Impacto de la edad, las comorbilidades y las complicaciones en pacientes con COVID-19 con síndrome de dificultad respiratoria aguda en la ventilación mecánica invasiva. Estudio multicéntrico observacional / Impact of Age, Comorbidities and Complications in COVID-19 Patients with Acute Respiratory Distress Syndrome on Invasive Mechanical Ventilation. An Observational Multicenter Study

Objetivos: Millones de pacientes con COVID-19 fueron internados en terapia intensiva en el mundo, la mitad desarrollaron síndrome de dificultad respiratoria aguda (SDRA) y recibieron ventilación mecánica invasiva (VMI), con una mortalidad del 50%. Analiza-mos cómo edad, comorbilidades y complicaciones, en pacientes con COVID-19 y SDRA que recibieron VMI, se asociaron con el riesgo de morir durante su hospitalización.Métodos: Estudio de cohorte observacional, retrospectivo y multicéntrico realizado en 5 hospitales (tres privados y dos públicos universitarios) de Argentina y Chile, durante el segundo semestre de 2020.Se incluyeron pacientes >18 años con infección por SARS-CoV-2 confirmada RT-PCR, que desarrollaron SDRA y fueron asistidos con VMI durante >48 horas, durante el se-gundo semestre de 2020. Se analizaron los antecedentes, las comorbilidades más fre-cuentes (obesidad, diabetes e hipertensión), y las complicaciones shock, insuficiencia renal aguda (IRA) y neumonía asociada a la ventilación mecánica (NAV), por un lado, y las alteraciones de parámetros clínicos y de laboratorio registrados.Resultados: El 69% era varón. La incidencia de comorbilidades difirió para los diferentes grupos de edad. La mortalidad aumentó significativamente con la edad (p<0,00001). Las comorbilidades, hipertensión y diabetes, y las complicaciones de IRA y shock se asociaron significativamente con la mortalidad. En el análisis multivariado, sólo la edad mayor de 60 años, la IRA y el shock permanecieron asociados con la mortalidad. Conclusiones: El SDRA en COVID-19 es más común entre los mayores. Solo la edad >60 años, el shock y la IRA se asociaron a la mortalidad en el análisis multivariado.

Objectives: Millions of patients with COVID-19 were admitted to intensive care world-wide, half developed acute respiratory distress syndrome (ARDS) and received invasive mechanical ventilation (IMV), with a mortality of 50%. We analyzed how age, comor-bidities and complications in patients with COVID-19 and ARDS who received IMV were associated with the risk of dying during their hospitalization.Methods: Observational, retrospective and multicenter cohort study carried out in 5 hospitals (three private and two public university hospitals) in Argentina and Chile, during the second half of 2020.Patients >18 years of age with SARS-CoV-2 infection confirmed by RT-PCR, who devel-oped ARDS and were assisted with IMV for >48 hours, during the second half of 2020, were included. History, the most frequent comorbidities (obesity, diabetes and hyper-tension) and the complications of shock, acute renal failure (AKI) and pneumonia as-sociated with mechanical ventilation (VAP), on the one hand, and the alterations of re-corded clinical and laboratory parameters, were analyzed.Results: 69% were men. The incidence of comorbidities differed for different age groups. Mortality increased significantly with age (p<0.00001). Comorbidities, hyper-tension and diabetes, and complications of ARF and shock were significantly associat-ed with mortality. In the multivariate analysis, only age over 60 years, ARF and shock remained associated with mortality.Conclusions: ARDS in COVID-19 is more common among the elderly. Only age >60 years, shock and ARF were associated with mortality in the multivariate analysis

Factores que influyen en la supervivencia de pacientes con diálisis en El Salvador / Influencing Factors in the Survival of Dialysis Patients in El Salvador

Introducción. La enfermedad renal crónica es responsable de aproximadamente 2,4 millones de defunciones a nivel mundial. La supervivencia a los cinco años después de iniciar diálisis se encuentra entre un 39 a 60 % dependiendo del país. Objetivo. Describir la situación epidemiológica de los pacientes con diálisis y analizar los factores que influyen en la supervivencia de pacientes a cinco años de iniciar tratamiento sustitutivo renal en El Salvador. Metodología. Estudio de cohorte retrospectivo de los pacientes incluidos en el Registro Nacional de Diálisis y Trasplante Renal desde enero de 2016 hasta febrero de 2023. El seguimiento se comenzó al inicio de la diálisis, el evento de interés fue la muerte del paciente. Se utilizó el método de Kaplan-Meier para determinar la supervivencia al año y a los cinco años y la regresión de Cox con el modelo de Royston-Parmar para analizar los factores que influyen sobre la supervivencia a los cinco años. Resultados. El estudio incluyó 7088 pacientes, la supervivencia a uno y cinco años fue del 79,5 % (IC 95 %: 78,6-80,5) y 50,6 % (IC 95 %: 49,1-52,1) respectivamente. La regresión de Cox para la edad de inicio de tratamiento resultó en un hazard ratio de 1,02 (IC 95 %: 1,01-1,02), mientras que para el oficio de ser agricultor el hazard ratio fue 1,1 (IC 95 %: 1,01-1,18) y para la etiología hipertensiva el hazard ratio fue de 0,7 (IC 95 %: 0,64-0,78). Conclusión. La edad de inicio de tratamiento y el ser agricultor están asociados con una menor supervivencia a cinco años en pacientes con diálisis

Introduction. The chronic kidney disease is responsible for approximately 2.4 million deaths worldwide, in El Salvador during 2019 death rate was 72.9 for 100 000 habitants, five year survival in patients after starting dialysis was between 39 and 60 % depending on the country. Objective. Analyze the factors that influence the five years survival in patients after starting renal replacement therapy in El Salvador. Methodology. It is a retrospective cohort study from patients included in dialysis and renal replacement therapy national registry from January 2016 to February 2023, the start point for the following was the initiation of dialysis, the event of interest was patient ́s death, the Kaplan-Meier method was used to determine one year and five year survival; and Cox regression with Royston-Parmar model was used to analyze the factors that influence survival. Results. The study included 7088 patients, one and five-years survival was 79.5 % (CI 95 %: 78.6-80.5) and 50.6 % (CI 95 %: 49.1-52.1) respectively. The Cox regression for age of treatment initiation resulted in a hazard ratio of 1.02 (CI 95 %: 1.01-1.02), while for farmers, the hazard ratio was 1.09 (CI 95 %: 1.00-1.18), for hypertensive etiology the hazard ratio was 0.7 (CI 95 %: 0.64-0.78). Conclusion. Data suggest that age of treatment initiation, and jobs related to agriculture were associated with less five year survival in dialysis patients.

Análise longitudinal dos parâmetros ventilatórios e escore SOFA de pacientes com COVID-19 hospitalizados em uma UTI no Sul do Brasil / Longitudinal analysis of ventilatory parameters and SOFA score of patients with COVID-19 hospitalised in an ICU in southern Brazil

Introdução: embora o Coronavírus da Síndrome Respiratória Aguda Grave 2 (SARS-CoV-2) seja mais conhecido por causar patologias respiratórias substanciais, o vírus também pode resultar em várias manifestações extrapulmonares, sobretudo nas alas de cuidados intensivos. Frente a essas implicações multissistêmicas, a monitoração do suporte ventilatório e utilização do escore Sequential Organ Failure Assessment (SOFA) foram fundamentais no manejo do paciente crítico com COVID-19 nas Unidades de Terapia Intensiva (UTIs) durante a pandemia. Objetivo: esse estudo pretende analisar os parâmetros ventilatórios e escore SOFA de pacientes com COVID-19 numa UTI no sul do Brasil e as principais complicações ocasionadas. Metodologia: foi realizado um estudo de coorte retrospectivo que analisou prontuários de pacientes com diagnóstico de COVID-19 na UTI do Hospital Nossa Senhora da Conceição, no estado de Santa Catarina, entre março de 2020 a dezembro de 2021. Resultados: foram incluídos 448 pacientes, com média de idade de 58,5 (±15,1) anos, mediana de internação de 15 (9-24) dias e média de ventilação mecânica de 15 (±8,7) dias, evoluindo para óbito 63,3%. Durante a internação, 86,4% das pessoas sofreram complicações, dentre as mais prevalentes Insuficiência Renal Aguda (46,8%) seguida por Pneumonia Associada à Ventilação (41,9%) e Choque séptico (22%). Na evolução clínica, o escore SOFA e a relação da pressão parcial de oxigênio pela fração de oxigênio inspirado (PaO2/FiO2) foram fatores de desfecho desfavorável nas três semanas de internação, com SOFA ≥ 5 e relação PaO2/FiO2 < 200. Além disso, 3 dos 6 componentes do SOFA (renal, respiratório e coagulação) tiveram relação com a ocorrência de complicações. Conclusão: o escore SOFA e a relação PaO2/FiO2 tiveram relação no prognóstico de pacientes com COVID-19 durante as três semanas de internação na UTI. Além disso, o SOFA se mostrou um possível indicador de complicações intra-hospitalares durante a evolução clínica.

Introduction: although Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is best known for causing significant respiratory pathologies, the virus can also result in various extrapulmonary manifestations, particularly in intensive care wards. Faced with these multisystem implications, monitoring ventilatory support and using the Sequential Organ Failure Assessment (SOFA) score were fundamental in managing critically ill patients with COVID-19 in Intensive Care Units (ICUs) during the pandemic. Objective: this study will analyse the ventilatory parameters and SOFA score of patients with COVID-19 in an ICU in southern Brazil and the main complications caused. Methodology: a retrospective cohort study was carried out that analysed medical records of patients diagnosed with COVID-19 in the ICU of Hospital Nossa Senhora da Conceição, in the state of Santa Catarina, between March 2020 and December 2021. Results: 448 patients were included, with a mean age of 58.5 (±15.1) years, a median hospital stay of 15 (9-24) days, and mean mechanical ventilation of 15 (±8.7) days, with 63.3% dying. During hospitalisation, 86.4% of people suffered complications, among the most prevalent Acute Renal Failure (46.8%), followed by Ventilation Associated Pneumonia (41.9%) and Septic Shock (22%). In the clinical evolution, the SOFA score and the ratio of partial pressure of oxygen to the fraction of inspired oxygen (PaO2/FiO2) were factors of unfavourable outcome in the three weeks of hospitalisation, with SOFA ≥ 5 and PaO2/FiO2 ratio < 200. In addition, three of the six components of the SOFA (renal, respiratory and coagulation) were related to the occurrence of complications. Conclusion: the SOFA score and the PaO2/FiO2 ratio were related to the prognosis of patients with COVID-19 during the three weeks of ICU stay. Furthermore, the SOFA proved to be a possible indicator of in-hospital complications during clinical evolution.

Colestasis intrahepática drepanocítica a propósito de un casoy revisión de la literatura / Sickle cell intrahepatic cholestasis regarding a case and reviewof the literature

La enfermedad de células falciformes (ECF) o anemia drepanocítica, es el trastorno hereditario más frecuente en los glóbulos rojos, y la enfermedad con más complicaciones en diferentes órganos, lo que provoca múltiples presentaciones de una misma enfermedad., se hace revisión literatura sobre ECF y colestasis intrahepática drepanocítica, y se describe un caso presentado en el Hospital General y de Especialidades Nuestra Señora de la Altagracia de Higüey Republica Dominicana en el año 2022. Es un varón de 24 años, con diagnóstico de ECF, que se complicó con una colestasis intrahepática drepanocítica muy severa que se manejó con hemodiálisis. El objetivo de publicar este caso es revisar la información respecto a la incidencia y la morbimortalidad de esta complicación, teniendo en cuenta que fue tratado por un equipo multidisciplinario usando la hemodiálisis como alternativa terapéutica(AU)

Sickle cell disease (SCD) or sickle cell anemia is the most common hereditary disorder in red blood cells, and the disease with the most complications in different organs, which causes multiple presentations of the same disease. Literature review on SCD is made and sickle cell intrahepatic cholestasis,and a case presented at the Hospital General y de Especialidades Nuestra Señora de la Altagracia de Higüey in the Dominican Republic in 2022 is described. Very severe sickle cell intrahepatic disease that was managed with hemodialysis. The purpose of publishing this case is to review the information regarding the incidence and morbidity and mortality of this complication,taking into account that it was treated by a multidisciplinary team using hemodialysis as a therapeutic alternative(AU)

Enfoque multidisciplinario en la atención de pacientes con enfermedad renal crónica. Una revisión narrativa / A multidisciplinary approach in the evaluation of patients with chronic renal disease.A narrative review

La enfermedad renal crónica (ERC) es un importante problema de salud pública. En el Perú al momento no existe un programa nacional de salud renal. Existe evidencia que el modelo multidisciplinario de atención en ERC mejora la calidad de atención y ha mostrado que enlentece la progresión de ERC y disminuye la mortalidad por todas las causas. Aunque aún hay puntos controversiales, como, por ejemplo, desde que nivel de tasa de filtración glomerular se debería iniciar el manejo multidisciplinario, es una práctica que ha mejorado la atención y el seguimiento de los pacientes renales. Sin embargo, se requiere para su implementación recursos financieros y profesionales y una capacidad organizativa del sistema de salud, que quizás en nuestro país se convierte en un reto.

SUMMARY Chronic renal disease (CRD) is an important public health problem. There is no a national renal health program in Peru. There is evidence that the multidisciplinary model of care in patients with CRD delays progression and reduces all-cause mortality. Although there is no agreement on certain topics, such as at which glomerular filtration rate should the multidisciplinary team work, it is clear that outcomes are improved. Human and financial resources are needed to implement this approach.

Grupo multifamiliar em transtornos alimentares durante a primeira onda da pandemia de covid-19: transição para a modalidade online / Multifamily group on eating disorders during the first wave of the covid-19 pandemic: transitioning to the online modality / Grupo multifamiliar de trastornos alimentarios durante la primera ola de la pandemia de la covid-19: transición a la modalidad en línea

As restrições impostas pela pandemia de covid-19 levaram os serviços de saúde a reorganizarem seu funcionamento, ajustando-se à modalidade remota. A transição repentina e sem o devido preparo técnico impôs desafios adicionais para usuários e profissionais. Para aprimorar as estratégias assistenciais, torna-se imprescindível dar voz aos usuários dos serviços, para que narrem suas experiências e possam manifestar suas facilidades e dificuldades com essa passagem. Este estudo tem como objetivo investigar como os principais cuidadores familiares de pessoas com transtornos alimentares vivenciaram a transição do grupo de apoio para o formato remoto e identificar vantagens e desvantagens percebidas nesse modelo. Estudo clínico-qualitativo, exploratório, realizado em um serviço de atendimento especializado de um hospital terciário. O cenário investigado foi o grupo de apoio psicológico aberto a familiares que, desde o início da pandemia de covid-19, passou a ser oferecido na modalidade online. Participaram do estudo cinco mães e três pais presentes em 13 sessões grupais consecutivas. Entrevistas individuais foram aplicadas com a Técnica do Incidente Crítico logo após o término de cada encontro grupal, totalizando 26 entrevistas audiogravadas, transcritas e submetidas à análise temática. A transição para o online foi vivenciada pelos participantes como um recurso válido para permitir que o grupo funcionasse em tempos de grave crise sanitária. Como vantagens, foram mencionadas: a continuidade do cuidado, maior acessibilidade e facilidade em relação à logística da participação. Como limitações do formato online, foram destacadas: nem todos os familiares contam com conexão de internet de qualidade e possível dificuldade para manusear a tecnologia digital. Apesar dos desafios impostos pela súbita mudança para a modalidade online, na perspectiva dos usuários do serviço os esforços de adaptação foram bem-sucedidos, possibilitando a continuidade do cuidado à saúde mental.(AU)

The constraints imposed by the COVID-19 pandemic led health services to reorganize their operation, adjusting to the online modality. The sudden and unprepared technical transition has imposed additional challenges for both users and professionals. To improve care strategies, it is essential to give voice to services users, so that they can narrate their experiences and express their facilities and difficulties with this transition. This study aims to investigate how main family caregivers of people with eating disorders experienced the transition of the support group to the remote modality and to identify perceived advantages and disadvantages in this model. This is a clinical-qualitative, exploratory study carried out in a specialized care service of a tertiary hospital. The investigated setting was the psychological support group open to family members, which since the beginning of the COVID-19 pandemic has been offered online. Five mothers and three fathers who attended 13 consecutive group sessions participated in the study. Individual interviews were carried out with the Critical Incident Technique shortly after the end of each group meeting with all members, totaling 26 audio-recorded interviews. Data were subjected to thematic analysis. Transition was experienced as a valid resource to maintain the group active in times of a severe health crisis. As advantages of the remote modality were mentioned: continuity of care, greater accessibility, and ease in relation to the logistics of participation. As limitations of the online format were highlighted: not everyone has a good-quality connection to the internet, and difficulty in handling the digital technology. Despite the challenges imposed by the sudden shift to the online modality, from the service users' perspective the adaptation efforts were successful, enabling continuity of mental health care.(AU)

Las limitaciones que impuso la pandemia de la COVID-19 llevaron a los servicios sanitarios a reorganizar su funcionamiento adaptándose a la modalidad remota. El súbito cambio y sin la preparación técnica adecuada implicó retos adicionales a los usuarios y profesionales. Para mejorar las estrategias de atención es fundamental dar voz a los usuarios de los servicios, para que puedan narrar sus experiencias y expresar sus facilidades y dificultades con esta transición. Este estudio pretende investigar cómo han vivido los cuidadores de personas con trastornos alimentarios la transición del grupo de apoyo presencial al formato remoto e identificar las ventajas y desventajas percibidas en este modelo. Se trata de un estudio clínicocualitativo, exploratorio. El escenario investigado fue el grupo de apoyo psicológico abierto a los familiares en la modalidad en línea. Cinco madres y tres padres participaron en 13 sesiones de grupo consecutivas. Se realizaron entrevistas individuales con la técnica de incidentes críticos inmediatamente después de cada reunión del grupo, con un total de 26 entrevistas grabadas en audio, transcritas y sometidas a análisis temático. La transición a la red fue experimentada como un recurso válido para permitir que el grupo funcione en tiempos de crisis sanitaria grave. Las ventajas de la modalidad remota fueron conexión segura en tiempos de confinamiento físico, continuidad, mayor accesibilidad y facilidad en relación con la logística de la participación. Las limitaciones del formato en línea fueron la falta de una conexión de calidad a Internet y la posible dificultad de manejo de la tecnología digital. A pesar de las dificultades impuestas por el cambio repentino a la modalidad en línea, desde la perspectiva de los usuarios del servicio los esfuerzos de adaptación fueron un éxito, lo que permitió seguir con la atención de salud mental.(AU)

The Efficacy and Safety of Daratumumab-Based Regimen in Treatment of Multiple Myeloma Patients with Renal Impairment / 中国实验血液学杂志

OBJECTIVE@#To investigate the efficacy and safety of daratumumab in treatment of multiple myeloma (MM) patients with renal impairment (RI).@*METHODS@#The clinical data of 15 MM patients with RI who received daratumumab-based regimen from January 2021 to March 2022 in three centers were retrospectively analyzed. Patients were treated with daratumumab or daratumumab combined with dexamethasone or daratumumab combined with bortezomib and dexamethasone and the curative effect and survival were analyzed.@*RESULTS@#The median age of 15 patients was 64 (ranged 54-82) years old. Six patients were IgG-MM, 2 were IgA-MM,1 was IgD-MM and 6 were light chain MM. Median estinated glomerular filtration rate (eGFR) was 22.48 ml/(min·1.73 M2). Overall response rate of 11 patients with MM was 91% (≥MR), including 1 case of stringent complete response (sCR), 2 cases of very good partial response (VGPR), 3 cases of partial response (PR) and 4 cases of minor response (MR). The rate of renal response was 60%(9/15), including 4 cases of complete response (CR), 1 case of PR and 4 cases of MR. A median time of optimal renal response was 21 (ranged 7-56) days. With a median follow-up of 3 months, the median progression-free survival and overall survival of all patients were not reached. After treatment with daratumumab-based regimen, grade 1-2 neutropenia was the most common hematological adverse reaction. Non-hematological adverse reactions were mainly infusion-related adverse reactions and infections.@*CONCLUSION@#Daratumumab-based regimens have good short-term efficacy and safety in the treatment of multiple myeloma patients with renal impairment.

Impact of different types of heart failure on long-term renal prognosis in patients with renal insufficiency and heart failure / 中华肝脏病杂志

Objective: To investigate the effects of different types of heart failure on long-term renal prognosis in patients with renal insufficiency and heart failure. Methods: The patients with renal insufficiency [baseline estimated glomerular filtration rate < 60 ml·min-1·(1.73 m2)-1] and heart failure followed-up for more than 2 years and hospitalized in Beijing Anzhen Hospital, Capital Medical University from January 1, 2018 to June 30, 2019 were enrolled in this retrospective cohort study. The patients were divided into three groups based on the baseline left ventricular ejection fraction (LVEF): heart failure with reduced ejection fraction (HFrEF, LVEF < 40%) group, heart failure with mildly reduced ejection fraction (HFmrEF, 40% ≤ LVEF < 50%) group, and heart failure with preserved ejection fraction (HFpEF, LVEF ≥ 50%) group. Clinical data were collected and endpoint events (adverse renal outcome: the composite outcome of all-cause death or worsening renal function) were recorded through the electronic medical record system. Kaplan-Meier survival curve was used to analyze the incidence of endpoint events of different heart failure subgroups. Cox regression model was performed to analyze the risk factors of endpoint events. Results: A total of 228 patients with renal insufficiency complicated with heart failure were included, with age of (68.14±14.21) years old and 138 males (60.5%). There were 85 patients (37.3%) in the HFrEF group, 40 patients (17.5%) in the HFmrEF group, and 103 patients (45.2%) in the HFpEF group. There were statistically significant differences in age, proportion of age > 65 years old, sex distribution, systolic blood pressure, pulmonary artery pressure, serum sodium, serum calcium, hemoglobin, serum cholesterol, low-density lipoprotein cholesterol, serum uric acid, troponin I, hypersensitive C-reactive protein, LVEF, ventricular septal thickness, left ventricular end-diastolic diameter, B-type natriuretic peptide, estimated glomerular filtration rate, and proportions of using beta blockers, using spirolactone, myocardial infarction, hypertension, cardiomyopathy and atrial fibrillation (all P < 0.05). During the median follow-up of 36.0 (28.0, 46.0) months, 73 patients (32.0%) had adverse renal outcomes. The total incidences of adverse renal outcomes were 32.9% (28/85) in the HFrEF group, 35.0% (14/40) in the HFmrEF group, and 30.1% (31/103) in the HFpEF group. Kaplan-Meier survival curve showed that there was no significant difference in the incidence of endpoint events among the three groups (log-rank test χ2=0.17, P=0.680). Multivariate Cox regression analysis showed that HFpEF (HFrEF as reference, HR=2.430, 95% CI 1.055-5.596, P=0.037) was an independent influencing factor of endpoint events. Conclusions: The long-term renal prognosis of patients with renal insufficiency and heart failure is poor. Compared with HFrEF, HFpEF is an independent risk factor of poor long-term renal prognosis in renal insufficiency patients with heart failure.

Ameliorating effects of ethanol extract of root bark of Salacia nitida on blood electrolyte and renal perturbations in Plasmodium berghei-infected mice

Abstract Malaria, a disease of public health concern is a known cause of kidney failure, and dependence on herbal medicines for its treatment is increasing due to the high cost of drugs. So this study is designed to evaluate the ameliorating effect of ethanol extract from Salacia nitida root bark on electrolyte and renal perturbations in Plasmodium berghei-infected mice. Thirty malariainfected mice divided into five groups of six mice each and another group of six uninfected mice were used for the study. 280, 430, and 580 mg/kg of extract were given to infected mice in groups B, C, and D, 4 mg/kg of artesunate given to group E mice, and 4 ml/kg of physiological saline given to group A and uninfected group F mice for five days. Serum Na+, K+, HCO3, Cl-, TB, urea, creatinine, BUN concentrations, and BUN/creatinine ratio were determined using standard methods. Results showed significant increases (p < 0.05) in Na+, K+, and HCO3 and decreases in Cl-, TB, urea, creatinine, BUN, and BUN/creatinine ratio in the infected treated mice in groups B - E. This study showed that ethanol extract of S. nitida root bark is efficient in the treatment of renal disorders and blood electrolyte perturbations

Risk of acute kidney injury and cost-effectiveness analysis comparing vancomycin and linezolid for the treatment of pediatric patients infected with Gram-positive bacteria / Risco de lesão renal aguda e custo-efetividade comparando vancomicina e linezolida para o tratamento de pacientes pediátricos infectados por bactérias Gram-positivas

Objective: This study aimed to compare the occurrence of acute kidney injury (AKI) in pediatric patients who used vancomycin (VAN) or linezolid (LNZ) to treat Gram-positive coccus (GPC) infections and to assess which treatment (VAN or LNZ) is the most cost-effective considering a pediatric hospital perspective. Methods: A retrospective cohort was performed to evaluate the occurrence of nephrotoxicity in pediatric patients without previous AKI, with GPC infections that used LNZ, or VAN monitored by serum VAN levels. Initially, descriptive analysis and Fisher and chisquare test were performed for this comparison. Then, a cost-effectiveness analysis was conducted through a decision tree model. The outcomes of interest were the rate of AKI related to the drug and the rate of admission to the intensive care unit (ICU) and cure. Results: In patients without previous acute kidney injury (AKI), 20% developed nephrotoxicity associated with VAN versus 9.6% in the LNZ group (p = 0.241). As there was no difference in nephrotoxicity between VAN andlinezolid (LNZ), vancomycin (VAN) monitored by serum VAN levels can optimize and rationalize the treatment. The nephrotoxicity risk criterion should not guide the prescription for LNZ. Furthermore, the average global cost of treatment with VAN was approximately R$ 43,000, while for LNZ, it was R$ 71,000. Conclusion: VAN was considered dominant (lower cost and greater effectiveness) over LNZ for treating patients with GPC infection.

Objetivo: Este estudo objetivou comparar a ocorrência de lesão renal aguda (LRA) em pacientes pediátricos que usaram vancomicina (VAN) ou linezolida (LNZ) para tratar infecções por cocos Gram-positivos (CGP) e avaliar qual tratamento (VAN ou LNZ) é o mais custo-efetivo considerando a perspectiva de um hospital pediátrico. Métodos: Foi realizada uma coorte retrospectiva para avaliar a ocorrência de nefrotoxicidade em pacientes pediátricos sem LRA prévia, com infecções por CGP que utilizaram LNZ ou VAN, combinada com vancocinemia. Para essa comparação, inicialmente foram realizados análise descritiva e testes de Fisher e qui-quadrado. Em seguida, foi realizada uma análise de custo-efetividade por meio de um modelo de árvore de decisão. Os desfechos de interesse foram a taxa de LRA relacionada ao medicamento e a taxa de internação em unidade de terapia intensiva e cura. Resultados: Nos pacientes sem LRA prévia, 20% deles desenvolveram nefrotoxicidade associada à VAN versus 9,6% no grupo LNZ (p = 0,241). Como não houve diferença na nefrotoxicidade entre VAN e LNZ, a VAN combinada com a vancocinemia pode otimizar e racionalizar o tratamento, e a prescrição de LNZ não deve ser guiada pelo critério de risco de nefrotoxicidade. Além disso, o custo médio global do tratamento com VAN foi de aproximadamente R$ 43.000, enquanto para LNZ foi de R$ 71.000. Conclusão: Assim, a VAN foi considerada dominante (menor custo e maior eficácia) sobre a LNZ para o tratamento de pacientes com infecção por CGP.

Repercussions of COVID-19 in hemodialysis patients: a systematic review / Repercusiones del COVID-19 en pacientes en hemodiálisis: Una revisión sistemática / Repercussões da COVID-19 em pacientes em hemodiálise: uma revisão sistemática

ntrodution: The immunosuppressive state of patients with CKD increases their risk of developing poor clinical outcomes if they acquire COVID-19 infection. Objetive: To identify the scientific evidence about the repercussions of COVID-19 in hemodialysis patients. Materials and méthods: A systematic review was conducted in this study. The databases Cochrane Library, Web of Science, Science Direct, PubMed, and Virtual Health Library were searched to identify relevant studies. The methodological quality of the studies was assessed using the adapted Downs and Black checklist. The review adhered to the PRISMA guidelines. Results:A total of 16 articles were included after the screening process. All articles had a methodological quality higher than 66.8%. The most common repercussions of COVID-19 in hemodialysis patients were the increased mortality rate (75%), development of typical signs and symptoms of the disease such as fever, cough, dyspnea, and fatigue (68.75%), lymphopenia (68.75%), progression to severe acute respiratory syndrome (56.25%), need for mechanical ventilation (50%), and admission to intensive (50%). Conclusión: The hemodialysis patients are more susceptible to COVID-19 infection and, when infected by SARS-CoV-2, these patients have more adverse clinical outcomes, more serious diseases, higher mortality, and worse prognosis than the general population. The repercussions of COVID-19 in hemodialysis patients reveal a need for preventive nursing care in hemodialysis clinics.

Introducción: El estado de inmunosupresión de los pacientes con enfermedad renal crónica (ERC) aumenta su riesgo de obtener resultados clínicos desfavorables si llegaran a contraer COVID-19. Objetivo: Identificar la evidencia científica acerca de las repercusiones que tiene el COVID-19 en los pacientes en hemodiálisis. Materiales y Métodos: Se realizó una revisión sistemática en este estudio. Se hizo una búsqueda en las bases de datos Cochrane Library, Web of Science, Science Direct, PubMed y Virtual Health Library para identificar estudios relevantes. La calidad metodológica de los estudios se evaluó mediante la lista de chequeo adaptada por Downs y Black. La revisión siguió los lineamientos de la declaración PRISMA. Resultados:Tras el proceso de selección se incluyeron un total de 16 artículos en la revisión. Todos los artículos obtuvieron una calidad metodológica superior a 66,8%. Las repercusiones más comunes del COVID-19 en los pacientes en hemodiálisis fueron el aumento de la tasa de mortalidad (75%), el desarrollo de signos y síntomas típicos de la enfermedad como fiebre, tos, disnea y fatiga (68,75%), linfopenia (68,75%), progresión a un síndrome respiratorio agudo grave (56,25%), necesidad de ventilación mecánica (50%) e ingreso a cuidados intensivos (50%). Conclusiones: Los pacientes en hemodiálisis son más susceptibles a contraer COVID-19 y, cuando contraen el SARS-CoV-2, tienen resultados clínicos más adversos, enfermedades más graves, mayor mortalidad y peor pronóstico que la población general.

Introdução: O estado imunossupressor dos pacientes com CKD aumenta seu risco de desenvolver maus resultados clínicos se eles adquirirem a infecção COVID-19. Objetivo: Identificar as evidências científicas sobre as repercussões da COVID-19 em pacientes com hemodiálise. Materiais e Métodos: Uma revisão sistemática foi conduzida neste estudo. As bases de dados Cochrane Library, Web of Science, Science Direct, PubMed e Virtual Health Library foram pesquisadas para identificar estudos relevantes. A qualidade metodológica dos estudos foi avaliada utilizando a lista de verificação Downs e Black adaptada. A revisão seguiu as diretrizes do PRISMA. Resultados: Um total de 16 artigos foram incluídos após o processo de triagem. Todos os artigos tinham uma qualidade metodológica superior a 66,8%. As repercussões mais comuns da COVID-19 em pacientes de hemodiálise foram o aumento da taxa de mortalidade (75%), desenvolvimento de sinais e sintomas típicos da doença como febre, tosse, dispnéia e fadiga (68,75%), linfopenia (68,75%), progressão para síndrome respiratória aguda grave (56,25%), necessidade de ventilação mecânica (50%) e admissão a intensivo (50%). Conclusões: Os pacientes em hemodiálise são mais suscetíveis à infecção por COVID-19 e, quando infectados pela SRA-CoV-2, estes pacientes têm resultados clínicos mais adversos, doenças mais graves, maior mortalidade e pior prognóstico do que a população em geral. As repercussões da COVID-19 em pacientes de hemodiálise revelam uma necessidade de cuidados preventivos de enfermagem em clínicas de hemodiálise.

Capacitación en reemplazo renal continuo, primera experiencia en el Sanatorio Allende. Relato de experiencia / Training in continuous renal replacement,first experience at the Allende Sanatorio. Experience report

La Insuficiencia Renal Aguda (IRA), es sin dudas una de las complicaciones más frecuentes que puede presentar el paciente crítico; la cual se define como la disminución en la capacidad que tienen los riñones para eliminar productos nitrogenados de desechos. En las unidades de cuidados críticos la causa de las mismas puede ser multifactorial y se relaciona con el fallo multiorgánico. El presente trabajo es un relato de experiencia, un trabajo descriptivo de experiencias de la terapia en reemplazo renal continuo, acompañado además de recolección bibliográfica, cuyo objetivo principal es la capacitación en el tratamiento de las insuficiencias renales en los pacientes críticos con la terapia de reemplazo renal continuo. Para abordar esta temática, se conformó un equipo multidisciplinario en el mes de Abril del año 2021, entre los servicios de Unidad de Cuidados Crítico y el Servicio de Nefrología, en donde se desarrolló un plan de capacitación de manera virtual para abordar el tratamiento a los pacientes con fallo renal, el cual contó además con la disertación y capacitación de personal altamente calificados en el tema, para posteriormente realizar un entrenamiento teórico-práctico en el servicio de Hemodiálisis del Sanatorio Allende de Nueva Córdoba, en la técnica de conexión y desconexión de catéteres de hemodiálisis, en el cual asistieron un total de 26 enfermeros del área de Terapia Intensiva de ambas sedes con el fin de aprender la técnica específica que se aplicará en los pacientes que serán sometidos a hemofiltración venovenosa continua[AU]

Acute Renal Insufficiency (AKI) is undoubtedly one of the most frequent complications that critical patients may present; which is defined as the decrease in the ability of the kidneys to eliminate nitrogenous waste products. In critical care units, their cause can be multifactorial and is related to multiorgan failure.The present work is a report of experiences, a descriptive work of experiences of continuous renal replacement therapy, accompanied by a bibliographic collection, whose main objective is training in the treatment of renal insufficiency in critical patients with replacement therapy. continuous kidney. To address this issue, a multidisciplinary team was formed in April 2021, between the services of the Critical Care Unit and the Nephrology Service, where a training plan was developed virtually to address the treatment of patients. patients with kidney failure, which also included the dissertation and training of highly qualified personnel on the subject, to subsequently carry out theoretical-practical training in the Hemodialysis service of the Allende Sanatorium in Nueva Córdoba, in the connection and disconnection technique of hemodialysis catheters, which was attended by a total of 26 nurses from the Intensive Care area of both sites in order to learn the specific technique that will be applied to patients who will undergo continuous venovenous hemofiltration[AU]

A Insuficiência Renal Aguda (LRA) é, semdúvida, uma das complicaçõesmaisfrequentes que os pacientes críticos podemapresentar; que é definida como a diminuição da capacidade dos rins de eliminar produtosresiduais nitrogenados. Em unidades de terapia intensiva, sua causa pode ser multifatorial e está relacionada à falência de múltiplos órgãos. O presente trabalho é um relato de experiências, umtrabalhodescritivo de experiências de terapia renal substitutiva contínua, acompanhado de umlevantamento bibliográfico, cujo objetivo principal é a capacitação no tratamento da insuficiência renal em pacientes críticos com terapia substitutiva renal. Para abordar essaquestão, uma equipe multidisciplinar foi formada em abril de 2021, entre os serviços da Unidade de Terapia Intensiva e o Serviço de Nefrologia, onde foi desenvolvido um plano de treinamento virtualmente para abordar o tratamento de pacientes com insuficiência renal, que incluiutambém o dissertação e treinamento de pessoal altamente qualificado no assunto, para posteriormente realizar treinamento teórico-prático no serviço de Hemodiálise do Sanatório Allende em Nueva Córdoba, na técnica de conexão e desconexão de cateteres de hemodiálise, que contoucom a participação de um total de 26 enfermeiros da área de Terapia Intensiva de ambos os locais para conhecer a técnica específica que será aplicada aos pacientes que ser ãosubmetidos à hemofiltração venovenosa contínua[AU]

Preeclampsia de presentación grave asociada a hígado graso agudo del embarazo / Severe preeclampsia associated with acute fatty liver of pregnancy / Pré-eclâmpsia grave associada a fígado gorduroso agudo da gravidez

La preeclampsia se puede asociar a una patología poco frecuente como es el hígado graso agudo del embarazo. Se reporta el caso clínico de una paciente de 35 años, tercigesta, cursando embarazo gemelar que presenta preeclampsia con elementos de gravedad, asociada a hígado graso agudo del embarazo. Se realiza diagnóstico y tratamiento precoz de ambas patologías, presentando buena evolución materno-fetal.

Preeclampsia can be associated with acute fatty liver of pregnancy, a rare disease. This report describes the case of a 35-year-old patient, gravida 3, pregnant with twins, who presented with severe pre-eclampsia associated with acute fatty liver of pregnancy. Early diagnosis and treatment of both pathologies was performed, resulting in good maternal-fetal evolution.

A pré-eclâmpsia pode estar associada a uma patologia rara, como o fígado gorduroso agudo da gravidez. Neste relato, apresentamos uma paciente de 35 anos, terciária, em gestação gemelar, apresentando pré-eclâmpsia grave, associada a esteatose hepática aguda na gestação. É realizado diagnóstico e tratamento precoces de ambas as patologias, apresentando boa evolução materno-fetal.

Análisis geográfico de nefropatía diabética e insuficiencia renal en el primer nivel de atención, IMSS 2019 / Geographic analysis of diabetic nephropathy and renal insufficiency in the primary care, IMSS 2019

Introducción: en un contexto donde la prevalencia de diabetes mellitus e hipertensión arterial ha aumentado significativamente en años recientes, las enfermedades renales adquieren importancia por la potencial demanda de atención especializada y de recursos en salud que requieren. Objetivo: analizar la distribución geográfica de la nefropatía diabética (ND) y la insuficiencia renal (IR) con base en las consultas otorgadas en unidades de primer nivel del Instituto Mexicano del Seguro Social (IMSS) durante 2019, para identificar las unidades médicas con mayor carga de atención. Material y métodos: estudio ecológico-exploratorio en el que se estimaron indicadores por cada mil derechohabientes en relación a las consultas otorgadas por ND e IR según la ocasión de servicio, la unidad médica familiar (UMF) de primer nivel y la representación. Se utilizó estadística espacial para analizar dichos indicadores. Resultados: el 45% de las consultas otorgadas fue por ND y el 52.4% por IR. La mayor carga por ND se registró en la UMF No. 50 de Cd. Juárez (Chihuahua) y en la No. 49 Gabino Barreda (Veracruz Sur), con 1.7 consultas de primera vez y 148.3 subsecuentes por mil derechohabientes, respectivamente. Mientras que en la UMF No. 40 Manlio Fabio Altamirano y No. 25 Cotaxtla, en Veracruz Norte, la mayor carga fue por IR, con 4.9 consultas de primera vez y 134.2 subsecuentes por mil derechohabientes, respectivamente. Conclusiones: los resultados podrían contribuir al fortalecimiento de las unidades médicas que así lo requieran y en la distribución eficiente de los recursos disponibles para atender la demanda de servicios de salud de ND e IR en el IMSS

Background: In a context where the prevalence of Diabetes Mellitus and Hypertension has increased significantly in recent years, kidney diseases become important for the potential demand for specialized health care and resources required. Objective: To analyze the geographical distribution of Diabetic Nephropathy (DN) and Renal Insufficiency (RI) based on the medical consultations given in first-level units of IMSS during 2019, to identify the medical units with the highest burden of care. Material and methods: Ecological-exploratory study in which indicators were estimated for every thousand persons in relation to medical consultations given by ND and RI according to service time, first-level medical unit (UMF) and representation to analyze the magnitude and geographic distribution at the national level. Results: 45% of medical consultations were by ND and 52.4% by RI. The highest burden per DN was registered in UMF No. 50 Cd. Juarez (Chihuahua) and No. 49 Gabino Barreda (Veracruz Sur), with 1.7 first-time medical consultations and 148.3 subsequent medical consultations per 1,000 persons, respectively. While in UMF No. 40 Manlio Fabio Altamirano and No. 25 Cotaxtla, in Veracruz Norte, the highest burden was for RI, with 4.9 first-time medical consultations and 134.2 subsequent medical consultations per 1000 persons, respectively. Conclusions: The results could contribute to strengthening of medical units where it is necessary and the efficient allocation of resources available to meet the demand for health services of ND and RI in IMSS.

Sobrevida a largo plazo de pacientes con infarto agudo del miocardio en presencia de oclusiones crónicas totales en vaso no culpable / Prognostic value of the presence of a chronic total occlusion in patients with acute myocardial infarction

BACKGROUND: The presence of a chronic total occlusion (CTO) in a non-infarct-related artery in patients with acute myocardial infarction (AMI), may be a sign of bad prognosis. AIM: To estimate the long-term survival of patients with AMI who were studied with coronarography during 2013-2014 who had one or more CTO in a non-infarct-related artery. MATERIAL AND METHODS: Review of coronary angiograms performed between 2013 and 2014 to patients with an AMI. Patients were grouped as having or not a CTO in a non-infarct-related artery. Their medical records were reviewed, and mortality was determined requesting their death certificates. RESULTS: Of 993 patients with AMI under-going coronarography, 233 (23.5%) had at least one CTO. Patients with CTO were older (66 and 62 years respectively). They also had a higher prevalence of hypertension, diabetes mellitus (DM), kidney failure and moderate to severe systolic ventricular dysfunction. The independent predictors of mortality were CTO, age, DM and kidney failure. Survival at an average follow-up period of 57 months was significantly higher in patients without CTO (89.5 and 80.3% respectively, p < 0.01). CONCLUSIONS: The presence of CTO in patients with acute myocardial infarction is associated with a higher frequency of cardiovascular risk factors and lower long-term survival.

Downer cow syndrome causing rhabdomyolysis and acute renal failure in a 17-month-old Guzerá heifer / Síndrome da vaca caída causando rabdomiólise e insuficiência renal aguda em uma novilha Guzerá de 17 meses

The downer cow syndrome (DCS) is characterized by an alert cow showing inability or reluctance to stand for 12 hours or more. This paper reported clinical, laboratory, and pathological findings in a Guzerá heifer with rhabdomyolysis, pigmenturia and acute renal failure following DCS. A 17-month-old Guzerá heifer was transported via a 350-km ride in a truck and showed sternal recumbency and severe difficulty in standing and walking. Neurological examination was unremarkable, and the heifer presented normal response to cranial nerves and spinal cord tests. Rectal palpation revealed a 5-month gravid uterus. No other abnormalities were noted in the pelvis or around the coxofemoral joints. Biochemical abnormalities included extremely high muscular enzyme activities (creatine phosphokinase and aspartate aminotransferase) and high creatinine levels. Urinalysis revealed blackish and cloudy urine, proteinuria, and a positive occult blood test. Spinal cord ultrasonography showed no abnormalities. This report highlighted an uncommon clinical presentation (myoglobinuria) and pathological findings in a heifer with DCS as a consequence of severe compressive muscle damage. Practitioners and producers must be aware of the risk of careless road transportation for long distances of cattle, especially obese cows, avoiding unnecessary suffering and expenses due to DCS.

A síndrome da vaca caída (SVC) é caracterizada por um bovino alerta que mostra incapacidade ou relutância em permanecer em estação por 12 horas ou mais. O objetivo deste trabalho é relatar os achados clínicos, laboratoriais e patológicos em uma novilha Guzerá com rabdomiólise, pigmentúria e insuficiência renal aguda após a SVC. Uma novilha da raça Guzerá, de 17 meses de idade, foi transportada de caminhão por 350 km e apresentou decúbito esternal, grande dificuldade para assumir estação e caminhar. O exame neurológico não demonstrou alterações, e a novilha possuía resposta normal aos testes de nervos cranianos e medula espinhal. A palpação retal revelou útero grávido de cinco meses. Nenhuma outra anormalidade foi observada na pelve ou na região das articulações coxofemorais. As anormalidades bioquímicas incluíram atividades de enzimas musculares (creatina fosfoquinase e aspartato aminotransferase) extremamente aumentadas e níveis elevados de creatinina. A urinálise revelou urina enegrecida e turva, proteinúria e teste de sangue oculto positivo. O exame ultrassonográfico da medula espinhal não apresentou anormalidades. Este relato evidencia uma apresentação clínica (mioglobinúria) e achados patológicos incomuns em uma novilha com SVC em consequência de extensa lesão muscular compressiva. Veterinários e produtores devem estar atentos aos riscos do transporte rodoviário descuidado por longas distâncias de bovinos, especialmente vacas obesas, evitando assim sofrimento e despesas desnecessárias decorrentes da SVC.

Analysis of SALL1 gene variant in a boy with Townes-Brocks syndrome without anal atresia / 中华医学遗传学杂志

OBJECTIVE@#To explore the genetic basis for a child presented with renal failure and multi-cystic dysplastic kidney without anal atresia.@*METHODS@#Peripheral blood sample of the child and his parents were collected and subjected to whole exome sequencing. Candidate variant was verified by Sanger sequencing.@*RESULTS@#The 40-day-old infant had presented with vomiting brown matter in a 7 days neonate and was transferred for kidney failure. Clinical examination has discovered renal failure, polycystic renal dysplasia, congenital hypothyroidism, bilateral thumb polydactyly, sensorineural hearing loss and preauricular dermatophyte. Genetic testing revealed that he has harbored a previously unreported c.824delT, p.L275Yfs*10 frameshift variant of SALL1 gene, which was confirmed by Sanger sequencing as de novo.@*CONCLUSION@#The patient was diagnosed with Townes-Brocks syndrome due to the novel de novo variant of SALL1 gene. Townes-Brocks syndrome without anal atresia is rare. Above finding has also enriched the mutational spectrum of the SALL1 gene.

Prevalência de positividade do anticorpo ANCA em pacientes hemodialisados / Prevalence of Positive ANCA Antibody in Patients in Hemodialysis

Objetivo: Estimar a prevalência do anticorpo anticitoplasma de neutrófilos (ANCA) positivo em pacientes submetidos à hemodiálise, assim como também associar essa prevalência às características sociodemográficas e clínicas destes pacientes. Métodos: Estudo transversal realizado em 78 pacientes de uma Clínica de Hemodiálise no Sul de Santa Catarina nos meses de agosto a novembro de 2013. Foi realizada entrevista, coleta de dados em prontuário eletrônico e pesquisa do anticorpo anticitoplasma de neutrófilos por imunofluorescência indireta WAMA em plasma heparinizado. Resultados: A prevalência de anticorpo anticitoplasma de neutrófilos reagente em amostra titulada 1:10 foi de 24,4%, sendo que 10,3% apresentaram padrão c-ANCA e 14,1% apresentaram padrão p-ANCA, do total. Não foram observadas associações com características clínicas e sociodemográficas. Conclusão: Com base na alta prevalência de anticorpo anticitoplasma de neutrófilos positivo encontrada neste estudo, salienta-se a necessidade de mais estudos nesse grupo de pacientes para definição da contribuição deste exame no diagnóstico e prognóstico da doença renal e suas complicações

Objective: To estimate the Antibodies, Antineutrophil Cytoplasmic (ANCA) prevalence in patients submitted to hemodialysis, as well as associate this prevalence to sociodemographic and clinical characteristics of these patients. Methods: Cross-sectional study performed with 78 users from a Hemodialysis Clinic in Southern Santa Catarina on the period from August to November 2013. Interviews, data collection of electronic records and antibodies, antineutrophil cytoplasmic research by WAMA indirect immunofluorescence on heparinized plasma were performed. Results: The prevalence of ANCA reagent 1:10 titrated sample was 24.4%, and 10.3% had c-ANCA pattern and 14.1% had p-ANCA pattern, from total sample. No associations were observed with clinical and sociodemographic characteristics. Conclusions: Based on the high antibodies, antineutrophil cytoplasmic prevalence in this study, and no statistically significant association with clinical and sociodemographic characteristics, we emphasize the need for more studies on this group of patients to determine the contribution of this exam in the diagnosis and prognosis of kidney disease and its complications.

Calcificación miocárdica de etiología multifactorial / Myocardial calcification with multifactorial etiology

En el presente trabajo se describe un caso de muerte súbita en una mujer de 70 años que fallece 20 días después de ser dada de alta tras ingreso por infección urinaria secundaria a litiasis renal complicada con shock séptico e insuficiencia renal y respiratoria. En el corazón se identificó una cardiopatía isquémica crónica y extensas áreas de miocardio calcificado. Además, se exponen los tipos de calcificaciones del miocardio existentes y sus causas; y se analizan aquellos factores que en el caso presentado han podido causar la calcificación del miocardio(AU)

In the present report, we describe a case of sudden death in a 70-year-old woman who died 20 days after been discharged after admission for urinary infection secondary to renal lithiasis complicated with septic shock and renal and respiratory failure. It has been identified chronic ischemic heart disease and extensive areas of calcified myocardium. Also, we review myocardial calfications subtypes and its causes, and we analyze the specifics of the presented case(AU)

Perfil clínico e fatores associados ao óbito de pacientes COVID-19 nos primeiros meses da pandemia / Perfil clínico y factores asociados a la muerte de pacientes COVID-19 en los primeros meses de la pandemia / Clinical profile and factors associated with the death of COVID-19 patients in the first months of the pandemic

RESUMO Objetivo analisar as características individuais, clínicas e os fatores associados à mortalidade de pacientes com COVID-19, em hospital público do estado do Paraná, Brasil. Métodos estudo seccional, retrospectivo, documental (n= 86), com pacientes adultos internados, de março a junho de 2020. Resultados a mortalidade foi de 12,8%, o grupo de maior risco foi de idosos com comorbidades, especialmente, cardiovasculares. A chance de óbito foi 58 vezes maior em idosos, comparada aos adultos, e oito vezes maior naqueles com comorbidades, comparadas aos hígidos. A maioria dos pacientes apresentou sintomatologia respiratória, febre e mialgia. Tratamento à base de antibióticos, anticoagulantes e antivirais, associado ao suporte ventilatório. As principais complicações foram hipóxia, insuficiência renal aguda e infecção secundária. Conclusão e implicações para a prática idosos com comorbidades cardiovasculares que necessitaram de cuidados intensivos apresentaram maior chance de óbito. Os resultados de um dos centros de referência na pandemia possibilitam discutir medidas epidemiológicas adotadas, com ênfase em conceitos restritivos nos primeiros meses.

RESUMEN Objetivo analizar las características individuales, clínicas y los factores asociados a la mortalidad en pacientes con COVID-19 en un hospital público del estado de Paraná. Métodos estudio transversal, retrospectivo, documental (n = 86), con pacientes adultos hospitalizados, de marzo a junio de 2020. Resultados la mortalidad fue del 12,8%, grupo de mayor riesgo para los ancianos con comorbilidades, especialmente enfermedades cardiovasculares. La probabilidad de muerte fue 58 veces mayor en los ancianos en comparación con los adultos y ocho veces mayor en aquellos con comorbilidades en comparación con los sanos. La mayoría de los pacientes presentaban síntomas respiratorios, fiebre y mialgia. Tratamiento a base de antibióticos, anticoagulantes y antivirales, asociado al soporte ventilatorio. Las principales complicaciones fueron hipoxia, insuficiencia renal aguda e infección secundaria. Conclusión e implicaciones para la práctica los ancianos con comorbilidades cardiovasculares que requirieron cuidados intensivos tenían una mayor probabilidad de muerte. Los resultados de uno de los centros de referencia pandémica permiten discutir las medidas epidemiológicas adoptadas, con énfasis en conceptos restrictivos en los primeros meses.

ABSTRACT Objective to analyze the individual and clinical characteristics and the factors associated with mortality in patients with COVID-19, in a public hospital in the state of Paraná, Brazil. Methods a cross-sectional, retrospective, documentary study (n= 86), with adult inpatients, from March to June 2020. Results mortality was 12.8%, the highest risk group was the elderly with comorbidities, especially cardiovascular ones. The chance of death was 58 times higher in the elderly compared to adults, and eight times higher in those with comorbidities compared to the healthy ones. Most patients presented with respiratory symptoms, fever, and myalgia. Treatment was based on antibiotics, anticoagulants and antivirals, associated with ventilatory support. The main complications were hypoxia, acute renal failure, and secondary infection. Conclusion and implications for practice elderly people with cardiovascular comorbidities who required intensive care had a higher chance of death. The results from one of the reference centers in the pandemic make it possible to discuss epidemiological measures adopted, with emphasis on restrictive concepts in the first months.