognitive dysfunction is often treated with modified San Hua Decoction （三化汤） to resolve phlegm and purge heat， regulate qi and tonify blood. And sluggish speech is often treated with Zishou Jieyu Decoction （资寿解语汤） to warm and tonify yang qi， expel wind and remove phlegm. Meanwhile， the self-made Zhinao Huayu Decoction （治脑化瘀汤） is used to prevent the occurrence of stroke sequelae， and to regulate the blood and qi by using wind medicinals and the method of relaxing and purging bowels to cure the disease.

Role of amniotic membrane transplantation in treating acute ocular manifestations in Steven–Johnson syndrome and its long-term impact

Background: Steven–Johnson syndrome (SJS) is a serious disorder affecting the skin and mucous membrane, causing multiple flaccid bullae and purpuric rashes with sheet?likeepithelial detachment including the ocular surface. The long?term outcomes following SJS are dismal and manifest as corneal vascularization, lid?wiper keratopathy, and severe dry eyes. The disease course can be modified if amniotic membrane graft is performed at the first week of disease, and the above?said complications can be avoided. This procedure thus not only decreases the morbidity but also improves the quality of life. Purpose: This video discusses the long?term sequelae of SJS which can be modified with timely intervention during the acute stage and thus significantly decreases morbidity. Synopsis: The video demonstrates the simple technique of amniotic membrane transplantation in the acute stage in SJS and its impact in long run. Highlights: There should be a low threshold for doing early amniotic membrane transplantation in patients with SJS with ocular surface involvement. Early intervention can change the disease course and decrease disease morbidity significantly.

Principales secuelas respiratorias del Covid-19: una revisión exploratoria / oria Main respiratory sequelae of Covid-19: an exploratory review

La Covid-19 es una enfermedad infecciosa que ha causado importantes tasas de morbi-mortalidad en la población mundial, la evidencia científica ha procurado describir la fisiopatogenia del SARS-CoV-2. En fase inicial, se produce un proceso inflamatorio agudo que empieza acentuándose en el tracto respiratorio y que afecta primera y principalmente al pulmón; lo que, posteriormente, puede desencadenar disfunciones respiratorias que perduran aún después del alta médico, lo que se considera como un síntoma persistente. De acuerdo con la metodología de la revisión sistemática exploratoria, se realizó esta investigación cuyo propósito se centró en encontrar referencias bibliográficas que sustente e identifiquen las principales secuelas respiratorias del Covid-19; para ello, se realizó una búsqueda de la literatura a través de las bases de datos PubMed, Scielo, Medline, Web of Science y Scopus. La indagación bibliográfica se llevó a cabo en enero de 2022, se dectectaron 70 documentos, los cuales fueron sometidos a evaluación de calidad. Se incluyeron 38 estudios observaionales, 3 artículos de revisión y 1 metaanálisis. Hasta la fecha no se ha llegado a un consenso respecto a la secuela más importante en el campo respiratorio post Covid, fundamentalmente destacan: fatiga, disnea, dolor torácico y la tos. Además, un porcentaje considerable de pacientes persisten con anomalías residuales de la función pulmonar, sugerentes fibrosis pulmonar, requiriendo asistencia médica aun despúes del alta hospitalario. Se recomienda continuar con investigaciones orientadas la valoración de las secuelas por Covid-19, para obtener basamentos claros relacionados con la capacidad funcional respiratoria post infección(AU)

Covid-19 is an infectious disease that has caused significant rates of morbidity and mortality in the world population, scientific evidence has sought to describe the pathophysiology of SARS-CoV-2. In the initial phase, an acute inflammatory process occurs that begins to be accentuated in the respiratory tract and affects the lungs first and foremost; which, subsequently, can trigger respiratory dysfunctions that persist even after medical discharge, which is considered a persistent symptom. In accordance with the methodology of the exploratory systematic review, this research was carried out whose purpose was focused on finding bibliographic references that support and identify the main respiratory sequelae of Covid-19; For this, a search of the literature was carried out through the PubMed, Scielo, Medline, Web of Science and Scopus databases. The bibliographic investigation was carried out in January 2022, 70 documents were detected, which were subjected to quality evaluation. 38 observational studies, 3 review articles and 1 meta-analysis were included. So far, no consensus has been reached regarding the most important sequela in the post-COVID respiratory field, fundamentally the following stand out: fatigue, dyspnea, chest pain and cough. In addition, a considerable percentage of patients persist with residual pulmonary function abnormalities, suggestive of pulmonary fibrosis, requiring medical assistance even after hospital discharge. It is recommended to continue with research aimed at assessing the sequelae of Covid-19, to obtain clear foundations related to post-infection respiratory functional capacity(AU)

Relación entre alteraciones de la tomografía computarizada de tórax en pacientes hospitalizados por neumonia COVID-19 y la recuperacion funcional respiratoria a los 3 meses del alta / Relationship between alterations of CT tomography of the thorax in patients hospitalized for pneumonía COVID-19 and respiratory functional recovery 3 months after discharge

Introducción: La neumonía por coronavirus SARS-CoV-2 es una enfermedad nueva, por lo que las secuelas a largo plazo siguen siendo poco claras y los reportes del tema son aún escasos. El presente estudio buscó describir los hallazgos tomográficos al ingreso hospitalario y luego de 3 meses de neumonía asociada a COVID-19 y correlacionarlos con la alteración de las pruebas de función pulmonar a los 3 meses de la hospitalización. Pacientes y Métodos: Estudio de cohorte prospectivo que evaluó las secuelas funcionales pulmonares y la evolución del compromiso imagenológico a los tres meses de hospitalización por neumonía asociada a COVID-19. Todos los exámenes fueron revisados por un radiólogo experto. Se identificó el patrón tomográfico predominante y se estableció la extensión de las alteraciones mediante un puntaje, previamente validado. En las TC de seguimiento, se evaluó la extensión del compromiso imagenológico, el porcentaje de reducción del compromiso del espacio aéreo y presencia de otras alteraciones. Estos hallazgos se relacionaron con las pruebas de función pulmonar (PFP) a los 3 meses (espirometría, DLCO y test de caminata de 6 min: TC6M). Para estos análisis los pacientes se agruparon según la oxigenoterapia utilizada en la hospitalización: oxigenación estándar (O2), cánula nasal de alto flujo (CNAF) o ventilación mecánica invasiva (VMI). Resultados: Se evaluaron un total de 116 pacientes, de los cuales 75 eran hombres, edad promedio fue 60,6 ± 14,5 años. Los pacientes fueron seguidos en promedio 100 días. 70 pacientes pertenecieron al grupo O2 estándar, 25 CNAF y 21 VMI. La TC control a los 3 meses mostró que 78 pacientes presentaron recuperación tomográfica mayor a 50%. El promedio del puntaje de extensión del compromiso tomográfico fue significativamente mayor en el grupo con PFP alterada, comparado con el grupo con PFP normal (espirometría 6,8 vs. 4,6, p = 0,03; DLCO 5,7 vs. 4,1, p = 0,04, TC6M 7,0 vs. 4,2, p = 0,002). Conclusiones: En el seguimiento de los pacientes adultos hospitalizados por neumonía asociada a COVID-19, los pacientes con mayor extensión del compromiso imagenológico pulmonar fueron los que presentaron alteraciones funcionales pulmonares significativas.

Introduction: SARS-CoV-2 pneumonia is an emergent disease, then long term sequelae are still on investigation. This study evaluated the imaging features at the admission to the hospital and then 3 months after discharge of patients hospitalized with COVID-19 pneumonia and compared findings with functional respiratory recovery. Patients and Methods: Prospective cohort study of patients hospitalized with SARS-CoV-2 pneumonia in "Hospital Naval Almirante Nef", Viña del Mar Chile. Imaging evolution and respiratory function were analyzed after 3 months discharge. All the imagens were reviewed by an expert radiologist, who identified a predominant pattern and defined an extension score previously validated. These findings were compared with 3 months CT and respiratory function evaluated with spirometry, DLCO and 6 minutes walking test (6MWT). Also, patients were categorized in 3 different group, depending on oxygen support: conventional oxygen, high-flow nasal cannula (HFNC) and mechanical ventilation. Results: 116 patients were evaluated, 75 men with a mean age of 60.6 ± 14.5 years-old. The median follow-up was 100 days. 70 patients were on conventional oxygen group, 25 in high-flow nasal cannula and 21 in mechanical ventilation. 3-month CT control showed tomographic recovery > 50% in 78 patients. The mean score of extension was significant higher in the group with altered respiratory functional test, compared with the group with normal results (spirometry 6.8 vs. 4.6, p = 0.03; DLCO 5.7 vs. 4.1, p = 0.04; 6MWT 7.0 vs. 4.2, p = 0.002). Conclusion: 3 months after discharge of COVID-19 pneumonia, patients with higher tomographic score present significant abnormalities in respiratory functional test.

Caracterización de los hallazgos tomográficos en pacientes con la COVID 19 y sospecha de fibrosis pulmonar

Introducción: La evaluación tomográfica del tórax permite conocer las complicaciones en pacientes con COVID-19, es la fibrosis pulmonar una de las más temidas, por su repercusión en la funcionabilidad pulmonar. Objetivo: Caracterizar los hallazgos tomográficos en pacientes con COVID-19 y sospecha de fibrosis pulmonar. Métodos: Se realizó un estudio observacional descriptivo retrospectivo en el Hospital Cubano de Qatar, en el período comprendido entre abril de 2020 a abril de 2021, el universo de estuvo constituido por 129 pacientes con COVID-19, la muestra quedó conformada por 85 pacientes con sospecha radiográfica de fibrosis pulmonar. La información se obtuvo de las historias clínicas. Se consideraron los principios bioéticos. Resultados: Predominó el sexo masculino, el grupo de edad de 45-59 años. El patrón de vidrio deslustrado fue el más frecuente en el 60 % de los casos. Existieron signos tomográficos de fibrosis pulmonar en el 58,62 %, con diagnóstico en fase avanzada, extensión moderada, localización bilateral y difusa. La afectación multilobar fue la más frecuente en pacientes con fibrosis evidente y en los dudosos de fibrosis pulmonar. Conclusiones: Predominaron los pacientes del sexo masculino con edades entre 45-59 años. El patrón de vidrio deslustrado fue el más frecuente. En más de la mitad de los pacientes se evidenciaron signos de fibrosis pulmonar en la fase avanzada de la COVID-19, con extensión moderada.

Introduction: The tomographic evaluation of the thorax allows us to know the complications in patients with COVID-19, pulmonary fibrosis being one of the most feared, due to its impact on lung function. Objective: To characterize the tomographic findings in patients with COVID-19 and suspected pulmonary fibrosis. Methods: A retrospective descriptive observational study was carried out at the Cuban Hospital in Qatar, between April 2020 and April 2021, the universe consisted of 129 patients with COVID 19, the sample was made up of 85 patients with radiographic suspicion of Pulmonary Fibrosis. The information was obtained from the medical records. Bioethical principles were taken into account. Results: The male sex prevailed, the age group of 45-59 years. The ground glass pattern was the most frequent in 60% of the cases. There were tomographic signs of Pulmonary Fibrosis in 58.62%, with diagnosis in advanced phase, moderate extension, bilateral and diffuse location. Multilobar involvement was the most frequent in patients with evident fibrosis and in those with doubtful pulmonary fibrosis. Conclusions: Male patients aged between 45-59 years predominated. The ground glass pattern was the most frequent. In more than half of the patients, signs of pulmonary fibrosis were evidenced in the advanced phase of COVID -19, with moderate extension. Bilateral and diffuse localization predominated. Multilobar involvement was the most frequent in patients with evident fibrosis and in those with doubtful pulmonary fibrosis. The contribution of this research lies in the fact that with the characterization of the tomographic findings in patients with COVID 19, future complications are prevented.

Secuelas respiratorias clínicas, funcionales y tomográficas de pacientes hospitalizados por COVID-19 a seis meses del diagnóstico: estudio SECUELAR-19 / Clinical, functional and tomographic respiratory sequels of patients hospitalized for COVID-19 at six month of diagnosis: SECUELAR-19 trial

Resumen Introducción: Hay información escasa sobre la evolución de los enfermos hospitalizados por neumonía por COVID-19 a mediano plazo. El objetivo de este estudio fue determinar en pacientes con neumonía moderada (NM) o grave (NG) por COVID-19, el impacto clínico, funcional respiratorio y tomográfico a los 6 meses. Métodos: Se realizó análisis según grupos de NM y NG, desaturadores (PD) en la prueba de cami nata de 6 minutos y presencia del patrón tomográfico de alta resolución (TACAR) símil fibrótico. Se compararon los resultados a los 3 y 6 meses. Resultados: Se incluyeron 129 pacientes, edad 57±11 años, comorbilidades frecuentes (hipertensión arterial 38.1%, diabetes 30.4% y respiratorias 18.6%). Al comparar 3 y 6 meses se ob servó mejoría de la calidad de vida en NM y NG. Los PD presentaron menor metraje caminado, peor calidad de vida y mayor presencia de patrón símil fibrótico. Este patrón se relacionó con la caída de la FVC 80% en NM y NG (p = 0.048 y p = 0.007), y con PD (p = 0.002). En el análisis multivariado, el patrón símil fibrótico s e asoció a la reducción de la CVF con OR = 4.44 (1.94-10.18, p<0.01) y a la desaturación, OR = 5.01 (1.63-15.42, p<0.01). En esta cohorte se observó mayor compromiso funcional y tomográfico en los PD. El patrón símil fibrótico se relacionó con peor evolución funcional y oximétrica. Discusión: Es importante el seguimiento de los pacientes con NG, los PD y los que presentan patrón fibrótico al alta de neumonía por COVID-19.

Abstract Introduction: There is scarce information about middle-term evolution of hospitalized patients who suffer from pneumonia caused by COVID-19. The objective of this study is to determine the clinical, respiratory, tomographic and functional impact on COVID-19 patients with moderate (MP) to severe (SP) pneumonia after six months of acute infection. Methods: Analysis was carried out by MP and SP groups, desaturators during the 6-minute-walking test and the presence of fibrotic like pattern on HRCT. Outcomes at 3 and 6 months were compared. Results: The analysis included 129 patients, between 57 ± 11 years old. Frequent comorbidities were: arterial hypertension 38.1%, diabetes 30.4%, respiratory 18.6%). Comparing 3 and 6 months, improvement in quality of life was observed in MP and SP. The DP walked less meters in the MWT, worsened life quality and more fibrotic like pattern. The fibrotic pattern was related to the fall of CVF < 80% on MP and SP (p = 0.048 and p = 0.007), and with DP (p = 0.002). On multivariated analysis, the fibrotic like pattern was associated to the reduction of CVF with OR = 4.44 (1.94-10.18, p<0.01) and desaturation OR = 5.01(1.63-15.42, p < 0.01). On this cohort it was observed more functional and tomographic compromise on the DP The fibrotic like pattern was related to worse functional evolution and oximetry. Discussion: Follow-up after discharge of COVID-19 patients with SP, DP or fibrotic changes in HCRT is underlined.

Panorama de Sequelas Decorrentes da Covid-19 e Perspectivas de Reabilitação: Revisão Não Sistemática / Overview of Sequelae Arising from COVID-19 and Prospects for Rehabilitation: a Non-Systemic Review

Introdução: A infecção pandêmica por Covid-19 é um importante problema de saúde em enfrentamento atualmente no mundo. É uma infecção com potencial gravidade, que pode cursar desde quadros leves até a morte. Indivíduos que apresentam quadro clínico com maior comprometimento podem ter sequelas diversas. Objetivo: Revisar potenciais complicações e sequelas que mais frequentemente podem ocorrer nos quadros moderados e graves com necessidade de internação hospitalar. Métodos: Revisão das bases Pubmed e Scopus limitada ao último ano na busca por artigos em língua inglesa com o tema "sequela", "incapacidade", "COVID - 19". Após seleção e leitura dos resumos, oito artigos foram selecionados. Resultados: As complicações mais frequentes são sequelas respiratórias, neurológicas e cardiovasculares. Pacientes com formas críticas podem ter impacto em múltiplos sistemas. O período prolongado em Unidade de Terapia Intensiva predispõe ao risco da Miopatia e Polineuropatia do Doente Crítico, com impacto negativo no desmame do suporte ventilatório. Pacientes devem ser mobilizados precocemente para evitar incapacidades físicas decorrentes do imobilismo e reduzir o tempo de suporte ventilatório. Conclusão: As consequências das fases subaguda e crônica da doença podem ser diversas, especialmente cardiopulmonar e neurológica. O período de recuperação é prolongado com necessidade de um programa de reabilitação organizado com multiprofissionais pós-alta hospitalar.

Introduction: The Covid-19 pandemic infection is a significant health problem confronted in the world today. It is a potentially severe infection that can range from mild to fatal. Individuals who present a more compromised clinical picture may have various sequelae. Objective: Review potential complications and sequelae that can occur more frequently in moderate and severe cases requiring hospitalization. Methods: Review of the Pubmed and Scopus databases limited to the last year in search of articles in the English language with the themes: "sequelae", "disability" and "COVID-19". After the selection and analysis of the abstracts, which led to the eight selected articles. Results: The most frequent complications are respiratory, neurological, and cardiovascular sequelae. Patients with critical forms may suffer impact in multiple systems. The prolonged period in an Intensive Care Unit predisposes the risk of Critical Illness Myopathy and Polyneuropathy and the negative impact the weaning from ventilatory support. Patients should be mobilized early to avoid physical disabilities caused by immobility and to reduce the ventilatory support time. Conclusion: The consequences of the subacute and chronic phases of the disease can be diverse, especially cardiopulmonary and neurological. The recovery period is prolonged with the need for an organized rehabilitation program with multi-professionals after hospital discharge.

Avaliação da incapacidade de indivíduos com diabetes mellitus: um estudo transversal com o WHODAS 2.0 / Evaluación de la incapacidad de individuos con diabetes mellitus: un estudio transversal con WHODAS 2.0 / Disability assessment of individuals with diabetes mellitus: a cross-sectional study with the WHODAS 2.0

RESUMO A diabetes mellitus (DM) causa diversas limitações funcionais, que podem impactar negativamente na vida pessoal e profissional do indivíduo, acarretando mais complicações e incapacidades. O objetivo do estudo foi identificar em quais domínios do World Health Organization Disability Assessment Schedule versão 2.0 (WHODAS 2.0) os indivíduos com DM apresentam as maiores incapacidades. Para tanto, foi realizado um estudo transversal com 111 pessoas com diagnóstico da doença, independentemente do tipo. Foram aplicados um questionário sociodemográfico e o WHODAS 2.0 com 36 questões, para avaliar as dificuldades apresentadas nos últimos 30 dias. A amostra foi composta predominantemente pelo sexo feminino (60,3%) e classificada como independente na comunidade (90,1%). A maior prevalência foi de indivíduos aposentados (35,1%). O domínio mobilidade apresentou o maior comprometimento (48±23), enquanto o domínio atividades de vida apresentou o menor comprometimento (28±13). Porém, para todos os domínios, o comprometimento ficou abaixo de 50, em uma escala que varia de 0 a 100. Todos os indivíduos com DM apresentaram alguma deficiência, havendo maior comprometimento do domínio relacionado à mobilidade.

RESUMEN La diabetes mellitus (DM) causa varias limitaciones funcionales que pueden impactar negativamente la vida personal y profesional del individuo, ocasionándole más complicaciones e incapacidades. El objetivo de este estudio fue identificar en qué dominios del World Health Organization Disability Assessment Schedule, versión 2.0 (WHODAS 2.0), las personas con DM presentan las mayores incapacidades. Para ello, se realizó un estudio transversal con 111 personas diagnosticadas con la enfermedad, independientemente del tipo. Se aplicaron un cuestionario sociodemográfico y WHODAS 2.0 con 36 preguntas para evaluar las dificultades presentadas en los últimos 30 días. La muestra fue predominantemente femenina (60,3%) y clasificada como independiente en la comunidad (90,1%). La mayor prevalencia fue de individuos jubilados (35,1%). El dominio movilidad tuvo mayor comprometimiento (48±23), mientras que el dominio actividades de la vida presentó el menor comprometimiento (28±13). Sin embargo, para todos los dominios, el comprometimiento fue inferior a 50 en una escala que varía de 0 a 100. Todos los individuos con DM presentaron una discapacidad, con mayor implicación del dominio relacionado con la movilidad.

ABSTRACT Diabetes mellitus (DM) causes several functional limitations, which can negatively affect the personal and professional life of individuals. This effect can lead to more complications and disabilities. This study aimed to analyze in which domains of the World Health Organization Disability Assessment Schedule version 2.0 (WHODAS 2.0) individuals with diabetes mellitus have the greatest disabilities. cross-sectional study was performed with 111 individuals with diabetes mellitus, of any type. A sociodemographic questionnaire and the WHODAS 2.0 with 36 questions were applied to assess individuals' difficulties in the last 30 days. Most individuals were women (60.3%) and classified as independent in the community (90.1%). The highest prevalence was among retired individuals (35.1%). The mobility domain presented the highest impairment (48±23) whereas the life activities domain presented the lowest impairment (28±13). However, for all domains, the impairment was below 50 on a scale ranging from zero to 100. All individuals with diabetes mellitus showed some disability, but the greatest impairment was in the mobility domain.

A rare case of rapid development of bullous lung

Tuberculosis, although an ancient disease, affecting humans for millennia; continues to present in atypical ways. Whilst the development of bullous lung disease in patients suffering from Pulmonary Tuberculosis, has been reported, it remains an extremely rare phenomenon. The underlying mechanisms remain unknown, and potential causes have been hypothesized, including the role of Isoniazid as part of antitubercular therapy. We reportedone such case of a rapid development of bullous lung as a complication of Pulmonary Tuberculosis.

A Scoping Review of Persistent Symptoms after COVID Infection at Different Follow-Up Periods

The clinical entity termed as long COVID has gained importance in the recent past. As this phenomenon is still evolving, it is important to document the magnitude of the syndrome during different time periods. This scoping review attempts to synthesize evidence generated from longitudinal studies which have follow‑up periods beyond 3 months, up to 12 months. The review also documents the reported prevalence of long COVID for the different regions of the World Health Organization. Longitudinal studies published till March 2022 were systematically searched on PubMed, Google Scholar, and medRxiv. Among the identified 594 studies, 48 were included in this review. Data from selected studies were synthesized. The overall pooled prevalence of long COVID was 49% (40%–58%). The pooled estimates after 3 months, 4–6 months, 7–9 months, and 10–12 months were 44% (32%–57%), 50% (43%–57%), 49% (37%–62%), and 54% (46%–62%), respectively. Eastern Mediterranean Region (EMR) had the highest pooled prevalence of 63% (34%–92%] and the South East Asian Region (SEAR) had the least pooled estimate of 15% (10%–21%). The study brings out the high prevalence of long COVID even after 12 months of follow‑up. It also shows the regional differences in the reported prevalence of the syndrome. This review highlights the need for well‑planned follow‑up studies, especially in developing nations to understand the magnitude and the pattern of long COVID‑related symptoms as they emerge.

1St Year Resident, Department Of Radio-Diagnosis; SVP Hospital; Smt. NHL Municipal Medical College; Ahmedabad

Background:Tuberculosis (TB) is a major public health problem. Pulmonary TB sequelae can affect a person's physical and functional capacity leading to decreased quality of life and societal participation. The study aims at evaluating exercise capacity, quality of life, and social participation in patients with post-pulmonary tuberculosis. Material And Methods:An analytical cross-sectional study was carried out in 100 post-tuberculosis patients by convenient sampling. Quality of life was assessed using WHOQOL BREF and social participation was evaluated with the Impact on Participation and Autonomy Questionnaire (IPAQ). Exercise capacity was measured using a six-minute walk test (6MWT). Result:The mean 6MWT distance in males was 333.76 ± 47.10 meters and in females was 335.04 ± 52.34 meters. The mean VO2 peak in males and females was 13.32 ± 2.37 ml/kg/min and 14.02 ± 2.84 ml/kg/min respectively. The quality of life and social participation in both males and females was good. There was a very weak positive correlation between 6MWT and WHOQOL BREF (spearman's rho=0.251) and a moderate negative correlation between WHOQOL BREF and IPAQ (spearman's rho= -0.663) There was no relationship between 6MWT and IPAQ score. Conclusion:The study concludes that the majority of the patients post pulmonary tuberculosis hasfair effort tolerance and good quality of life. It also concludes that there is no statistically significant difference in the quality of life and social participation between males and females.