Purtscher-like retinopathy in a patient with COVID-19-associated coagulopathy / Retinopatia tipo Purtscher em paciente com coagulopatia associada ao COVID-19

ABSTRACT The most frequently reported ophthalmic manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is conjunctivitis. We have described a case of Purtscher-like retinopathy in a patient with severe coronavirus disease 2019 (COVID-19)-associated coagulopathy. A young woman with multiple comorbidities was admitted for COVID-19-related acute respiratory distress syndrome. Her course was complicated by fungemia. Ophthalmic examination revealed bilateral posterior pole, intraretinal lesions and fluconazole was added for presumed fungal retinitis. At 1-week follow-up, widespread peripapillary cotton-wool spots and hemorrhages suggestive of Purtscher-like retinopathy were observed. The levels of D-dimers, fibrinogen, and C-reactive protein were markedly elevated prior to our consultation, indicating preceding prothrombotic and pro-inflammatory states. Subsequent venous duplex revealed deep venous thrombosis in the right subclavian and internal jugular veins. Von Willebrand factor indices were markedly elevated, suggesting severe COVID-19-associated coagulopathy. Purtscher-like retinopathy, a rare occlusive microangiopathy has been described in various pro-inflammatory and prothrombotic conditions. To the best of our knowledge, this is the first report of Purtscher-like retinopathy in COVID-19-associated coagulopathy.

RESUMO A manifestação oftálmica mais frequentemente re­latada da infecção por SARS-CoV-2 é a conjuntivite. Trata-se de estudo de caso de retinopatia tipo Purtscher em uma paciente com coagulopatia grave associada ao COVID-19. Uma jovem com múltiplas comorbidades foi admitida por síndrome do desconforto respiratório agudo relacionado ao COVID-19. Seu quadro foi complicado pela fungemia. O exame oftálmico revelou pólo posterior bilateral, lesões intraretinianas e o fluconazol foi adicionado para tratar a retinite fúngica presumida. No decorrer de uma semana, manchas largas peripapilares de algodão e hemorragias sugestivas de retinopatia tipo Purtscher foram observadas. Os dímeros D, o fibrinogênio e a proteína c-reativa estavam acentuadamente elevados antes da nossa consulta, indicando um estado pró-trombótico e pró-inflamatório precedente. O duplex venoso subsequente revelou trombose venosa profunda nas veias subclávia direita e jugular interna. Os índices de fatores von Willebrand estavam marcadamente elevados, sugerindo coagulopatia grave associada ao COVID-19. A retinopatia tipo Purtscher, uma microangiopatia oclusiva rara foi descrita em várias condições pró-inflamatórias e pró-trombóticas. Para nosso conhecimento, este é o primeiro relatório de retinopatia tipo Purtscher com coagulopatia associada ao COVID-19.

Joint Recommendations From The Latin American Association of Cardiac and Endovascular Surgery (LACES) and The Cardiovascular Anesthesia Committee of The Latin American Confederation of Anesthesia Societies (CLASA) on the Timing for Cardiac Surgery After COVID-19 Infection

ABSTRACT Introduction: Since the coronavirus disease 2019 (COVID-19) pandemic, cardiac surgeries in patients with previous infection by COVID-19 were suspended or postponed, which led to surgeries performed in patients with an advanced stage of their disease and an increase in the waiting list. There is a heterogeneous attitude in Latin America on the optimal timing to cardiac surgery in patients with previous COVID-19 infection due to scarce data on its outcome. Two Latin American associations joined to establish common suggestions on the optimal timing of surgery in patients with previous COVID-19 infection. Methods: Data collection was performed using a pre-established form, which included year of publication, objective, type of study (prospective/retrospective, descriptive/analytical), number of patients, year of study, waiting time between infection and surgery, type of surgery, morbidity, mortality, and conclusions regarding the association between mortality and morbidity. Final recommendations were approved by the board of directors of Latin American Association of Cardiac and Endovascular Surgery (LACES) and Latin American Confederation of Anesthesia Societies (CLASA). Results: Of the initial 1,016 articles, 11 comprised the final selection. Only six of them included patients who underwent cardiac surgery. According to the analyzed literature, optimal timing for cardiac surgery needs to consider the following aspects: deferable surgery, symptomatic COVID-19 infection, completeness of COVID-19 vaccination. Conclusion: These recommendations derive from the analysis of the scarce literature published at present on outcomes after cardiac surgery in patients with previous COVID-19 infection. These are to be taken as a dynamic recommendation in which Latin American reality was taken into consideration.

Infección natural por SARS-CoV-2 en gatos y perros domésticos de personas con diagnóstico de COVID-19 en el Valle de Aburrá, Antioquia / Natural SARS-CoV- 2 infection in domestic cats and dogs of humans diagnosed with COVID-19 in Valle de Aburrá, Antioquia

Introducción. El síndrome respiratorio agudo grave causado por el nuevo coronavirus SARS-CoV-2 es causa de la emergencia sanitaria por la pandemia de COVID-19. Si bien el humano es el principal huésped vulnerable, en estudios experimentales y reportes de infección natural, se han encontrado casos de zoonosis inversa de SARS-CoV-2 en animales. Objetivo. Evaluar la infección natural por SARS-CoV-2 en gatos y perros de propietarios con diagnóstico de COVID-19 en el Valle de Aburrá, Antioquia, Colombia. Materiales y métodos. La circulación del SARS-CoV-2 se evaluó por RT-qPCR y RT-PCR en muestras de frotis nasofaríngeos y orofaríngeos de gatos y perros cuyos propietarios se encontraban dentro del periodo de los 14 días de aislamiento. Los casos positivos se verificaron amplificando fragmentos de los genes RdRp, N y E; se secuenció el gen RdRp y se analizó filogenéticamente. Resultados. De 80 animales evaluados, seis gatos y tres perros fueron casos confirmados de infección natural por SARS-CoV-2. Los animales no presentaron signos clínicos y sus propietarios, que padecían la infección, reportaron únicamente signos leves de la enfermedad sin complicaciones clínicas. En el análisis de una de las secuencias, se encontró un polimorfismo de un solo nucleótido (SNP) con un cambio en la posición 647, con sustitución del aminoácido serina (S) por una isoleucina (I). Los casos se presentaron en los municipios de Caldas, Medellín y Envigado. Conclusiones. Se infiere que la infección natural en los gatos y perros se asocia al contacto directo con un paciente con COVID-19. No obstante, no es posible determinar la virulencia del virus en este huésped, ni su capacidad de transmisión zoonótica o entre especie.

Introduction: The severe acute respiratory syndrome caused by the new coronavirus SARS-CoV-2 is the cause of the health emergency due to the COVID-19 pandemic. Although humans are the main susceptible host, experimental studies and reported cases of natural infection have evidenced scenarios of SARS-CoV-2 reverse zoonosis in animals. Objective: To evaluate the natural infection of SARS-CoV-2 in cats and dogs with owners diagnosed with COVID-19 in the Valle de Aburrá subregion in Antioquia, Colombia. Materials and methods. The circulation of SARS-CoV-2 was evaluated by RT-qPCR and RT-PCR in samples of nasopharyngeal and oropharyngeal smears from cats and dogs whose owners presented latent COVID-19 infection. Positive cases were verified through amplification of N, E and RdRp gene fragments; with the latter being sequenced and the phylogenetically analyzed. Results. From 80 tested animals, 6 cats and 3 dogs resulted positive for natural SARS-CoV-2 infection. These animals did not show any clinical signs; and their infected owners only reported mild signs of COVID-19, without clinical complications. Regarding analysis of one of the sequences, a single nucleotide polymorphism (SNP) was found, with a substitution in position 647, resulting in the change of the amino acid serine (S) for isoleucine (I). The cases occurred in the municipalities of Caldas, Medellín and Envigado. Conclusions. It is inferred that natural infection in cats and dogs is associated with direct contact with a positive COVID-19 patient.

COVID largo, síntomas más frecuentes en pacientes post COVID-19, Paraguay, 2021

RESUMEN Introducción: la infección por SARS-CoV-2 causó una pandemia con múltiples consecuencias sanitarias, sociales y económicas, entre ellas la persistencia de los síntomas después de la infección aguda, el llamado COVID largo. Varios estudios alrededor del mundo han reportado varios síntomas persistentes, citando entre los más frecuentes a la fatiga, la disnea, la anosmia y el debut de patologías neurológicas entre otros. Objetivos: establecer la incidencia del COVID largo, determinar el tiempo de persistencia de los síntomas, identificar los síntomas post COVID-19. Métodos: se realizó un estudio descriptivo, observacional, de corte transversal en el periodo 03/2021 a 11/2021. El muestreo fue no probabilístico de casos consecutivos a través de una encuesta online. Resultados: de una muestra total de 1905 encuestados, el 80% tuvo persistencia de los síntomas, el 31% refirió persistencia de los síntomas luego de un mes, 16% dentro de los dos meses, y un 4% hasta los seis meses posteriores. Entre los síntomas más frecuentes se citan: fatiga 55%, problemas de memoria 29% y anosmia 27%. El 76% presentó más de un síntoma acompañante. Conclusiones: hasta el 80% refirió la persistencia de síntomas una vez superada la infección aguda por COVID-19, la mayoría de los mismos con más de un síntoma concomitante, los cuales se mantuvieron a lo largo del tiempo con mayor frecuencia durante el primer y segundo mes.

ABSTRACT Introduction: SARS-CoV-2 infection caused a pandemic with multiple health, social, and economic consequences, including the persistence of symptoms after acute infection, the so-called long COVID. Several studies around the world have reported several persistent symptoms, citing among the most frequent fatigue, dyspnea, anosmia and the onset of neurological pathologies, among others. Objectives: To establish the incidence of long COVID, determine the persistence time of symptoms, and identify post-COVID-19 symptoms. Methods: A descriptive, observational, cross-sectional study was carried out in the period of March to November, 2021. The sampling was non-probabilistic of consecutive cases through an online survey. Results: Out of 1905 responses analyzed, 80% had persistence of symptoms, 31% reported persistence of symptoms after one month, 16% within two months, and 4% up to six months later. Among the most frequent symptoms, these were cited: fatigue 55%, memory problems 29% and anosmia 27% while 76% presented more than one accompanying symptom. Conclusions: Up to 80% reported the persistence of symptoms once the acute COVID-19 infection was over, most of them with more than one concomitant symptom, which were maintained over time, more frequently during the first and second month.

Avaliação da capacidade física em pacientes hospitalizados com diagnóstico de COVID-19 / Evaluación de la capacidad física en pacientes hospitalizados por Covid-19 / Physical capacity assessment in patients hospitalized with COVID-19 diagnose

RESUMO A infecção por SARS-CoV-2 pode ocasionar a síndrome respiratória aguda grave (SRAG), levando a hipoxemia. A avaliação da capacidade física pode ser realizada anteriormente à alta hospitalar, através de testes de exercícios submáximos. O objetivo deste estudo foi avaliar a capacidade física e a tolerância ao exercício físico por meio do teste de degrau de seis minutos (TD6) em pacientes hospitalizados com diagnóstico de COVID-19 que fizeram uso de suporte de oxigênio (O2) durante a internação. Trata-se de um estudo prospectivo e intervencionista, incluindo pacientes com idade entre 18 e 90 anos, que necessitaram de oxigenoterapia durante a hospitalização. Foi realizada avaliação através do Perme escore, seguida do TD6, com análise da saturação periférica de oxigênio (SpO2), frequência cardíaca (FC), pressão arterial (PA) e percepção subjetiva do esforço através da escala de Borg, antes e imediatamente após o TD6. Foram avaliados 31 pacientes, com idade média de 51,9 anos. O dispositivo de O2 mais utilizado foi o cateter nasal (CN), em 64,5% dos pacientes. Em relação à FC, PA e escala de Borg, pudemos observar um aumento no valor médio dessas variáveis após o TD6. A SpO2 teve uma média menor quando comparada à avaliação inicial do TD6. O teste foi finalizado por 86,9% dos pacientes, sendo que, destes, 48,3% finalizaram com interrupções; 12,9% dos participantes suspenderam o teste. O TD6 foi capaz de avaliar a capacidade física e a tolerância ao exercício, tornando-se uma ferramenta eficaz para avaliação do paciente com COVID-19.

RESUMEN La infección por SARS-CoV-2 puede provocar el síndrome respiratorio agudo severo (SRAS), resultando en hipoxemia. La evaluación de la capacidad física se puede realizar antes del alta hospitalaria mediante pruebas de ejercicio submáximas. El objetivo de este estudio fue evaluar la capacidad física y la tolerancia al ejercicio a través del test de escalón de seis minutos (TE6) en pacientes hospitalizados por Covid-19 que utilizaron soporte de oxígeno (O2) durante la hospitalización. Se trata de un estudio prospectivo e intervencionista, en el que se incluyeron a pacientes con edades entre los 18 y los 90 años, que necesitaron la oxigenoterapia durante su hospitalización. La evaluación se realizó mediante el puntaje de Perme, seguido del TE6, con análisis de saturación de oxígeno periférico (SpO2), frecuencia cardíaca (FC), presión arterial (PA) y esfuerzo percibido mediante la escala de Borg, antes e inmediatamente después del TE6. Se evaluaron a 31 pacientes, con una edad media de 51,9 años. El dispositivo de O2 más utilizado fue el catéter nasal (CN) por el 64,5% de los pacientes. Con relación a la FC, PA y la escala de Borg, se observa un aumento en el valor medio de estas variables después del TE6. La SpO2 tuvo una media más baja en comparación con la evaluación inicial del TE6. El 86,9% de los pacientes completaron el test, de los cuales el 48,3% terminó con interrupciones; y el 12,9% lo suspendió. El TE6 pudo evaluar la capacidad física y la tolerancia al ejercicio, lo que resulta ser una herramienta eficaz para evaluar a los pacientes con Covid-19.

ABSTRACT SARS-CoV-2 infection can cause severe acute respiratory syndrome (SARS), leading to hypoxemia. Physical capacity assessment can be performed before hospital discharge using submaximal exercise testing. This study sought to assess physical capacity and exercise tolerance with the six-minute step test (6MST) in hospitalized COVID-19 patients who required oxygen (O2) support during hospitalization. A prospective, interventional study was conducted with patients aged from 18 to 90 years who required oxygen therapy during hospitalization. Assessment was performed using Perme Score, followed by the 6MST tests, assessing the peripheral oxygen saturation (SpO2), heart rate (HR), blood pressure (BP), and subjective exertion perception by Borg Scale, before and immediately after the 6MST. A total of 31 patients, with a mean age of 51.9 years, were evaluated. Nasal cannula (NC) was the most used device (64.5% of patients). Regarding HR, BP, and Borg Scale, their mean value increased after 6MST. SpO2 showed a lower mean value after 6MST. Out of the 86.9% of patients who completed the test, 48.3% completed it with interruptions, and 12.9% had to suspend it. The 6MST was able to assess physical capacity and exercise tolerance, proving to be an effective tool for evaluating COVID-19 patients.

Supresión de la visita de tercer trimestre en embarazo de bajo riesgo en la pandemia de SARS-CoV-2

Resumen Objetivo: La pandemia de SARS-CoV-2 ha obligado a una reorganización de las visitas presenciales, y por ese motivo se han minimizado hasta el punto de reconsiderar la realización de la visita del tercer trimestre. Nuestro centro suprimió dicha visita obstétrica y obtuvo datos propios para comparar los resultados perinatales logrados con dicho manejo. Método: Se realizó un estudio de cohortes retrospectivo, en marzo de 2020, con una cohorte con visita presencial única en la semana 40 de gestación (122 gestantes) frente a una cohorte con seguimiento convencional con visita presencial en la semana 36 de gestación (162 gestantes). Se evaluaron la restricción del crecimiento fetal, la edad gestacional al nacimiento, el peso neonatal y las tasas de inducciones, partos eutócicos y cesáreas urgentes en trabajo de parto. Resultados: Se encontraron diferencias leves en la tasa de nuliparidad (p < 0,04), sin hallarlas en el resto de las variables maternas. No hubo diferencias entre las dos cohortes en los resultados neonatales. Conclusiones: No hay diferencias entre los resultados materno-fetales obtenidos en gestantes con seguimiento gestacional con restricción de la visita del tercer trimestre respecto del seguimiento tradicional, excepto en el diagnóstico de las alteraciones de la estática fetal al término de la gestación.

Abstract Objective: The SARS-CoV-2 pandemic has forced a reorganization of face-to-face visits, for this reason they have been minimized to the point of reconsidering the completion of the third trimester visit. Our center eliminated the performance of this obstetric visit and obtained its own data to compare the perinatal results obtained with such management. Method: A retrospective cohort study was carried out in March 2020, with a cohort with a single face-to-face visit at 40th week of gestation (122 pregnant women), versus a cohort with conventional follow-up with face-to-face visit at 36th week of gestation (162 pregnant women). The following were evaluated fetal growth restriction, gestational age at birth, neonatal weight, rate of inductions, of eutocic deliveries, and of urgent cesarean sections in labor. Results: Slight differences were found in the nulliparity rate (p < 0.04), without finding them in the rest of the maternal variables. There were no differences between the two cohorts in neonatal outcomes. Conclusions: There were no differences between the maternal-fetal results obtained in pregnant women with gestational follow-up with restriction of the third trimester visit compared to traditional follow-up, except in the diagnosis of alterations in fetal statics at the end of pregnancy.

Aspectos clínicos-epidemiológicos de la COVID-19 en pacientes de Pinar del Río / Clinical-epidemiological characteristics of COVID-19 patients from Pinar del Rio

RESUMEN Introducción: la COVID-19 es una enfermedad infecciosa causada por el virus SARS-CoV-2, que puede provocar un síndrome respiratorio agudo por lo que constituye en la actualidad una emergencia de salud pública internacional. Objetivo: identificar los factores clínicos epidemiológicos de la COVID-19 en el período de marzo de 2020 a mayo de 2021 en Pinar del Río. Métodos: se realizó un estudio transversal descriptivo en la provincia de Pinar del Río. Se exploraron los datos tomados de los informes estadísticos de la Unidad Provincial de Higiene y Epidemiología de los pacientes egresados por COVID-19. Se identificaron variables clínicas y epidemiológicas. Resultados: los grupos etarios de 41-50 años, 51-60 años representaron el 17,16 % para ambos seguido del grupo de 21-30 años que representó 16,23 %. El sexo masculino predominó sobre el femenino, para un 52,82 %. Predominaron los casos con evolución asintomática, lo que representó el 53,28 %. El curso sintomático fue mayor en los grupos etarios de 21-30 años y 51-60 años. Los síntomas predominantes fueron tos y fiebre, seguidos por rinorrea y odinofagia. La hipertensión arterial fue la enfermedad más frecuente seguida del asma y diabetes mellitus tipo 2. El municipio de Pinar del Río presentó el mayor número de casos positivos. Conclusiones: existió un ligero predominio de pacientes asintomáticos. La fiebre y los síntomas respiratorios fueron predominantes. Las enfermedades crónicas más frecuentes fueron la hipertensión arterial y el asma. El municipio Pinar del Río fue el más afectado.

ABSTRACT Introduction: COVID-19 is an infectious disease caused by the SARS-CoV-2 virus, which can cause acute respiratory syndrome and is currently an international public health emergency. Objective: to identify the epidemiological clinical factors of COVID-19 in the period from March 2020 to May 2021 in Pinar del Rio. Methods: a descriptive cross-sectional study was conducted in Pinar del Rio province. Data collected from the statistical reports of the Provincial Unit of Hygiene and Epidemiology of COVID-19 discharged patients were explored. Clinical and epidemiological variables were identified. Results: the age groups 41-50 years, 51-60 years represented 17,16 % for both, followed by the group 21-30 years which represented 16,23 %. Male sex predominated over the female sex, representing 52,82 %. Cases with asymptomatic evolution predominated, representing 53,28 %. The symptomatic course of the disease predominated in the age groups 21-30 and 51-60 years old. The most predominant symptoms were cough and fever, followed by rhinorrhea and odynophagia. Hypertension was the most frequent disease followed by asthma and type 2 diabetes mellitus. The Pinar del Rio municipality presented the highest number of positive cases. Conclusions: there was a slight predominance of asymptomatic patients. Fever and respiratory symptoms prevailed. The most frequent chronic diseases were hypertension and asthma. Pinar del Rio municipality was the most affected region.

Perfil epidemiológico, risco de agravamento e óbito por COVID-19 em cardiopatas no Brasil / Epidemiological profile, risk of worsening and death by COVID-19 in patients with heart disease in Brazil / Perfil epidemiológico, riesgo de empeoramiento y muerte por COVID-19 en pacientes con cardiopatía en Brasil

Objetivo:traçar o perfil epidemiológico de cardiopatas que contraíram COVID-19 no primeiro ano pandêmico. Método:estudo observacional, do tipo coorte retrospectiva. Foram incluídos cardiopatas com resultado de PCR positivo, de março a dezembro de 2020. Excluíram-se os registros com dados incompletos para as variáveis analisadas. Na análise bivariada, foram calculadas as razões de prevalência (com IC 95%) como medida de associação entre a variável dependente (cardiopatia) e as variáveis independentes (idade, sexo, escolaridade e zona de residência) empregando-se o teste do χ2de Mantel Haenszel. Resultados:identificou-se associação com significância estatística em relação às variáveis faixa etária, sexo e escolaridade. O maior risco de ocorrer desfecho desfavorável, foi para a faixa etária acima de 70 anos (59,97%), seguido do intervalo de idade de 60 a 69 anos (38,31%), sexo masculino (45,28%) e escolaridade para o nível superior. Conclusão:evidenciou-se que os cardiopatas requerem maiores cuidados após o diagnóstico da doença, especialmente pelo fato deste grupo apresentar um maior índice de mortalidade.

Objective:to establish the epidemiological profile of patients with heart disease who contracted COVID-19 in the first pandemic year. Method:observational, retrospective cohort study. Patients with heart disease with positive PCR results from March to December 2020 were included. Records with incomplete data for the variables analyzed were excluded. In the bivariate analysis, the prevalence ratios (with CI 95%) were calculated as a measure of association between the dependent variable (cardiopathy) and the independent variables (age, sex, education and area of residence) using the χ2 test of Mantel Haenszel. Results:an association with statistical significance was identified in relation to the variables age, sex and education. The highest risk of an unfavorable outcome was for the age group over 70 years old (59.97%), followed by the age range from 60 to 69 years old (38.31%), male sex (45.28%) and schooling to higher level. Conclusion:it was evidenced that patients with heart disease require greater care after the diagnosis of the disease, especially because this group has a higher mortality rate.

Objetivo:establecer el perfil epidemiológico de los pacientes con cardiopatías que contrajeron COVID-19 en el primer año de pandemia. Método:estudio observacional de cohortes retrospectivo. Se incluyeron pacientes con cardiopatías con PCR positiva de marzo a diciembre de 2020. Se excluyeron los registros con datos incompletos para las variables analizadas. En el análisis bivariado se calcularon las razones de prevalencia (con IC 95%) como medida de asociación entre la variable dependiente (cardiopatía) y las variables independientes (edad, sexo, escolaridad y zona de residencia) mediante la prueba de χ2 de Mantel Haenszel. Resultados:se identificó una asociación con significancia estadística en relación a las variables edad, sexo y escolaridad. El mayor riesgo dedesenlace desfavorable fue para el grupo de edad de más de 70 años (59,97%), seguido del rango de edad de 60 a 69 años (38,31%), sexo masculino (45,28%) y nivel de escolaridad superior. Conclusión:se evidenció que los pacientes con cardiopatía requieren mayor cuidado luego del diagnóstico de la enfermedad, sobre todo porque este grupo presenta una mayor tasa de mortalidad.

Influência da mechanical power e de seus componentes na ventilação mecânica em SARS-CoV-2 / Influence of mechanical power and its components on mechanical ventilation in SARS-CoV-2

RESUMO Objetivo: Analisar a influência da mechanical power e de seus componentes na ventilação mecânica em SARS-CoV-2; identificar os valores dos componentes da ventilação mecânica e verificar suas correlações entre si e com a mechanical power e efeitos sobre o resultado das fórmulas de Gattinoni-S e Giosa. Métodos: Estudo observacional, longitudinal, analítico e quantitativo dos parâmetros do respirador e da mechanical power no SARS-CoV-2. Resultados: A mechanical power média foi de 26,9J/minuto (Gattinoni-S) e 30,3J/minuto (Giosa). A driving pressure foi de 14,4cmH2O, a pressão de platô de 26,5cmH2O, a pressão expiratória positiva final 12,1cmH2O, a elastância de 40,6cmH2O/L, o volume corrente foi de 0,36L e a frequência respiratória de 32/minuto. A correlação entre as fórmulas de Gattinoni e de Giosa foi de 0,98, com viés de -3,4J/minuto e diferença na correlação da pressão de resistência de 0,39 (Gattinoni-S) e 0,24 (Giosa). Entre os componentes, destacaram-se as correlações da elastância com a driving pressure (0,88), pressão expiratória positiva final (-0,54) e volume corrente (-0,44). Conclusão: Na análise da ventilação mecânica da SARS-CoV-2, constatou-se que as correlações de seus componentes com a mechanical power influenciaram em seus valores momentâneos elevados, e que as correlações de seus componentes entre si influenciaram em seu comportamento ao longo do tempo. Por possuírem efeitos específicos sobre as fórmulas de Gatinnoni-S e Giosa, os componentes da ventilação mecânica tiveram influência em seus cálculos e causaram divergências nos valores da mechanical power.

ABSTRACT Objective: To analyze the influence of mechanical power and its components on mechanical ventilation for patients infected with SARS-CoV-2; identify the values of the mechanical ventilation components and verify their correlations with each other and with the mechanical power and effects on the result of the Gattinoni-S and Giosa formulas. Methods: This was an observational, longitudinal, analytical and quantitative study of respirator and mechanical power parameters in patients with SARS-CoV-2. Results: The mean mechanical power was 26.9J/minute (Gattinoni-S) and 30.3 J/minute (Giosa). The driving pressure was 14.4cmH2O, the plateau pressure was 26.5cmH2O, the positive end-expiratory pressure was 12.1cmH2O, the elastance was 40.6cmH2O/L, the tidal volume was 0.36L, and the respiratory rate was 32 breaths/minute. The correlation between the Gattinoni and Giosa formulas was 0.98, with a bias of -3.4J/minute and a difference in the correlation of the resistance pressure of 0.39 (Gattinoni) and 0.24 (Giosa). Among the components, the correlations between elastance and driving pressure (0.88), positive end-expiratory pressure (-0.54) and tidal volume (-0.44) stood out. Conclusion: In the analysis of mechanical ventilation for patients with SARS-CoV-2, it was found that the correlations of its components with mechanical power influenced its high momentary values and and that the correlations of its components with each other influenced their behavior throughout the study period. Because they have specific effects on the Gatinnoni-S and Giosa formulas, the mechanical ventilation components influenced their calculations and caused divergence in the mechanical power values.

The Role of the Immune System on the Cardiac Complications Observed in SARS-CoV-2

Abstract An acute respiratory syndrome caused by SARS-CoV2 was declared a pandemic by the World Health Organization. Current data in the world and in Brazil show that approximately 40% of patients who died have some type of cardiac comorbidity. There are also robust reports showing an increase in IL-6 / IL-1B / TNF-alpha and the presence of lymphopenia in patients with COVID-19. Our team and others have shown that increased cytokines are the link between arrhythmias/Left ventricular dysfunction and the immune system in different diseases. In addition, it has been well demonstrated that lymphopenia can not only be a good marker, but also a factor that causes heart failure. Thus, the present review focused on the role of the immune system upon the cardiac alterations observed in the SARS-CoV2 infection. Additionally, it was well described that SARS-CoV-2 is able to infect cardiac cells. Therefore, here it will be reviewed in deep.

COVID19: uncovering interindividual variability for tailoring appropriate therapeutic interventions / COVID19: a variabilidade individual da resposta imunoinflamatória

The severity of SARS-CoV2 infection, Covid19 disease, should account for the diversity of human individual immu-noinflammatory responses. Serum immunological markers during Covid19 illness may lead to individualized thera-peutics with better outcomes. Efficient treatment for Covid19 may require: 1) early disease detection, 2) combined drug therapy for 3) targeting the virus replication cycle, and 4) individualized drug treatment for specific immu-noinflammatory human profile responses administered in a 5) timely manner. Covid19 is unlikely to be the last emergent human disease with fast pandemic potential. Gathering knowledge on the individual human host profiles of immunoinflammatory responses is an opportunity that could lead us to understand individual differences in re-sponse to infection at the individual and population level, paving the way to faster, more efficient strategies to tack-le upcoming infectious diseases. This is a position paper based on an integrative non-exhaustive literature revision (AU)

A diversidade das respostas imunoinflamatórias individuais humanas muito provavelmente tem papel na gravidade da doença Covid19 causada pela infecção pelo vírus SARS-CoV2. Marcadores imunológicos séricos durante a Covid19 po-dem guiar a escolha de terapias individualizadas com melhores resultados. O tratamento eficiente para Covid19 pode exigir: 1) detecção precoce da doença, 2) terapia medicamentosa combinada com alvo ao 3) ciclo de replicação do ví-rus e 4) terapia anti-inflamatória individualizada para perfis de respostas imunoinflamatórias humanas, administradas em tempo hábil. É improvável que a Covid19 seja a última doença humana emergente com potencial de alastramento veloz pandêmico. Reunir conhecimento sobre perfis de respostas imunoinflamatórias individuais dos hospedeiros humanos é uma oportunidade ímpar que pode nos levar a entender as diferenças dessas respostas entre indivíduos, abrindo caminho para estratégias terapêuticas mais rápidas e eficientes no combate à futuras epidemias (AU)

Síndrome respiratória aguda grave por covid-19: perfil epidemiológico em gestantes e puérperas no Amazonas / Severe acute respiratory syndrome by covid-19: epidemiological profile in pregnant and postpartum women in the state of Amazonas

Objetivos: descrever o perfil epidemiológico de gestantes e puérperas com Síndrome Respiratória Aguda Grave (SRAG) por COVID-19 no Amazonas. Métodos: trata-se de um estudo quantitativo, transversal que extraiu dados de gestantes e puérperas residentes no estado do Amazonas que foram notificadas no Sistema de Informação da Vi-gilância Epidemiológica da Gripe (SIVEP-Gripe) e tiveram diagnóstico confirmado de SRAG por COVID-19 de 16 de fevereiro de 2020 a 31 de dezembro de 2021. Foram coletados dados sociodemográficos e características clínicas como internação em Unidade de Terapia Intensiva, uso de suporte ventilatório, uso de terapia antiviral e desfechos. Os dados foram analisados e apresentados em frequências absolutas e relativas. Resultados e Discussão: duran-te o período pesquisado, o Amazonas registrou 828 casos de SRAG por COVID-19 em gestantes e puérperas. Des-tes, 58 casos permaneciam em andamento, sem desfecho. A maioria das mulheres tinha idade entre 20 e 34 anos, cor parda, ensino médio, residiam em zona urbana e estavam no terceiro trimestre da gestação no momento do diagnóstico. Em relação às manifestações clínicas, houve predominância de tosse, desconforto respiratório, febre e dispneia. As comorbidades mais frequentes foram asma, doença cardiovascular crônica, diabetes mellitus e obe-sidade. Em relação aos dados clínicos, 19,7% das gestantes e puérperas foram internadas em UTI. Destas, 70,6% utilizaram ventilação mecânica invasiva, 80,2% fizeram uso de terapia antiviral e 79 (10,3%) evoluíram para óbito. Conclusão: o estudo permitiu a caracterização do perfil epidemiológico de gestantes e puérperas com SRAG por COVID-19 no Amazonas e demonstrou taxa elevada de óbito no período estudado, sobretudo na capital. Esse perfil pode ter relação com os determinantes sociais da saúde e as dificuldades de acesso aos serviços de saúde podem ter papel fundamental na assistência. Com isso, o atendimento às gestantes e puérperas com SRAG por COVID-19 deve ser prioridade nos serviços de saúde, principalmente nos casos em que as pacientes possuem comorbidades (AU)

Objectives: To describe the epidemiological profile of pregnant and postpartum women with severe acute res-piratory syndrome (SARS) caused by severe acute respiratory syndrome corona virus (SARS-CoV-2) in Amazonas. Methods: This quantitative, cross-sectional study extracted data from pregnant and postpartum women residing in the state of Amazonas who were notified in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) and had a confirmed diagnosis of SARS during corona virus disease (COVID-19) from February 16, 2020, to December 31, 2021. Sociodemographic data and clinical characteristics, such as admission to the intensive care unit, use of ventilatory support, use of antiviral therapy, and outcomes were collected. Data were analyzed and presented with relative frequencies. Results and Discussion: During the study period, Amazonas recorded 828 cases of SARS caused by SARS-CoV-2 in pregnant and postpartum women. Of these, 58 patients remained in progress with no outcomes. Most women were aged between 20 and 34 years, educated to high school level, lived in urban areas, and were in the third trimester of pregnancy at the time of diagnosis. Predominant clinical manifes-tation was cough, respiratory distress, fever, and dyspnea. The most frequent comorbidities were asthma, chronic cardiovascular diseases, diabetes mellitus, and obesity. 19.7% of pregnant and postpartum women were admitted to the intensive care unit (ICU). Of these, 70.6% needed invasive mechanical ventilation, 80.2% antiviral therapy, and 79 patients (10.3%) died. Conclusion: This study characterized the epidemiological profile of pregnant and postpartum women with SARS caused by SARS-CoV-2 in Amazonas and showed a high death rate during the study period, especially in the capital (AU)

Valor pronóstico del compromiso renal en COVID-19 / Prognostic value of kidney involvement in COVID-19

RESUMEN Introducción:La insuficiencia renal agudaes una complicación descripta en pacientes con infección por SARS-CoV-2que ronda 0,5-7% de los casos. Objetivo: evaluar el valor pronóstico del compromiso renal en los pacientes internados por enfermedad por COVID-19. Material y métodos:Se analizó una cohorte prospectiva de pacientes mayores de 18 años con diagnóstico de enfermedad por COVID-19 en el período comprendido entre los meses demayo a octubre de 2020.Todos fueron seguidos hasta el alta hospitalaria o muerte. Se evaluaron parámetros clínicos, laboratorio, score de Charlson, mortalidad y gravedad de enfermedad COVID-19. Resultados:Ingresaron 412 pacientes al estudio, 57% hombres y con promedio de edad de 51 ±16 años. El 20% tenía un score de Charlson≥3, la incidencia de insuficiencia renal aguda, definida como el aumento de la creatinina sérica 0,3 mg/dl del valor basal, fue 5,5% (n=23) yla mortalidad hospitalaria de2,2% (n=9). El análisis bi y multivariado mostró que el sexo masculino[OR= 0,32(IC0,12-0,82), p=0,017], dímero D>500ng/ml[OR= 3,68(IC 1,23-10,96), p=0,019], relación proteinuria/creatininuria >0,20[OR=2,43 (IC 1,03-5,74), p=0,043],insuficiencia renal aguda[OR=10,53 (IC 2,99-37,09), p0,0001]fueron predictores de COVID-19 grave, definido como frecuencia respiratoria 30 x min, saturación de oxígeno <93% o PO2/FIO2300.En el análisis bivariado la mortalidad se asoció con el desarrollo de COVID-19graveOR= 68.76 (IC 8,39-563,36), p0,0001 e insuficiencia renal agudaOR= 45,41 (IC 10,45-197,22), p0,0001. Conclusión:El compromiso renal está asociado a peor evolución y mayor mortalidad en COVID-19. La valoración de la función renal y la proteinuria son parámetros accesibles que deberían ser incluidos como factores de riesgo en la evaluación inicial.

ABSTRACT Introduction:Acute kidney injuryis a complication described in patients with SARS-CoV-2 infection that is around 0.5-7% of cases. Objective:evaluate the prognostic value of kidney involvement in patients hospitalized for COVID-19 disease. Methods:A prospective cohort of patients over 18 years with a diagnosis of COVID-19 disease in the period from May to October 2020 was analyzed. All were followed up until hospital discharge or death.Clinical and biochemicalparameters, Charlson score, mortality and severity of COVID-19 disease were evaluated. Results:Four hundred twelve patients entered the study, 57% men and mean age 51 ± 16 years. Twenty percent had a Charlson score ≥3, the incidence of acute kidney injury, defined as the increase in serum creatinine 0.3 mg / dl from baseline, was 5.5% (n = 23) and hospital mortality was 2.2% (n = 9). The bivariate and multivariate analysis showed that the male sex [OR= 0.32 (IC 0.12-0.82), p =0.017], D-dimer> 500 ng/ml [OR= 3.68 (IC 1.23-10.96), p = 0.019], urinary protein/creatinine> 0.20 [OR= 2.43 (CI 1.03-5.74), p = 0.043], and AKI [OR= 10.53 (CI 2.99-37.09), p <0.0001] were predictors of severe COVID-19, defined as respiratory rate>30 x min, oxygen saturation <93% or PO2/FIO2300. The univariate analysis of mortality was associated with the development of severe COVID-19 [OR= 68.76 (CI 8.39-563.36), p <0.0001 and acute kidney injury OR= 45.41 (CI 10.45-197.22), p 0.0001. Conclusion:Renal involvement is associated with worse evolution and higher mortality in COVID-19. The assessment of renal function and proteinuria are accessible parameters that should be included as risk factors in the initial evaluation of these patients.

Glomerulonefritis por cambios mínimos post vacuna COVID-19 AstraZeneca / Glomerulonephritis due to minimal change disease post COVID-19 vaccine AstraZeneca

RESUMEN Reportamos un caso de una mujer de 28 años, con síndrome nefrótico debido a glomerulonefritis por cambios mínimos 48horas después de la administración de la vacuna contra SARS-CoV2 de AstraZeneca. La paciente tuvo síndrome nefrótico idiopático en la infancia tratado empíricamente con corticoides y ciclosporina, en remisión completa desde los 9 años. Algunos reportes sugieren que determinadas enfermedades glomerulares podrían asociarse infrecuentemente a las vacunas.

ABSTRACT We report a case of a 28-year-old woman with minimal change disease secondary nephrotic syndrome 48 hours after the administration of the AstraZeneca SARS-CoV2 vaccine. The patient had suffered idiopathic nephrotic syndrome in childhood treated empirically with corticosteroids and cyclosporine, in complete remission from the age of 9. Some reports suggest that glomerular disease might appear infrequently associated to some vaccines.

Infecção pelo sars-cov-2 e disfunção autonômica ­ labilidade pressórica na covid-19 / Sars-cov-2 infection and autonomic dysfunction - pressure liability at covid-19

Homem de 53 anos, hipertenso e portador de bronquite, admitido em um serviço de urgência no dia 15 de dezembro de 2020 devido sintomas gripais, febre e cefaleia iniciados há oito dias. Após constatação de acometimento pulmonar importante mediante tomografia computadorizada (TC) de tórax, sugestivo de infecção pelo vírus SARS-CoV2, o paciente foi internado em unidade de terapia intensiva. Foi intubado no décimo dia de internação, e, dois dias após, evoluiu com labilidade pressórica importante, recorrendo ao uso de noradrenalina e nitroprussiato, além de outros anti-hipertensivos, conforme a necessidade. O quadro predominante foi a hipertensão arterial sistêmica, manifestada principalmente com a mudança de decúbito, sendo o maior valor pressórico registrado de 240x90 mmHg. A disautonomia também se manifestou por ausência de dejeções, sudorese excessiva e espasmos musculares. A frequência cardíaca se manteve estável e dentro dos parâmetros de normalidade.A partir do trigésimo dia de internação, observou-se melhora progressiva do quadro e reestabelecimento da homeostase. Obteve alta após 59 dias de internação, sem sequelas significativas. A explicação mais razoável para o caso é o aumento da resistência vascular periférica, por ação da angiotensina II, associada à supressão do sistema parassimpático, o que explica, também, a incompetência do barorreflexo para compensação da frequência cardíaca. Adicionalmente, o paciente estava em uso de carvedilol. Este caso enfatiza o desafio diagnóstico precoce da disautonomia em pacientes críticos, devido a carência de ferramentas adequadas para uso na prática cotidiana. A estimulação vagal pode constituir opção terapêutica eficaz, mas carece de mais estudos

A 53-year-old male, hypertensive and with bronchitis, was admitted to the emergency department on December 15, 2020 due to flu-like symptoms, fever and headache that started eight days ago. After finding significant lung involvement by chest computed tomography (CT) suggestive of SARS-CoV2 virus infection, the patient was admitted to the intensive care unit. He was intubated on the tenth day of hospitalization, and, 2 days later, he evolved with significant pressure lability, using norepinephrine and nitroprusside, in addition to other antihypertensive drugs, as needed. The predominant state was hypertension, expressed mainly when there is interference from the patient's position in bed. The highest pressure value recorded was 240x90 mmHg. Dysautonomy was also manifested by the absence of stools, excessive sweating and muscle spasms. Heart rate remains stable and within normal limits. From the thirtieth day of hospitalization onwards, there was an evolution with progressive improvement and restoration of homeostasis. He was discharged after 59 days of hospitalization, without sequelae. The most reasonable explanation for the case is the increase in peripheral vascular resistance, due to the action of angiotensin II, associated with the suppression of the parasympathetic system, which also explains the incompetence of the baroreflex to compensate the heart rate. Additionally, the patient was using carvedilol. This case emphasizes the importance of tools that early identify dysautonomy, prepare the team. Vagal stimulation can be an effective therapeutic option, but further studies are needed

Cuidados de enfermagem e posição prona: revisão integrativa / Atención de enfermería y decúbito prono: revisión integradora / Nursing care and prone position: Integrative review

Objetivo: explorar, na literatura científica, práticas atuais de cuidado de enfermagem ou intervenções para pacientes com síndrome respiratório agudo grave (SRAG) submetidos à posição prona. Síntese do conteúdo: revisão integrativa, na qual foram realizadas buscas nas bases de dados PubMed, CINAHL, Scopus, Web of Science e LILACS em setembro de 2020 e janeiro de 2022, sem recorte temporal, por meio da questão deste estudo: "Quais são os cuidados de enfermagem para pacientes com SRAG submetidos à posição prona?". Foram selecionados 15 artigos, a partir da busca nas bases de dados. Após a leitura, os cuidados encontrados foram categorizados em alinhamento do corpo para a prevenção de lesões neuromusculares, cuidados com equipamentos diversos, cuidados tegumentares e recomendações neurológicas. Conclusões: o enfermeiro deve ter conhecimento sobre as implicações e as complicações de se manter um paciente na posição prona. Tal conhecimento permitirá tomadas de decisões na construção ou no seguimento de protocolos institucionais que contribuam com a prevenção de riscos e resultem em melhores desfechos para o paciente.

Objetivo: explorar dentro de la literatura científica las prácticas o intervenciones actuales del cuidado de enfermería para los pacientes con síndrome respiratorio agudo grave (SRAG) sometidos a la posición de decúbito prono. Síntesis de contenido: revisión integradora mediante búsquedas en las bases de datos Pubmed, CINAHL, Scopus, Web of Science y LILACS, entre septiembre de 2020 y enero de 2022, sin recorte temporal, a través de la pregunta: ¿cuáles son los cuidados de enfermería para los pacientes con SRAS sometidos a la posición de decúbito prono? En total, se seleccionaron 15 artículos tras la búsqueda en bases. Tras la lectura de estos documentos, se observó que los cuidados identificados se podían categorizar en lineación corporal para prevenir lesiones neuromusculares, cuidados con equipos diversos, cuidados cutáneos y recomendaciones neurológicas. Conclusiones: el profesional de enfermería debe conocer las implicaciones y complicaciones de mantener a los pacientes en decúbito prono. Este conocimiento permitirá tomar decisiones para la construcción o el seguimiento de protocolos institucionales que contribuyan a la prevención de riesgos y generen mejores resultados para el paciente.

Objective: To explore within scientific literature the current nursing care practices or interventions for patients with severe acute respiratory syndrome (SARS) submitted to prone positioning. Content synthesis: Integrative review carried out in Pubmed, CINAHL, Scopus, Web of Science and LILACS databases from September 2020 to January 2022, with no time cutting, addressing the question: What are the nursing care practices for patients with SARS and placed under prone positioning? A total of 15 articles were selected from the database search. After analysis, it was observed that the care provided by nursing professionals could be categorized in body alignment to prevent neuromuscular injuries, care with various equipment, cutaneous care, and neurological recommendations. Conclusions: Nurses must acknowledge the implications and complications of keeping a patient in the prone position. Such awareness will allow decision making in the development or follow-up of institutional protocols that contribute to risk prevention and that will result in better outcomes for patients.

Infarto agudo de miocardio asociado a COVID-19. Informe de caso / Acute myocardial infarction associated with COVID-19. Case report

Se presenta el caso de un paciente masculino de 43 años, que ingresa con cuadro clínico caracterizado por dolor precordial de tipo opresivo con irradiación a cuello y mandíbula, cuya intensidad era de 8/10 atendiendo a la escala del dolor visual análoga (EVA). Además, manifestó diaforesis, disnea de pequeños esfuerzos, hiposmia y ageusia. El diagnóstico establecido fue de infección por coronavirus más infarto del miocardio. Las condiciones extraordinarias generadas por la pandemia de Covid-19 provocó que se decidiera una intervención mediante tratamiento fibrinolítico, obteniendo resultados positivos

The case of a 43-year-old male patient is presented, who is admitted with a clinical picture characterized by Chest pain of an oppressive type with irradiation to the neck and jaw, whose intensity was 8/10 according to the analogous visual pain scale (VAS). In addition, he manifes-ted diaphoresis, dyspnea on small efforts, hyposmia and ageusia. The determined diagnosis was coronavirus infection plus myocardial infarction. The extraordinary conditions generated by the Covid-19 pandemic led to an intervention by fibrinolytic treatment being decided, obtaining positive results.

Causes of death and post-mortem testing for SARS-CoV-2 in a tertiary hospital during the COVID-19 pandemic in Ghana

Background: Causes of death during the coronavirus disease 2019 (COVID-19) pandemic ranhttp://crossmark.crossref.org/dialog/?doi=10.4102/ajlm.v11i1.1766=pdf&date_stamp=2022-11-23ge from direct consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to deaths unrelated to SARS-CoV-2. Another feature of the pandemic is the post-mortem testing for SARS-CoV-2. Understanding these aspects of COVID-19 are essential in planning and limiting the impact of SARS-CoV-2 virus on healthcare systems. Objective: This study investigated the underlying causes of death and the presence of SARS-CoV-2 in bodies received at the 37 Military Hospital, Accra, Ghana, during the COVID-19 pandemic. Methods: The study was conducted from 4­27 May 2020. Deceased patients that met the inclusion criteria were prospectively selected during the expanded surveillance period for SARS-CoV-2 testing, autopsy and determination of underlying and immediate cause of death. Results: A total of 161 deceased patients were analysed with 53 autopsies. The overall positive test rate for SARS-CoV-2 was 14.9% (24/161 patients), with a positive rate of 5.0% (8/161 patients) for nasopharyngeal samples and 30.2% (16/161 patients) for bronchopulmonary samples. The underlying causes of death were not related to SARS-CoV-2 infection in 85.1% (137/161) of patients, SARS-CoV-2-associated 12.4% (20/161) and SARS-CoV-2-induced in 2.5% (4/161). Cardiovascular complications formed the most common cause of death in patients with or without SARS-CoV-2. Conclusion: There was a high positive rate of SARS-CoV-2 in post-mortem cases. However, most deaths were not caused by SARS-CoV-2 but by cardiovascular complications. The high rate of bronchopulmonary positive results for SARS-CoV-2 requires that autopsies be done in suspicious cases with negative nasopharyngeal sampling.