Síndrome inflamatória multissistêmica em crianças infectadas por coronavírus: uma revisão integrativa / Multisystemic inflamatory syndrome in children infected by coronavirus: an integrative review / Síndrome inflamatorio multisistémico en niños infectados por coronavirus: una revisión integradora

Durante a pandemia de COVID-19, foram observadas manifestações atípicas em pacientes pediátricos em diversas regiões do mundo, e o conjunto desses sintomas caracterizou uma nova patologia denominada Síndrome Inflamatória Multissistêmica em Crianças (MIS-C), ou Síndrome Inflamatória Multissistêmica Pediátrica Temporariamente associada ao COVID-19 (PIMS- TS). O objetivo desta revisão foi analisar as manifestações clínicas e as possíveis complicações relacionadas a tal quadro inflamatório. Foi realizada uma busca por artigos científicos nas bases de dados Embase, PubMed e Web of Science, por meio da combinação dos descritores "MIS-C", "PIMS- TS" e "COVID-19". Após a análise dos artigos encontrados, e considerando critérios de inclusão e exclusão, foram selecionados 15 estudos para compor esta revisão. A maioria dos estudos mencionaram complicações gastrointestinais, cardiovasculares, respiratórias e mucocutâneas. Ademais, foram encontrados marcadores que indicavam estado inflamatório generalizado e coagulopatia. Assim, concluiu-se que MIS-C provavelmente é uma síndrome manifestada após a infecção por SARS-CoV-2, podendo ocasionar quadros mais graves, mas com baixas taxas de mortalidade.

During the COVID-19 pandemic, atypical manifestations were observed in pediatric patients in different regions of the world, and the set of these symptoms characterized a new pathology called Multisystemic Inflammatory Syndrome in Children (MIS-C), or Pediatric Multisystemic Inflammatory Syndrome Temporarily associated with COVID-19 (PIMS-TS). The purpose of this review was to analyze the clinical manifestations and possible complications related to such an inflammatory condition. A search for scientific articles was carried out in the databases Embase, PubMed and Web of Science, by combining the descriptors "MIS-C", "PIMS-TS" and "COVID-19". After analyzing the articles found, and considering inclusion and exclusion criteria, 15 studies were selected to compose this review. Most studies mentioned gastrointestinal, cardiovascular, respiratory and mucocutaneous complications. In addition, markers were found that indicated generalized inflammatory status and coagulopathy. Thus, it was concluded that MIS-C is probably a syndrome manifested after infection by SARS-CoV-2, which can cause more severe conditions, but with low mortality rates.

Durante la pandemia de COVID-19 se observaron manifestaciones atípicas en pacientes pediátricos de diferentes regiones del mundo, y el conjunto de estos síntomas caracterizó una nueva patología denominada Síndrome Inflamatorio Multisistémico en Niños (SMI-C), o Síndrome Inflamatorio Multisistémico Pediátrico Asociado Temporalmente a COVID-19 (SIPM-TS). El propósito de esta revisión fue analizar las manifestaciones clínicas y las posibles complicaciones relacionadas con dicha condición inflamatoria. Se realizó una búsqueda de artículos científicos en las bases de datos Embase, PubMed y Web of Science, combinando los descriptores "MIS-C", "PIMS- TS" y "COVID-19". Tras analizar los artículos encontrados, y teniendo en cuenta los criterios de inclusión y exclusión, se seleccionaron 15 estudios para componer esta revisión. La mayoría de los estudios mencionaron complicaciones gastrointestinales, cardiovasculares, respiratorias y mucocutáneas. Además, se encontraron marcadores que indicaban un estado inflamatorio generalizado y coagulopatía. Así pues, se concluyó que el SMI-C es probablemente un síndrome que se manifiesta tras la infección por el SARS-CoV-2, que puede causar cuadros más graves, pero con bajas tasas de mortalidad.

Una revisión de literatura del síndrome pos-COVID-19 / A literature review about post-COVID-19 syndrome

Introducción: El COVID-19 es una enfermedad vírica que ha generado gran afectación en la salud de la población global. Varios estudios han demostrado que después de dos o tres meses de la infección por coronavirus los pacientes continúan refiriendo sintomatología: la fatiga, la disnea y el dolor de cabeza son los más frecuentes. Objetivo: Exponer información relevante de carácter científico sobre el síndrome pos-COVID. Desarrollo: Se hizo una revisión de la literatura entre noviembre de 2019 y febrero de 2021, que comprendió las fases de planeación, diseño y gestión, análisis, elaboración y formalización. Se realizó la búsqueda estratégica mediante ScienceDirect, PubMed/Medline, NusrginsOvid, SciELO y Google Académico, a través de la combinación de los operadores OR, AND y NOT. Se consideraron textos completos, en español, inglés y portugués, entre 2019 y 2021. Después de realizada la selección y revisión profunda se obtuvieron 38 artículos que cumplieron con el objetivo planeado, los cuales fueron sometidos a la metodología PRISMA. Conclusiones: Existe un síndrome pos-COVID, el cual se relaciona de forma directa con un proceso de inflamación multisistémico, lo que evidencia síntomas en pacientes después de tres meses de culminado el proceso infeccioso. Entre estos, la fatiga, la disnea y el dolor de cabeza resultan los más frecuentes; además de consecuencias cardíacas, psicológicas y neurobiológicas(AU)

Introduction: COVID-19 is a viral disease that has caused great affectation in the health of the global population. Several studies have shown that two to three months after coronavirus infection patients continue to report symptoms, fatigue, dyspnea and headache being the most frequent. Objective: To present relevant scientific information on post-COVID-19 syndrome. Development: A literature review was conducted between November 2020 and February 2021, consisting of the phases of planning, design and management, analysis, elaboration and formalization. The strategic search was carried out using ScienceDirect, PubMed/Medline, NusrginsOvid, SciELO and Google Scholar, through the combination of the Boolean operators OR, AND and NOT. Full texts were considered, in Spanish, English and Portuguese, from 2019 to 2021. After the selection and an in-depth review, 38 articles were obtained that met the set objective, which were processed with the PRISMA methodology. Conclusions: There is a post-COVID-19 syndrome, directly related to a multisystem inflammatory process, which shows symptoms in patients three months after the end of the infectious process. Among these, fatigue, dyspnea and headache are the most frequent, in addition to cardiac, psychological and neurobiological consequences(AU)

Modos ventilatorios usados en pacientes críticos con covid-19 en la región de Lombardía, Italia / Ventilation modes used in critical patient with COVID-19 in the region of Lombardy, Italy

RESUMEN Introducción: la covid-19 es una enfermedad donde la ventilación mecánica artificial cobra vital importancia. Se estima que el 50 % de los casos graves o críticos que requieren manejo en unidades de cuidados intensivos fallecen. Objetivos: se evaluó el impacto de los modos ventilatorios usados en pacientes con covid-19 en Lombardía, Italia, en la oxigenación, la hemodinámica y la mortalidad. Materiales y métodos: se realizó un estudio analítico longitudinal retrospectivo en 86 pacientes críticos con covid-19, en el Hospital Mayor de Crema, en Lombardía, Italia, desde el 1 de abril al 20 de mayo de 2020. Se realizaron análisis no paramétrico y de la varianza. Resultados: Hubo una supervivencia del 76,7 %. El modo utilizado tuvo igual comportamiento en occisos (BiPAP-3, PCV-4, VCRP-4, APRV-5, VCV-4) y en vivos (BiPAP-10, PCV-17, VCRP-14, APRV-15, VCV-10); test de x2 = 0,59; test de análisis de la varianza media índice PO2/FIO2 (PCV = 132), (BiPAP = 132) (VCV = 115) p = 0,924. La presión de final de espiración positiva (BiPAP-12, PCV-13, VCRP-13, APRV-13, VCV-14) con p = 0,205. PCO2 (BiPAP-55, PCV-52, VCRP-57, APRV-59, VCV-57) con p = 0,512. La tensión arterial media (BiPAP-84, PCV-83, VCRP-84, APRV-82, VCV-83) con p = 0,988. Modelos de cálculo de la presión de final de espiración positiva, según modo ventilatorio: BiPAP: PEEP = -0,0331 (índice PO2/FiO2) +18,215; PCV: PEEP = -0,0047 (índice PO2/FiO2) +13,717; VCRP: PEEP = -0,0204 (índice PO2/FiO2) +15,678; APRV: PEEP = -0,0092 (índice PO2/FiO2) +14,889. Conclusiones: la evolución del paciente crítico con covid-19 está determinada en gran medida por la ventilación mecánica invasiva; sin embargo, no existió suficiente evidencia para recomendar una u otra modalidad ventilatoria. El éxito está en conocer con exactitud las características del respirador, su modalidad y el paciente en cuestión. (AU)

ABSTRACT Introduction: COVID-19 is a disease in which mechanical ventilation acquires vital importance. It is estimated that 50 % of the serious and critical patients requiring management in intensive care units die. Objectives: to assess the impact of the ventilation modes used in patients with COVID-19 in Lombardy, Italy, on oxygenation, hemodynamics and mortality. Materials and methods: a retrospective, longitudinal, analytic study was carried out in 86 critical patients with COVID-19 who entered the Main Hospital of Crema, in Lombardy, Italy, from April 1st to May 20, 2020. Results: the survival was 76.7 %. The used mode showed the same behavior in deceased patients (BiPAP-3, PCV-4, VCRP-4, APRV-5, VCV-4) and in alive patients (BiPAP-10, PCV-17, VCRP-14, APRV-15, VCV-10). X2 = 0.59. ANOVA test index PO2/FIO2 (PCV = 132), (BiPAP = 132) (VCV=115) p = 0.924. PEEP (BiPAP-12, PCV-13, VCRP-13, APRV-13, VCV-14) p = 0.205. PCO2 (BiPAP-55, PCV-52, VCRP-57, APRV-59, VCV-57) p = 0.512. Average blood pressure (BiPAP-84, PCV-83, VCRP-84, APRV-82, VCV-83) p = 0.988. PEEP models according to ventilation mode: BiPAP: PEEP = -0.0331 (PO2/FiO2 index) +18.215. PCV: PEEP = -0.0047 (PO2/FiO2 index) + 13.717; VCRP: PEEP = -0.0204 (PO2/FiO2 index) + 15.678; APRV: PEEP = -0.0092 (PO2/FiO2 index) +14.889. Conclusion: the evolution of the critical patient with COVID-19 is determined mostly by the invasive mechanical ventilation; but we did not find evidence enough to recommend one or the other ventilation mode. The success stands in knowing accurately the characteristics of the ventilator, the ventilation modes and the patient (AU).

Desórdenes del metabolismo glucídico y síndrome metabólico en pacientes de covid-19 / Glucide metabolism disorders and metabolic syndrome in COVID-19 patients

RESUMEN El síndrome metabólico comprende un conjunto de factores de riesgo cardiovascular asociado a resistencia a la insulina, que propicia la aparición de enfermedad cardiovascular y de diabetes mellitus tipo 2. Su etiología se atribuye a la combinación de factores genéticos y ambientales, asociados al estilo de vida, que favorecen un estado proinflamatorio y protrombótico que empeora el cuadro clínico de los pacientes con covid-19. El objetivo de la revisión consistió en analizar el estado actual del conocimiento científico en las investigaciones sobre la interrelación entre los desórdenes del metabolismo glucídico y el síndrome metabólico, asociados a la condición proinflamatoria exacerbada en pacientes de covid-19. Se hicieron búsquedas en las bases de datos PubMed, SciELO, ClinicalKey y LILACS. Al proceso proinflamatorio generado por malos hábitos alimentarios, la sobrealimentación calórica de alto índice glicémico, y estilos de vida sedentarios, se atribuye un papel relevante en la patogénesis del síndrome metabólico, así como en sus posibles complicaciones en pacientes de covid-19 con comorbilidades asociadas. Es posible reducir la condición inflamatoria del síndrome metabólico mediante modificaciones en el estilo de vida y hábitos alimentarios, que prevengan la obesidad y sus efectos en la resistencia a la insulina, lo cual propicia reducir la gravedad asociada a los procesos inflamatorios inherentes (AU).

ABSTRACT Metabolic syndrome includes a set of cardiovascular risk factors associated with resistance to insulin, favoring the appearance of cardiovascular disease and diabetes mellitus type 2. Its etiology is attributed to the combination of genetic and environmental factors, associated to lifestyle, and favoring a proinflammatory and prothrombotic status that worsens the clinical characteristics of the patients with COVID-19. The objective of the review was to analyze the current state of the scientific knowledge in research on the interrelationship between glucide metabolism disorders and metabolic syndrome, associated with the exacerbated proinflammatory condition in COVID-19 patients. Searches were conducted in PubMed, SciELO, CinicalKey, and LILACS databases. A relevant role in the metabolic syndrome pathogenesis is attributed to the inflammatory process generated by poor eating habits, high caloric overfeeding, and to sedentary lifestyle, and also to possible complications with associated comorbidities in COVID-19 patients. It is possible to reduce the metabolic syndrome inflammatory condition through life style and alimentary habits changes that prevent obesity and its effects on insulin resistance and propitiate the reduction of the disease severity associated with the inherent inflammatory processes (AU).

Fracaso multiorgánico secundario a infección por coronavirus no COVID-19 / Multiple-organ failure as a result of non-COVID-19 coronavirus infection

Las infecciones por coronavirus son habituales en los pacientes pediátricos. Por lo general, producen un cuadro clínico leve de infección del tracto respiratorio superior que no suele afectar a los pulmones, salvo en prematuros y niños con enfermedades crónicas de base. Excepcionalmente, afectan a otros órganos (corazón, cerebro, tracto gastrointestinal) e incrementan su gravedad.En relación con la coincidencia temporal con el inicio de la actual pandemia por el nuevo beta coronavirus (SARS-CoV-2), responsable de su enfermedad asociada (COVID-19), se presenta el caso clínico de un paciente de 5 años con fracaso multiorgánico y secuelas neurológicas por afectación bulbar y trombosis vascular ocasionados por un alfa coronavirus (CoV-NL63) debido a su gravedad y excepcionalidad

Coronavirus infections (CoV) are common in pediatric patients. In general, they produce a mild clinical presentation consisting of an upper respiratory tract infection that does not usually infect the lungs, with the exception of preterm infants and children with chronic diseases. These infections exceptionally affect other organs (heart, brain, gastrointestinal tract), thus increasing their severity.In relation to the temporal coincidence with the beginning of the current situation of pandemic by the new beta coronavirus SARS-CoV-2 responsible for its associated disease (COVID-19), this study presents a clinical case of a 5-year-old patient showing multiple-organ failure and neurological sequelae due to bulbar injury and vascular thrombosis caused by an alpha coronavirus (CoV-NL63) due to its severity and exceptionality

Modelo temporal del comportamiento de pacientes críticos con covid-19 durante su estadía en cuidados intensivos. Lombardía, Italia / Temporal model of the behavior of critically ill patients with COVID-19 during their staying in intensive care. Lombardy, Italy

RESUMEN Introducción: una serie temporal es el producto de la observación de una variable en el tiempo. Es una herramienta matemática que se aplica con frecuencia en la salud. No se han elaborado modelos temporales que predigan el comportamiento de los pacientes durante su ingreso en la Unidad de Cuidados Intensivos. Objetivos: crear una serie temporal que permita predecir el comportamiento, durante su ingreso en la Unidad de Cuidados Intensivos, de pacientes graves producto de la covid-19 en la región de Lombardía, Italia. Materiales y métodos: analítico, longitudinal prospectivo con un grupo de pacientes críticos que ingresaron del 1 de abril al 1 de mayo de 2020, con diagnóstico de covid-19, en el Hospital Mayor de Crema, en la región de Lombardía, Italia. El universo estuvo constituido por 28 pacientes y se trabajó con el total de ellos. Resultados: composición por sexo: 48 % masculino. Media de edad: 83 años. Serie temporal: Modelo 1 que ajusta (Hold) PO2/FiO2 p = 0,251; Modelo 2 (ARIMA) SatO2/FiO2 p = 0,674 (en los dos primeros modelos el resultado se incrementó con los días, siguiendo un comportamiento predecible); Modelo 3 (ARIMA) p = 0,406 (en este caso, el resultado esperado decreció a medida que transcurrió el tiempo). Las funciones obtenidas permiten calcular el valor esperado según el día desde el ingreso. Conclusiones: predecir la evolución del paciente en la Unidad de Cuidados Intensivos permitió detectar tempranamente aquellos con una curva inesperada y dirigir hacia a ellos las terapéuticas más agresivas (AU).

ABSTRACT Introduction: a time series is the product of the observation of a variable in time. It is a mathematical tool frequently applied in health. No temporal models have been developed to predict patients' behavior during their staying in the Intensive Care Unit. Objectives: to create a time series allowing to predict the behavior of seriously-ill patients due to COVID-19, during their staying in the Intensive Care Unit in the region of Lombardy, Italy. Materials and methods: analytic, longitudinal prospective study with a group of critical patients who were admitted from April 1st to May 1st, with COVID-19 diagnosis, to Ospedale Maggiore di Crema, in the Lombardy region, Italy. The universe was formed by 28 patients and all of them were worked on. Results: 48% of patients were male. Average age: 83 years; Time series: Model 1 holding PO2/FiO2 p = 0.251; Model 2 (ARIMA) SatO2/FiO2 p = 0.674 (in the two first models the result increased with the days, following a predictable behavior=; Model 3 (ARIMA) p = 0.406 (in this case the expected result decreased as time passed). The obtained functions allow to calculate the expected value according to the day from the admission. Conclusions: predicting patient's evolution in the Intensive Care Unit allowed early detecting those with unexpected curves and targeting more aggressive therapies toward them (AU).

Repercusión de la covid-19 en la salud materno-infantil / Covid-19 repercussions on maternal and infantile health

RESUMEN El año 2020 ha sorprendido al planeta con la pandemia de la covid-19. Este artículo tiene como objetivo reflexionar sobre las repercusiones del nuevo coronavirus en la salud materno-infantil. Pese al poco tiempo transcurrido desde el inicio de la pandemia, en las embarazadas con covid-19 se han descrito algunas comorbilidades, así como alteraciones placentarias, abortos espontáneos, muertes fetales y maternas, e incremento en los partos por cesárea y nacimientos pretérminos. Los riesgos potenciales demandarán una vigilancia estrecha del comportamiento del embarazo en el futuro inmediato. Por otra parte, del total de la población afectada por la covid-19, los pacientes en edad pediátrica representan entre el 1 y el 2 %, y la mayoría presentan manifestaciones clínicas leves. No obstante, en los menores de un año cerca del 10 % puede evolucionar a formas severas o críticas. De especial interés ha sido la presentación del síndrome inflamatorio multisistémico en niños, debido a su gravedad y riesgo para la vida. En los recién nacidos, la infección por SARS-CoV-2 podría asociarse a dos formas, de acuerdo al momento de adquisición: la covid perinatal y la postnatal. Hasta el momento, las evidencias sobre la existencia de la vía de transmisión vertical son insuficientes, pero no pueden ser descartadas. En conclusión, por tratarse de un fenómeno en desarrollo, aún quedan muchas interrogantes sobre los efectos de la covid-19 en la salud materna e infantil, que demandarán en los próximos meses un gran esfuerzo por parte de investigadores, médicos de asistencia y directivos (AU).

ABSTRACT The year 2020 has surprised the planet with the covid-19 pandemics. This article is aimed to reflect on the repercussions of the novel coronavirus on maternal and infantile health. Despite of the short time elapsed from the onset of the pandemics, some comorbidities have been described in pregnant women with COVID-19, as well as placental anomalies, spontaneous abortions, stillbirths, maternal deaths, and an increasing number on cesarean section and preterm births. The potential risk will demand a close surveillance of pregnancy behavior in the near future. Moreover, pediatric patients are among 1 and 2% of the population affected by COVID-19, and most of them show mild clinical signs. Nevertheless, about 10% of the children aged less than a year may evolve to severe and critical forms. The multisystem inflammatory syndrome in children has been of special interest, due to its severity and risk for life. In newborns, SARS-CoV-2 infection could be associated to two forms according to the acquisition time: perinatal and postnatal COVID-19. Up to the moment, evidences on vertical transmission are insufficient, but they could not be discarded. In conclusion, as this is an ongoing phenomenon, many questions about the effects of COVID-19 on maternal and infantile health are pending; they will demand a crucial effort by researchers, health providers and decision makers (AU).

Aplicación de un modelo cubano predictivo de mortalidad en pacientes graves por covid-19 en Lombardía, Italia / Application of a Cuban mortality-predictive model in seriously-ill patients with Covid-19 in Lombardy, Italy

RESUMEN Introducción: la neumonía por covid-19 es la enfermedad infecciosa que ha revolucionado al mundo en los últimos meses. El diagnóstico pasa por varios momentos: el cuadro clínico, la analítica sanguínea y las imágenes. La estratificación del riesgo de muerte es muy importante para optimizar los recursos. Objetivos: validar un modelo matemático cubano predictivo de mortalidad en pacientes ingresados por covid-19. Materiales y métodos: estudio de cohorte con 191 pacientes, que ingresaron graves en el Hospital Mayor de Crema, en la provincia de Cremona, región de Lombardía (Italia), en el período de abril a mayo de 2020. El universo estuvo constituido por 191 pacientes, y no se tomó muestra alguna. Las variables fueron: edad, estado del paciente, niveles de creatinina plasmática, frecuencia respiratoria, frecuencia cardiaca, presión arterial, niveles de oxígeno y de dióxido de carbono en sangre, valor del sodio y de hemoglobina. Resultados: mortalidad del 22 % en pacientes graves y críticos, con media de la edad (grupo 1: 59 años) (grupo 2: 73 años); t-Student = 0,00. Test de Hosmer-Lemenshow (0,766) con elevado ajuste. Sensibilidad = 93 %. Área bajo la curva = 0,957. Porcentaje de aciertos en la regresión logística de 86,4 % y en la red neuronal de 91,2 %. Media del modelo por grupos (grupo 1: 4 458) (grupo 2: 2 911) t-Student = 0,00. Conclusiones: el modelo demostró ser muy útil en el flujograma de pacientes atendidos con la covid-19. Permitió detectar tempranamente (a los cinco días del ingreso) los pacientes con alto riesgo de muerte y discriminar aquellos que no tendrían este riesgo, de manera que pudieran ser tratados en unidades de cuidados mínimos (AU).

ABSTRACT Introduction: COVID-19 pneumonia is an infectious disease that has revolutionized the world in the last months. The diagnosis goes thought several moments: clinical features, blood analytic and images. Death risk stratification is very important to optimize resources. Objective: to validate the Cuban mathematic predictive model of mortality in patients admitted due to COVID-19. Materials and methods: cohort study with 191 seriously-ill patients who were admitted to Maggiore di Crema Hospital, Cremona, Lombardy region, Italy, in the period April-May 2020. The universe were 191 patients and no sample was chosen. The variables were: age; patient's status; plasma creatinine levels; respiratory rate; heart rate; arterial pressure; blood oxygen and carbon dioxide levels; values of sodium and hemoglobin. Results: 22 % of mortality in seriously-ill and critical patients, with average age in Group 1: 59 years, in Group 2: 73 years; t-Student = 0.00. Hosmer-Lemenshow test (0.766) with high adjustment. Sensitivity= 93 %. Area below the curve=0.957. Success percentage in logistic regression of 86.4 % and 91.2 % in the neuronal net. Model media per groups: Group 1= 4 458; Group 2= 2 911, t-Student = 0.00. Conclusions: the model showed to be very useful in the flow chart of patients attended with COVID-19. It allowed to early detect the patients at high death risk five days from admission and discriminating those who were not at risk, in a way that they could be treated in minimal care units (AU).

Manifestaciones cardiovasculares en pacientes con enfermedades reumáticas y COVID-19 / Cardiovascular manifestations in patients with rheumatic diseases and COVID-19

Introducción: La COVID-19 causa una variada gama de manifestaciones clínicas. En pacientes con enfermedades reumáticas destacan, además de las manifestaciones respiratorias, las manifestaciones articulares, dermatológicas, generales y cardiovasculares. Objetivo: Identificar las manifestaciones cardiovasculares que con mayor frecuencia se presentan en pacientes con enfermedades reumáticas afectados por la COVID-19. Métodos: Se realizó una investigación básica, no experimental, con alcance exploratorio, descriptivo y explicativo de un universo constituido por 37 pacientes con diagnóstico previo de enfermedad reumática y diagnóstico confirmado de COVID-19. Se empleó la observación dirigida y la revisión documental como técnicas de investigación para identificar la presencia de manifestaciones cardiovasculares en este tipo de pacientes. Resultados: Predominaron las pacientes femeninas (59,56 por ciento), con diagnóstico de osteoartritis (72,97 por ciento) y artritis reumatoide (72,97 por ciento) y con comorbilidades asociadas (83,78 por ciento). La hipertensión arterial (61,29 por ciento) y el hipotiroidismo (38,71 por ciento) fueron las comorbilidades más frecuentes. El 70,27 por ciento de los pacientes presentaron manifestaciones cardiovasculares: hipertensión arterial (65,38 por ciento), trastornos del ritmo cardiaco (57,69 por ciento) y el síndrome de Raynaud (53,85 por ciento). El 80,0 por ciento de los pacientes masculinos presentaron manifestaciones cardiovasculares, al igual que el 80,64 por ciento de los casos con enfermedad reumática, COVID-19 y comorbilidades asociadas. Conclusiones: Las manifestaciones cardiovasculares se presentaron con elevada frecuencia en los pacientes reumáticos con diagnóstico de COVID-19, sobre todo pacientes masculinos con comorbilidades asociadas. Las manifestaciones cardiovasculares más frecuentes fueron la hipertensión arterial, los trastornos del ritmo y el síndrome de Raynaud(AU)

Introduction: COVID-19 generates a wide range of clinical manifestations in general. In patients with rheumatic diseases, in addition to respiratory manifestations, joint, dermatological, general and cardiovascular manifestations, among others, stand out. Objective: To identify the cardiovascular manifestations that most frequently occur in patients with rheumatic diseases and COVID-19. Methods: A basic, non-experimental research was carried out, with an exploratory, descriptive and explanatory scope. Universe made up of 37 patients with a previous diagnosis of rheumatic disease and a confirmed diagnosis of COVID-19. Directed observation and documentary review were used as research techniques to identify the presence of cardiovascular manifestations in this type of patient. Results: Predominance of female patients (59.56 percent), diagnosed with osteoarthritis (72.97 percent) and rheumatoid arthritis (72.97 percent) and with associated comorbidities (83.78 percent). Hypertension (61.29 percent) and hypothyroidism (38.71 percent) were the most frequent comorbidities. 70.27 percent of the patients presented cardiovascular manifestations, predominantly arterial hypertension (65.38 percent), rhythm disorders (57.69 percent) and Raynaud´s syndrome (53.85 percent). 80.0 percent of the male patients presented cardiovascular manifestations, as did 80.64 percent of the cases with rheumatic disease, COVID-19 and associated comorbidities. Conclusions: Cardiovascular manifestations occurred with high frequency in rheumatic patients diagnosed with COVID-19; being more frequent in male patients and with associated comorbidities. High blood pressure, rhythm disorders and Raynaud's syndrome were the most frequent(AU)

Obesidade como fator agravante da COVID-19 em adultos hospitalizados: revisão integrativa / Obesidad como factor agravante de COVID-19 en adultos hospitalizados: revisión integradora / Obesity as an aggravating factor of COVID-19 in hospitalized adults: an integrative review

Resumo Objetivo: Identificar, na literatura científica, a relação da obesidade como fator de risco agravante para a morbidade por COVID-19. Métodos: Trata-se de um estudo bibliográfico, tipo revisão integrativa de literatura, nos idiomas português, inglês e espanhol, por meio da estratégia PICo, em cinco bases de dados,PubMed, Scopus, Web of Science, Embasee BVS, realizada de maio a junho de 2020. Os critérios de inclusão adotados foram: artigos primários realizados com adultos; disponíveis na íntegra; publicados durante o período de 2019 a 2020; nos idiomas português, inglês e espanhol. Os critérios de exclusão foram: relato de casos; casos clínicos; dissertações; teses; os já selecionados na busca em outra base de dados e que não respondessem à questão da pesquisa. Resultados: A seleção resultou em noveestudos, sendo que quatro estudos - 44,4% (E3, E5, E6 e E7) - apresentaram a prevalência de obesidade em adultos hospitalizados por COVID-19, dois estudos - 22,2% (E6, E9) - associaram a obesidade ao desenvolvimento da COVID-19 grave, três estudos - 33,3% (E1, E4 e E7) - associaram a obesidade à necessidade de ventilação mecânica e três estudos - 33,3% (E2, E4 e E8) - associaram a obesidade à mortalidade por COVID-19. Conclusão: A obesidade trata-se de uma doença crônica não transmissível, sendo um fator de risco considerado importante para o agravamento da doença COVID-19, no entanto, é passível de prevenção, pois hábitos saudáveis de vida podem reduzir o quadro grave de infecção por COVID-19.

Resumen Objetivo: Identificar en la literatura científica la relación de la obesidad como factor de riesgo agravante para la morbilidad por COVID-19. Métodos: Se trata de un estudio bibliográfico, tipo revisión integradora de literatura, en idioma portugués, inglés y español, por medio de la estrategia PICO, en cinco bases de datos: PubMed, Scopus, Web of Science, Embase y BVS, realizada de mayo a junio de 2020. Los criterios de inclusión adoptados fueron: artículos primarios realizados con adultos, con texto completo disponible, publicados durante el período de 2019 a 2020, en idioma portugués, inglés y español. Los criterios de exclusión fueron: relato de casos, casos clínicos, tesis de maestría y doctorado, los artículos ya seleccionados en la búsqueda en otra base de datos y los que no respondieran la pregunta de investigación. Resultados: La selección tuvo como resultado nueve estudios, de los cuales cuatro — 44,4% (E3, E5, E6 y E7) — presentaron prevalencia de obesidad en adultos hospitalizados por COVID-19; en dos estudios — 22,2% (E6, E9) — se relacionó la obesidad con el desarrollo de COVID-19 grave; en tres estudios — 33,3% (E1, E4 y E7) — se relacionó la obesidad con la necesidad de ventilación mecánica; y en tres estudios — 33,3% (E2, E4 y E8) — se relacionó la obesidad con la mortalidad por COVID-19. Conclusión: La obesidad se trata de una enfermedad crónica no transmisible y es considerada un factor de riesgo importante para el agravamiento de la enfermedad COVID-19. Sin embargo, la prevención es posible, ya que los hábitos de vida saludables pueden reducir el cuadro grave de infección por COVID-19.

Abstract Objective: To identify, in scientific literature, the relationship of obesity as an aggravating risk factor for morbidity by COVID-19. Methods: This is a bibliographic and integrative literature review study, in Brazilian Portuguese, English and Spanish languages, through PICo strategy, in the PubMed, Scopus, Web of Science, Embase and VHL databases, held from May to June 2020. Primary articles conducted with adults, available in full, published during the period 2019 to 2020, in Brazilian Portuguese, English and Spanish were included. Case reports, clinical cases, dissertations, theses, the already selected in the search in another database and that did not answer the question of the search were excluded. Results: The selection resulted in nine studies. Four studies - 44.4% (E3, E5, E6 and E7) - presented the prevalence of obesity in adults hospitalized by COVID-19. Two studies - 22.2% (E6, E9) - associated obesity with the development of severe COVID-19. Three studies - 33.3% (E1, E4 and E7) - associated obesity with the need for mechanical ventilation. Three studies - 33.3% (E2, E4 and E8) - associated obesity with mortality due to COVID-19. Conclusion: Obesity is a chronic non-communicable disease, being a risk factor considered important for the worsening of COVID-19 disease, however, it is preventable, because healthy lifestyle habits can reduce the severe picture of COVID-19 infection.

COVID-19: estudo seccional de casos suspeitos internados em um hospital federal do Rio de Janeiro e fatores associados ao óbito hospitalar / COVID-19: estudio seccional de casos sospechosos ingresados a un hospital federal de Rio de Janeiro, Brasil, y factores asociados a óbito hospitalario / COVID-19: a cross-sectional study of suspected cases admitted to a federal hospital in Rio de Janeiro, Brazil, and factors associated with hospital death

Objetivo: Descrever o perfil clínico-epidemiológico dos casos suspeitos de COVID-19 internados em hospital federal do Rio de Janeiro, RJ, Brasil, e identificar fatores associados ao óbito. Métodos: Estudo seccional, utilizando dados da vigilância epidemiológica local até a Semana Epidemiológica 27 de 2020. Empregou-se regressão logística. Resultados: Foram incluídos 376 casos internados suspeitos de COVID-19, dos quais 52,9% eram mulheres, 57,4% tinham 50 anos ou mais de idade e 80,1% exibiam comorbidades. Foram confirmados para COVID-19 195 casos (51,9%), cuja letalidade (37,9%) foi maior, comparada à dos descartados (24,2%). Na análise ajustada, associaram-se ao óbito, nos casos confirmados, ter 50 a 69 (OR=11,65 - IC95% 1,69;80,33) e 70 ou mais anos (OR=8,43 - IC95% 1,22;58,14), apresentar neoplasia (OR=4,34 - IC95% 1,28;14,76) e usar suporte ventilatório invasivo (OR=70,20 - IC95% 19,09;258,19). Conclusão: Houve elevada prevalência de comorbidades e letalidade; os principais fatores associados ao óbito foram idade, presença de neoplasia e suporte ventilatório invasivo.

Objetivo: Describir el perfil clínico-epidemiológico de casos sospechosos de COVID-19 ingresados en hospital federal de Río de Janeiro, RJ, Brasil, y factores asociados al óbito. Métodos: Estudio transversal utilizando datos de la vigilancia epidemiológica local de casos sospechosos hospitalizados hasta la Semana Epidemiológica 27 de 2020 y regresión logística. Resultados: Se incluyeron 376 casos, de los cuales 52,9% era de mujeres, 57,4% tenía 50 años o más, 80,1% tenía comorbilidades. Se confirmó para COVID-19 un 51,9% . Los casos confirmados tuvieron una mayor letalidad (37,9%) que los descartados (24,2%). La mortalidad ajustada en los confirmados fue mayor en los grupos de edad de 50 a 69 años (OR=11,65 - IC95% 1,69; 80,33), 70 años o más (OR=8,43 - IC95% 1,22;58,14), con neoplasia (OR=4,34 - IC95% 1,28;14,76) y uso de soporte ventilatorio invasivo (OR=70,20 - IC95% 19,09;258,19). Conclusión: La mayor mortalidad se asoció con personas de edad avanzada, con neoplasias y uso de soporte ventilatorio invasivo.

Objective: To describe the clinical and epidemiological profile of suspected COVID-19 cases admitted to a federal hospital in Rio de Janeiro, RJ, Brazil, and to identify factors associated with death. Methods:This was a cross-sectional study using local epidemiological surveillance data as at epidemiological week 27 of 2020 and logistic regression. Results: 376 hospitalized suspected COVID-19 cases were included; 52.9% were female, 57.4% were 50 years old or over and 80.1% had comorbidities. 195 (51.9%) COVID-19 cases were confirmed and their lethality was higher (37.9%) than among discarded cases (24.2%). In the adjusted analysis, death among confirmed cases was associated with being in the 50-69 age group (OR=11.65 - 95%CI 1.69;80.33), being aged 70 or over (OR=8.43 - 95%CI 1.22;58.14), presence of neoplasms (OR=4.34 - 95%CI 1.28;14.76) and use of invasive ventilatory support (OR=70.20 - 95%CI 19.09;258.19). Conclusion: High prevalence of comorbidities and lethality was found; the main factors associated with death were being older, neoplasms and invasive ventilatory support.

Relations between the ocular surface and SARS-CoV-2 / Relações entre superfície ocular e SARS-CoV-2

ABSTRACT Introduction: The SARS-CoV-2 pandemic has been a major challenge for the international scientific community. Since its inception, studies aiming to describe pathophysiological aspects and clinical manifestations of the disease have been conducted, raising hypotheses and confirming possible associations. One aspect of this scientific medical production is the role of the ocular surface as a means of transmission and clinical presentation of viral syndrome. Objectives: To analyze the role of the ocular surface in transmission, pathophysiology, and clinical manifestations of SARS-CoV-2, by means of a systematic review. Methods: The search was carried out in three databases: Cochrane, PubMed Central Journals and MEDLINE, using the following descriptors: "COVID-19, ophthalmology". The filters last five years and studies on humans resulted in 32 studies; in that 12 were excluded for not meeting the purpose of the study. Results: There are still few published studies on the relation between SARS-CoV-2 and the ocular route. Most studies showed an association between the presence of nonspecific ocular manifestations and infection by the new coronavirus, with limitations in the number of patients analyzed and the methodology adopted. Hypotheses about the pathophysiological role are largely anchored in the association of SARS-CoV and the ocular surface evaluated in the past. Comments: The results found are still not sufficient to confirm the role of the ocular surface in the pathophysiology of the disease. Most of these preliminary studies are of considerable importance in raising hypotheses based on the medical analysis of the patients studied. However, larger studies with standardized methodology for diagnostic protocol and laboratory analysis of the individuals assessed are required.

RESUMO Introdução: A pandemia da SARS-CoV-2 tem sido um grande desafio para a comunidade científica internacional. Desde seu surgimento, estudos com a intenção de descrever os aspectos fisiopatológicos e as manifestações clínicas da doença vêm sendo conduzidos, levantando hipóteses e confirmando possíveis associações. Um dos temas dessa produção médica científica é o papel da superfície ocular como meio de transmissão e apresentação clínica da síndrome viral. Objetivo: Analisar o papel da superfície ocular na transmissão, na fisiopatologia e nas manifestações clínicas de SARS-CoV-2, através de uma revisão sistemática. Realizou-se a busca em três bancos de dados Cochrane Database, PubMed® e MEDLINE®, utilizando os descritores "COVID-19 e ophthalmology". Foram definidos como filtros o artigo ter sido publicado nos últimos 5 anos e estudo realizado em humanos, tendo sido encontrados 32 artigos. Destes, foram excluídos 12 por não corresponderem ao objetivo do estudo. Resultados: Ainda são poucos os estudos publicados sobre a relação entre o coronavírus 2 da síndrome respiratória aguda grave (SARS-CoV-2) e a via ocular. A maioria dos estudos mostrou associação entre a presença de manifestações oculares inespecíficas e a infecção pelo novo coronavírus, com limitações no número de pacientes analisados e na metodologia adotada. Hipóteses sobre o papel fisiopatológico se ancoram, em grande parte, na associação estudada entre o SARS-CoV-2 e a superfície ocular no passado. Comentários: Os resultados encontrados ainda não são suficientes para confirmar o papel da superfície ocular na fisiopatologia da doença. Grande parte desses estudos preliminares têm importância considerável ao levantar hipóteses baseadas na análise clínica dos pacientes estudados. No entanto, são necessários estudos maiores e com metodologia padronizada para protocolo diagnóstico e análise laboratorial dos indivíduos avaliados.

Estrategias en el manejo y actualización de las enfermedades autoinmunes y reumáticas en la epidemia por SARSCoV-2 y la COVID-19 Sociedad Cubana de Reumatología y su Grupo Nacional / Strategies in its Management and Updating of the Autoimmune-rheumatic Diseases in the SARSCoV-2 Pandemic and COVID-19 Cuban Rheumatology Society and its National Group

Al igual que en las enfermedades autoinmunes y reumáticas, las infecciones por virus pueden ser disparadores de mecanismos inmunopatogénicos. El SARSCoV-2 puede causar la liberación de citocinas y provocar un daño tisular grave, sobre todo pulmonar, con peligro para la vida. Se suma a ello el riesgo del uso de medicamentos inmunosupresores, empleados en los protocolos de tratamiento de las afecciones autoinmunes y también contra la infección viral de COVID-19. Hoy no contamos con conocimientos y evidencias científicas suficientemente sólidas para el enfrentamiento a la COVID-19, y cómo puede impactar entre los pacientes inmunodeprimidos por afecciones reumáticas. El Grupo Nacional de Atención y Enfrentamiento a la COVID-19 de la Sociedad Cubana de Reumatología se propuso elaborar un documento científico actualizado con las bases teórico-prácticas que permita acceder al conocimiento acerca de la infección por SARSCoV-2 y la COVID-19, y su repercusión sobre los pacientes con enfermedades autoinmunes y reumáticas para esbozar una estrategia de trabajo y ofrecer recomendaciones para los reumatólogos y pacientes cubanos. Se realizó un estudio de revisión y actualización acerca de la asociación entre las enfermedades reumáticas y autoinmunes y la COVID-19. Se emplearon las palabras clave enfermedades reumáticas, lupus eritematoso sistémico, artritis reumatoide, virus SARSCoV-2 y COVID-19. Se realizó una amplia búsqueda en MEDLINE y LILACS, y se revisaron más de 150 artículos, boletines de actualización de los sitios Web, páginas de salud de Cuba, resúmenes seleccionados por su calidad metodológica, revisiones y metaanálisis sobre el tema. A partir de la información recogida, se estableció una discusión y análisis considerando las principales experiencias internacionales, criterios de expertos, experiencias previas con otros virus en el Sistema de Salud de Cuba, con la participación de su red de científicos liderados por la Sociedad Cubana de Reumatología y su Grupo Nacional y el apoyo de la comunidad de reumatólogos(AU)

The outbreak of the infection by the new coronavirus SARSCoV-2, COVID-19, in December in Wuhan Province of China, has become a pandemic and health emergency given the deficiency of antiviral therapy for the acute respiratory syndrome that generates danger to life. The debut of the epidemic was in China, then the epicenter developed in Europe, northern Italy that suffered a severe blow. Worldwide, more than 10 million people are infected with the virus that has impacted on health systems until it practically collapsed, resulting in thousands of deaths. Today the epicenter of the pandemic has shifted to the Americas. Alarming figures highlight the United States of North America with some 2,737,600 infected and more than 128,471 deaths, followed by the South American giant Brazil with 1.3 million infections and 57,659 deaths. The Caribbean has a better setting. In Cuba, by the end of June, 2,340 cases of patients infected with deaths from COVID-19 were reported. We conducted a review, analysis and evaluation study of more than 150 articles from international journals, update bulletins of the WEB sites, health pages of the MINSAP of Cuba, and summaries selected for their methodological quality, and reviews, on the subject COVID-19 and autoimmune-rheumatic diseases by MEDLINE: database prepared by the National Library of Medicine of The USA contains bibliographic references and abstracts from more than 4,000 biomedical journals published in the United States and in 70 other countries, We also use Latin American and Caribbean Center for Information on Health Sciences: System, in Latin America and the Caribbean, since 1982. Our objective and results achieved have been to develop the theoretical-practical bases in an updated scientific document that allow access in an essential and summarized way to current knowledge about the infection by SACOV-2, COVID-19, and its repercussion and impact on patients suffering from rheumatic autoimmune diseases, and thus outline a coping and action strategy with recommendations for the Cuban rheumatologists in their health care work, and for patients as a guideline, given their well-founded concerns and fears given their underlying condition and the immunosuppressive drugs prescribed in an unfavorable context of a pandemic. The information is based on international experiences with the most published scientific evidence and those treasured national experiences in the face of similar situations of epidemics, faced by the vast health system and achievements of Cuban science(AU)

Anticoncepción hormonal y COVID-19 / Hormonal contraception and COVID-19

La enfermedad producida por el nuevo coronavirus SARS-CoV-2 se identificó por primera vez en diciembre de 2019 en la ciudad de Wuhan, en la República Popular China, y en pocos meses se convirtió en una pandemia. Desde el comienzo ha sido un desafío mundial, que amenazó la salud pública y obligó a tomar medidas estrictas de aislamiento social. Como consecuencia de la emergencia sanitaria se ha producido una reducción importante de la actividad asistencial, que puso en riesgo el acceso y la continuidad de los métodos anticonceptivos, exponiendo a mujeres a embarazos no intencionales. Los derechos sexuales y reproductivos resultan esenciales y deben garantizarse siempre. (AU)

The disease caused by the new coronavirus SARS-CoV-2 was identified for the first time in December 2019 in the city of Wuhan, in the People's Republic of China, and within a few months it became a pandemic. From the beginning, it has been a global challenge, threatening public health, having to take strict measures of social isolation. As a consequence of the health emergency, there has been a significant reduction in healthcare activity, putting access and continuity of contraceptive methods at risk, exposing women to unintended pregnancies. Sexual and reproductive rights are essential and must always be guaranteed. (AU)

Olfactory and taste disorders in COVID-19: a systematic review / Desordens olfativas e gustativas na COVID-19: uma revisão sistemática

Abstract Introduction: The SARS-CoV-2 virus causes COVID-19, and it is responsible for the largest pandemic since the 1918 H1N1 influenza outbreak. The classic symptoms of the disease have been well defined by the World Health Organization; however, olfactory/gustatory disorders have been reported in some studies, but there are still several missing points in the understanding and in the consensus about the clinical management of these cases. Objective: To identify evidence in the scientific literature about olfactory/gustatory disorders, their clinical presentation, prevalence and possible specific treatments associated with COVID-19. Methods: A systematic review of articles published up to April 25, 2020 was performed in Medline, Cochrane Clinical Trials, ScienceDirect, Lilacs, Scopus and Google Schoolar, OpenGrey.eu, DissOnline, The New York Academy of Medicine and Reasearch Gate. Inclusion criteria: (1) Studies on patients with COVID-19; (2) Records of COVID-19 signs/symptoms, and olfactory/gustatory functions. Exclusion criteria: (1) Studies on non-human coronavirus; (2) Review articles; (3) Experimental studies (in animals or in vitro); (4) Olfactory/gustatory disorders initiated prior to SARS-CoV-2 infection. The risk assessment of bias of the selected studies was performed using the Newcastle-Ottawa scale. Results: Six articles from the 1788 records met the inclusion criteria and were analyzed. A total of 1457 patients of different ethnicities were assessed; of them, 885 (60.7%) and 822 (56.4%) had smell and taste disorders, respectively, with women being most often affected. There were olfactory/gustatory disorders even without nasal obstruction/rhinorrhea and beginning even before the signs/symptoms of COVID-19; the recovery of smell/taste, when it occurs, usually happened in the first two weeks after COVID-19 resolution. There is evidence that olfactory/gustatory disorders are strong predictors of infection by SARS-CoV-2, and it is possible to recommend patient isolation, as early as of the medical consultation, preventing the spread of the virus. No scientific evidence has been identified for effective treatments for any of the disorders. Conclusion: Olfactory/gustatory disorders may occur at varying intensities and prior to the general symptoms of COVID-19 and should be considered as part of the clinical features of COVID-19, even in mild cases. There is still no scientific evidence of specific treatments for such disorders in COVID-19 disease.

Resumo Introdução: O vírus SARS-CoV-2 causa a COVID-19 e é responsável pela maior pandemia desde o surto de influenza H1N1 de 1918. Os sintomas clássicos da doença já foram bem definidos pela Organização Mundial da Saúde; entretanto, distúrbios olfativo-gustativos têm sido relatados em alguns estudos, mas ainda com várias lacunas no entendimento e no consenso sobre a condução clínica desses casos. Objetivo: Identificar evidências na literatura científica sobre os distúrbios olfativo-gustativos acerca da apresentação clínica, prevalência e possíveis tratamentos específicos associados à COVID-19. Método: Revisão sistemática de artigos publicados até 25 de abril de 2020 nas bases de dados: Medline, Cochrane Clinical Trials, ScienceDirect, Lilacs, Scopus e Google Schoolar, OpenGrey.eu, DissOnline, The New York Academy of Medicine e Research Gate. Foram critérios de inclusão: 1) Estudos com indivíduos com COVID-19; 2) Registro dos sinais/sintomas da COVID-19 e das funções olfativo-gustativa. Foram critérios de exclusão: 1) Estudos sobre coronavírus não humano; 2) Artigos de revisão; 3) Estudos experimentais (em animais ou in vitro); 4) Distúrbios olfativos-gustativos iniciados previamente à infecção pelo SARS-CoV-2. A avaliação de risco de viés dos estudos selecionados foi feita por meio da escala de Newcastle-Ottawa. Resultados: Seis artigos dos 1.788 registros foram selecionados. Um total de 1.457 pacientes de diversas etnias foi avaliado; desses, 885 (60,7%) apresentaram perda do olfato e 822 (56,4%) perda do paladar, sendo as mulheres as mais afetadas. Os distúrbios olfativo-gustativos estiveram presentes mesmo sem obstrução nasal/rinorreia e com início mesmo antes dos sinais/sintomas clínicos da COVID-19; a recuperação do olfato/paladar, quando ocorre, geralmente se dá nas duas primeiras semanas após a resolução da doença. Há evidências de que os distúrbios olfativo-gustativos sejam fortes preditores de infecção pelo SARS-CoV-2, podendo-se recomendar o isolamento do paciente, já a partir da consulta médica, para evitar a disseminação do vírus. Não foram identificadas evidências científicas para tratamentos eficazes para qualquer dos distúrbios. Conclusão: Podem ocorrer distúrbios olfativo-gustativos em intensidades variáveis e prévios aos sintomas gerais da COVID-19, devem ser considerados como parte dos sintomas da doença, mesmo em quadros leves. Não há ainda evidências científicas de tratamentos específicos para tais distúrbios na COVID-19.

Características clínico-epidemiológicas de los pacientes ingresados en el Hospital "Amalia Simoni" durante la pandemia Covid-19 / Clinical-epidemiologic characteristics of the patients admitted in the Hospital "Amalia Simoni" during the Covid-19 pandemics

RESUMEN Introducción: desde los finales del año pasado en Wuhan, se informó de una neumonía de etiología desconocida, que llevó a la Organización Mundial de la Salud a declarar la infección por SARS-CoV-2, como una emergencia sanitaria denominándola como enfermedad por coronavirus 2019 (COVID-19). En Cuba se confeccionó un programa de enfrentamiento, en el cual la atención hospitalaria, siguió un riguroso protocolo de atención a pacientes positivos de la COVID-19, en áreas de cuidados mínimos, intensivos o progresivos. Objetivo: caracterizar clínica/epidemiológica pacientes positivos de la COVID-19, ingresados en el Hospital "Amalia Simoni". Materiales y métodos: se realizó un estudio descriptivo, transversal de 1 066 ingresos en el Hospital "Amalia Simoni", de marzo-mayo del 2020. Se revisaron historias clínicas y se obtuvo: edad, sexo, procedencia, sintomatología, comorbilidades y evolución epidemiológica. Datos que se evaluaron mediante estadísticas descriptivas. Resultados: se halló un predominio de edad media, sin diferencias de sexo, predominaron los casos de la ciudad de Camagüey y de los municipios con mayor urbanización. Prevalecieron la tos y la fiebre, además de la mitad de los casos sin comorbilidades, con solo un pequeño porcentaje de casos confirmados. Conclusiones: con un enfoque basado en la medicina preventiva en los casos estudiados, predominó la edad media, de procedencia de áreas urbanizadas con mayor población y aglomeraciones sociales. Se destacó que el ingreso precoz, basada en la pesquisa de la Atención Primaria logró disminuir los casos confirmados a un pequeño porcentaje, al igual que los graves y un solo fallecido (AU).

ABSTRACT Introduction: from the end of the last year in Wuhan, China, it was informed an unknown etiology pneumonia leading the World Health Organization to declare the infection with SARS-CoV-2 a sanitary emergency naming it coronavirus disease 2019 (Covid-19). A confrontation program was elaborated in Cuba, in which hospital care followed a rigorous protocol to take care to Covid-19-positive patients in areas of minimal, intensive and progressive care. Objective: to clinically/epidemiologically characterize Covid-19-positive patients admitted in the Hospital "Amalia Simoni". Materials and methods: a cross-sectional, descriptive study was carried out in 1 066 patients admitted in the Hospital "Amalia Simoni" in the period March-May 2020. Clinical records were reviewed and data gathered were age, sex, origin, symptomatology, co-morbidities and epidemiological evolution, data obtained through descriptive statistics. Results: it was found the predominance of medium age, without sex differences; the cases of patients from the city of Camaguey and from the municipalities with biggest urbanization predominated. Cough and fever prevailed; half of cases did not have comorbidities, and only a little percent of cases was confirmed. Conclusions: with an approach based in preventive medicine, medium age, and provenance from urban areas with bigger population and social concentrations predominated in the studied cases. It was showed that precocious admission, based on the Primary Health Care screening, succeeded in diminish confirmed cases to a little percent, as diminished the seriously ill ones; only one patient died (AU).

Esclerosis múltiple en el contexto de la pandemia de COVID-19 / Multiple sclerosis in the context of pandemic COVID-19

En la esclerosis múltiple se pierde la tolerancia inmunológica a las vainas de mielina. Los virus pueden intervenir en su etiopatogenia. La actual pandemia de COVID-19 puede incrementar los casos y exacerbar los brotes de esclerosis múltiple(AU)

Multiple sclerosis causes the loss of immune tolerance to myelin sheaths. Viruses may be involved in its pathogenesis. The current COVID-19 pandemic may increase the number of cases and exacerbate the outbreaks of this disease(AU)