ABSTRACT
Introducción: en marzo de 2020, en Uruguay se decretó la emergencia sanitaria al detectarse los primeros casos de infección por SARS-CoV-2 (COVID-19). El confinamiento domiciliario voluntario fue una de las medidas de salud pública adoptadas en el control de la pandemia. Objetivo: describir el efecto del confinamiento sobre los hábitos de sueño, alimentación y actividad física de adolescentes de Montevideo y Canelones durante la pandemia de COVID-19. Metodología: encuesta elaborada ad hoc, voluntaria, anónima, online y autoadministrada a adolescentes de 12 a 19 años, usuarios de CASMU, CRAMI, COMECA y Asociación Española, entre el 1 de junio y el 1 de julio de 2020. Se aplicaron cuestionarios validados para evaluar sueño, alimentación y actividad física. Resultados: se encuestaron 465 adolescentes, 70,1% mujeres y 48,2% de adolescencia media. Refirieron permanecer más de 6 horas al día conectados a internet y al celular 58,3% y 42,4%, respectivamente. La convivencia durante el confinamiento resultó agradable en la mayoría. El 76% refirió dormir menos de 9 horas/día. Señaló un consumo adecuado de frutas 6%, verduras 5,8% y lácteos 32,2%. El porcentaje de adolescentes activos descendió de 30,7% previo a la pandemia a 19,7% durante la misma. A la pregunta "¿cuál es la primera palabra que te viene a la mente cuando escuchas pandemia de COVID-19?" la mayoría brindó respuestas negativas. Conclusiones: las medidas de confinamiento no se asociaron con problemas importantes en la convivencia familiar en este grupo de adolescentes. Se observó una profundización de los problemas en los hábitos de alimentación, actividad física, sueño que favorecen el "ambiente obesogénico" y el riesgo de desarrollo de enfermedades crónicas no transmisibles. Resulta relevante considerar el impacto negativo del confinamiento y planificar las medidas preventivas tendientes a mitigar sus efectos.
Introduction: in March 2020, a Health Emergency was decreed in Uruguay when the first cases of the SARS-CoV-2 (COVID 19) infection were detected. Voluntary home confinement was one of the public health measures adopted in theto control the pandemic. Objectives: describe the effects of confinement on sleep, eating and exercise habits of adolescents assisted by private health providers in Montevideo and Canelones during the COVID-19 pandemic. Methodology: ad hoc, voluntary, anonymous, online and self-administered survey to adolescents of 12 to 19 years of age, users of CASMU, CRAMI, COMECA and Asociación Española HMOs, between June 1 and July 1, 2020. Validated questionnaires were applied to assess sleep, diet and exercise habits. Results: 465 adolescents were surveyed, 70.1% women and 48.2% in mid-adolescence. They reported having been connected to Internet and cell phone more than 6 hours a day, 58.3% and 42.4%, respectively. Coexistence during confinement was mostly pleasant. 76% reported sleeping less than 9 hours/day. They reported an appropriate consumption of fruit 6%, vegetables 5.8% and dairy 32.2%. The percentage of active adolescents fell from 30.7% before the pandemic to 19.7% during the pandemic. To the question, What is the first word that comes to mind when you hear about the COVID-19 pandemic? most gave negative responses. Conclusions: confinement measures were not linked to important problems regarding coexistence with relatives in this group of adolescents. We observed a worsening of the eating, exercise and sleep habits, which may favor the "obesogenic environment" and increase the risk of developing chronic non-communicable diseases. It is relevant to consider the negative impact of confinement and plan preventive measures aimed at mitigating its effects.
Introdução: em março de 2020, a Emergência Sanitária foi decretada no Uruguai quando foram detectados os primeiros casos de infecção por SARS-CoV-2 (COVID 19). O confinamento domiciliar voluntário foi uma das medidas de saúde pública adotadas para controlar a pandemia. Objetivo: descrever o efeito do confinamento nos hábitos de sono, alimentação e atividade física de adolescentes em Montevidéu e Canelones durante a pandemia de COVID-19. Metodologia: inquérito ad hoc, voluntário, anônimo, online e autoadministrado a adolescentes de 12 a 19 anos de idade atendido pelas prestadoras CASMU, CRAMI, COMECA e Associação Espanhola, entre 1 de junho e 1 de julho de 2020. Foram aplicados questionários validados para avaliar os seus hábitos de sono, alimentação e atividade física. Resultados: foram pesquisados 465 adolescentes, 70,1% mulheres e 48,2% na adolescência média. 58,3% e 42,4%, respectivamente, relataram ficar mais de 6 horas por dia conectados à internet e ao celular. A convivência durante o confinamento foi agradável para a maioria. 76% relataram dormir menos de 9 horas/dia. 6% deles indicou consumo adequado de frutas, vegetais 5,8% e laticínios 32,2%. O percentual de adolescentes ativos caiu de 30,7% antes da pandemia para 19,7% durante ela. Quando perguntados: Qual é a primeira palavra que vem à mente quando você ouve a pandemia do COVID-19? a maioria forneceu respostas negativas. Conclusões: as medidas de confinamento não estiveram associadas a problemas importantes na vida familiar neste grupo de adolescentes. Observou-se aprofundamento dos problemas nos hábitos alimentares, de exercício físico e de sono que favorecem o "ambiente obesogênico" e o risco de desenvolver doenças crônicas não transmissíveis. É relevante considerar o impacto negativo do confinamento e planejar medidas preventivas visando mitigar seus efeitos.
Subject(s)
Humans , Male , Female , Child , Adolescent , Health Behavior , Quarantine , COVID-19/complications , COVID-19/epidemiology , Uruguay/epidemiology , Health Surveys , Affect , Age and Sex Distribution , Family Relations , Cell Phone Use/statistics & numerical data , Internet Use/statistics & numerical data , Sleep Initiation and Maintenance Disorders/epidemiologyABSTRACT
Objetivo: describir las características de ocho pacientes pediátricos que se presentaron con síndrome inflamatorio multisistémico (MIS-C) asociado a SARS-CoV-2 y compromiso cardíaco. Material y métodos: estudio descriptivo, retrospectivo de ocho pacientes con edades entre 1 y 13 años, con diagnóstico de MIS-C y compromiso cardíaco, asistidos en el CHPR. Se analiza su historia clínica, evolución y tratamiento. Resultados: los pacientes presentaron fiebre en el 100%, exantema e hiperemia conjuntival en el 88%, síntomas digestivos en el 50%, insuficiencia respiratoria en el 25% y shock en el 50%. Todos requirieron ingreso a cuidados intensivos. La alteración de la contractilidad cardíaca estuvo presente en el 63% de los pacientes, fue leve y segmentaria en el 80%, el 60% requirió soporte inotrópico por 3 días, recuperando una función normal en 7 días. La insuficiencia mitral se presentó en el 25% y el derrame pericárdico en el 38%, ambos de grado leve. Un paciente presentó dilatación de arterias coronarias con Z score < 2. El 85% de los pacientes presentó alteraciones del ECG, en el 29% se trató de alteración en la repolarización, en el 29% intervalo QTc prolongado, en el 15% bloqueo atrioventricular de 1er grado y bloqueo incompleto de rama derecha. Un paciente tuvo fibrilación auricular por 3 días con remisión espontánea a ritmo sinusal. Las troponinas estuvieron altas en el 57% de los pacientes y el ProBNP elevado en el 100%. Todos recibieron inmunoglobulinas, metilprednisolona y aspirina. Conclusiones: se presentaron ocho pacientes pediátricos con MIS-C y compromiso cardíaco, el 50% se presentó en shock, todos requirieron ingreso a cuidados intensivos. El 85% presento alteraciones en el ECG. El 63% presentó compromiso de la contractilidad sectorial y leve, se normalizó en 7 días. El 60% requirió soporte inotrópico por una media de 3 días.
Objective: describe the characteristics of 8 children who presented Multisystem Inflammatory Syndrome associated with SARS-CoV2 infections (MIS-C) and cardiac involvement. Material and methods: descriptive, retrospective study of 8 patients of between 1 and 13 years of age, diagnosed with MIS-C and cardiac involvement, assisted at the Pereira Rossell Children Hospital, analysis of their medical records, evolution and treatment. Results: the patients showed: fever in 100% of the cases, rash and conjunctival hyperemia in 88%, digestive symptoms in 50%, respiratory failure in 25% and shock in 50%. All required admission to Intensive Care. Cardiac contractility alteration was present in 63% of patients, the affectation was mild and segmental in 80%, 60% required inotropic support for 3 days and recovered normal functions in 7 days. Mitral regurgitation was present in 25% of the cases and pericardial effusion in 38%, mild in both cases. One patient had dilated coronary arteries with a Z score <2. 85% of the patients presented ECG abnormalities, 29% present alteration of repolarization, 29% prolonged QTc, 15% 1st degree atrioventricular block and incomplete right bundle branch block. One patient had atrial fibrillation for 3 days with spontaneous remission to sinus rhythm. Troponins were increased in 57% of the patients and ProBNP elevated in 100%. All patients received Immunoglobulins, Methylprednisolone and Aspirin. Conclusions: we present eight pediatric patients with MIS-C and cardiac involvement, 50% suffered shock, all required admission to Intensive Care. ECG abnormalities were found in 85% of the patients. Mild and segmental contractility compromise was found in 63% of the patients and normalized in 7 days. 60% required inotropic support for a mean of 3 days.
Objetivo: descrever as características de 8 pacientes pediátricos que apresentaram Síndrome Inflamatória Multissistêmica (MIS-C) associada ao SARS-CoV-2 e comprometimento cardíaco. Material e métodos: estudo descritivo, retrospectivo, de oito pacientes com idade entre 1 e 13 anos, com diagnóstico de MIS-C e comprometimento cardíaco, assistidos pelo CHPR. Seu prontuário médico, evolução e tratamento são analisados. Resultados: os pacientes apresentaram febre em 100%, erupção cutânea e hiperemia conjuntival em 88%, sintomas digestivos em 50%, insuficiência respiratória em 25% e choque em 50%. Todos necessitaram de internação nos cuidados intensivos. A alteração da contratilidade cardíaca esteve presente em 63% dos pacientes, foi leve e segmentar em 80%, 60% necessitaram de suporte inotrópico por 3 dias, recuperando a função normal em 7 dias. A regurgitação mitral ocorreu em 25% dos pacientes e o derrame pericárdico em 38%, ambos de grau leve. Um paciente apresentou dilatação da artéria coronária com escore Z < 2. 85% dos pacientes apresentaram anormalidades no ECG, 29% foram alterações de repolarização, 29% intervalo QTc prolongado em bloqueio atrioventricular de 1º grau a 15% e bloqueio incompleto do ramo direito. Um paciente apresentou fibrilação atrial por 3 dias com remissão espontânea ao ritmo sinusal. As troponinas foram elevadas em 57% dos doentes e ProBNP elevado em 100%. Todos receberam imunoglobulinas, Metilprednisolona e aspirina. Conclusões: houve oito pacientes pediátricos com SMIM-C e comprometimento cardíaco, 50% em choque, todos necessitaram de internação em terapia intensiva. 85% apresentaram elevações no ECG. 63% apresentaram comprometimento setorial e de contratilidade leve, normalizados em 7 dias. 60% necessitaram de suporte inotrópico por uma média de 3 dias.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Cardiovascular Diseases/diagnostic imaging , Systemic Inflammatory Response Syndrome/complications , COVID-19/complications , Methylprednisolone/therapeutic use , Heparin/therapeutic use , Cardiovascular Diseases/etiology , Cardiovascular Diseases/drug therapy , Intensive Care Units, Pediatric , Aspirin/therapeutic use , Treatment Outcome , Immunoglobulins, Intravenous/administration & dosage , Fibrinolytic Agents/therapeutic use , Heparin Antagonists/therapeutic use , Immunologic Factors/administration & dosage , Anti-Inflammatory Agents/therapeutic useABSTRACT
Introducción: Los cuidados domiciliarios para los niños con enfermedades neoplásicas, representan costos sociales y económicos, además de posibles riesgos de infección. Por lo que, la importancia del cuidado de los menores ante las infecciones respiratorias virales durante la infancia radica en asegurar las correctas medidas de prevención del contagio. El objetivo de este estudio fue determinar la relación existente entre la competencia para el cuidado domiciliario y la presencia de infecciones respiratorias en los niños con tratamiento oncológico. Método: Estudio de enfoque cuantitativo, diseño correlacional, de corte transversal y descriptivo. La muestra se compone de 75 díadas. La competencia del cuidado domiciliario se midió con el instrumento CUIDAR. El análisis estadístico se realizó con el programa estadístico SPSS versión 25, utilizando estadística descriptiva y estadística inferencial no paramétrica. Resultados: La prevalencia de infecciones respiratorias fue del 4% para los menores con cuidadores con un nivel alto de competencia para el cuidado domiciliario, 12% para el nivel medio y 21.3%para el nivel bajo, mostrando dependencia entre las variables de estudio(X2=14.4, gl= 2, p=0.001). Además, se determinó una asociación (r=-.439, p<.001)entre las mismas. Discusión: La competencia con un nivel alto en los cuidados domiciliarios, supone un adecuado desempeño del rol como cuidador familiar con efecto en calidad de vida de la díada cuidador familiar-persona con cáncer. Conclusiones: A mayor competencia para el cuidado, menor la prevalencia de infecciones respiratorias; existiendo una relación entre la competencia para el cuidado domiciliario y la presencia de infecciones respiratorias en los niños con tratamiento oncológico.
Introduction: Home care for children with neoplastic diseases represents social and economic costs, as well as possible risks of infection. Therefore, the importance of caring for minors in the face of viral respiratory infections during childhood lies in ensuring the correct measures to prevent contagion. The objectiveof this study was to determine the relationship between competence for home care and the presence of respiratory infections in children undergoing cancer treatment. Method: Study of quantitative approach, correlational, cross-sectional and descriptive design. The sample consists of 75 dyads. Home care competence was measured with the CARE instrument. Statistical analysis was performed with the statistical program SPSS version 25.0, using descriptive statistics and non-parametric inferential statistics. Results: The prevalence of respiratory infections was 4% for children with caregivers with a high level of home care competence, 12% for the medium level and 21.3% for the low level, showing dependence between the study variables (X2=14.4, gl= 2, p=0.001). In addition, an association (r=-.439, p<.001) was determined between them. Discussion: The competence with a high level in home care supposes an adequate performance of the role as family caregiver with effect on quality of life of the family caregiver-person with a cancer dyad. Conclusions:The higher the caregiving competence, the lower the prevalence of respiratory infections; there is a relationship between home caregiving competence and the presence of respiratory infections in children undergoing cancer treatment.
Introdução: Os cuidados domiciliares para as crianças com doenças neoplásicas representam custos sociais e econômicos, além dos possíveis riscos de infecção. Por isso, a importância de tomar conta delas no que diz respeito às infecções respiratórias virais durante sua meninice radica em segurar as medidas adequadas para prevenir o contágio. O objetivo deste estúdio foi determinar a relação entre as infecções respiratórias nas crianças sob tratamento contra o cancro e a habilitação para lhes fornecer os cuidados em casa. Método: Estúdio da abordagem quantitativa, desenho correlacional, de corte transversal e descritivo. A amostra se compõe de 75 díades. A habilitação dos cuidados em casa foi medida com o instrumento TOMAR CONTA. A análise estatística se realizou com o programa estatístico SPSS, versão 25. Foi utilizada a estatística descritiva e a estatística inferencial não paramétrica. Resultados: A prevalência de infecções respiratórias foi de 4% para as crianças que receberam os cuidados em casa com um alto nível de efetividade; 12%, quando a efetividade dos cuidados foi intermediária; e para a baixa chegou até 21,3%. Isto demonstra a correlação entre as variáveis de estudo (X2= 14,4; gl= 2; p= 0,001). Além disso, se determinou uma associação (r= -,439; p<,001) entre elas. Discussão:A aptidão adequada para fornecer os cuidados em casa aponta que o responsável pela família desempenhou bem seu papel, o que fez com que houvesse repercussões positivas na qualidade de vida da díade "cuidador familiar-pessoa com câncer". Conclusões: Quanto maior é a proficiência para dar os cuidados, menor é o impacto das infecções respiratórias. Existe uma relação entre a habilitação para os cuidados em casa e a presença de infecções respiratórias nas crianças que recebem tratamentos oncológicos
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Respiratory Tract Infections/complications , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , COVID-19/complications , Home Nursing/psychology , Child Care/psychology , Health Knowledge, Attitudes, Practice , Cross-Sectional Studies , Prospective Studies , Surveys and Questionnaires , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Correlation of Data , MexicoABSTRACT
La enfermedad por coronavirus 2019 (COVID-19) causada por la infección por SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) se ha extendido por todo el mundo desde diciembre de 2019. Luego de la primera ola de COVID-19, se reporta por primera vez en mayo de 2020 en el Reino Unido un estado hiperinflamatorio asociado temporalmente a la infección por SARS-CoV-2 en un grupo de niños ingresados a unidades de cuidado intensivo pediátrico. Este nuevo fenotipo, con características similares a la enfermedad de Kawasaki y al síndrome del shock tóxico, se ha denominado síndrome inflamatorio multisistémico en niños (MIS-C). Es fundamental la sospecha y el reconocimiento tempranos de esta entidad, con el fin de ofrecer un tratamiento médico oportuno, para prevenir la muerte y el desarrollo de secuelas. Presentamos el caso de una preescolar de 5 años, en la que se realizó diagnóstico de MIS-C con un fenotipo shock e íleo paralítico.
The coronavirus disease 2019 (COVID-19) caused by the infection by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has spread worldwide since December 2019. After the first wave of COVID-19, a hyperinflammatory condition temporarily associated with SARS-CoV-2 infection appeared in a group of children admitted to pediatric intensive care units and reported for the first time in May 2020 in the United Kingdom. This new phenotype shared characteristics with the Kawasaki disease and toxic shock syndrome and has been called multisystem inflammatory syndrome in children (MIS-C). Early suspicion and recognition of this condition is key in order to offer timely medical treatment to prevent death and the development of sequelae. We present the case of a 5-year-old child, in which diagnosis of MIS-C with a shock phenotype and paralytic ileus.
A doença de coronavírus 2019 (COVID-19) causada pela infecção por SARS-CoV-2 (síndrome respiratória aguda grave coronavírus 2) se espalhou pelo mundo desde dezembro de 2019. Após a primeira onda de COVID-19, houve relatos pela primeira vez em maio de 2020 no Reino Unido duma doença hiperinflamatória temporariamente associada à infecção por SARS-CoV-2 num grupo de crianças internadas em unidades de terapia intensiva pediátrica. Esse novo fenótipo com características semelhantes à doença de Kawasaki e a síndrome do choque tóxico foi chamado de síndrome inflamatória multissistêmica em crianças (MIS-C). A suspeita precoce e o reconhecimento dessa entidade são essenciais, a fim de oferecer tratamento médico oportuno, para prevenir a morte e o desenvolvimento de sequelas. Apresentamos o caso de uma menina pré-escolar de 5 anos que foi diagnosticada com MIS-C com fenótipo de choque e íleo paralítico.
Subject(s)
Humans , Female , Child, Preschool , Shock, Septic/complications , Systemic Inflammatory Response Syndrome/diagnosis , COVID-19/complications , Immunoglobulins, Intravenous/administration & dosage , Enoxaparin/administration & dosage , Systemic Inflammatory Response Syndrome/therapyABSTRACT
Se presenta el reporte de un caso de miositis aguda en un niño de 4 años de edad con COVID-19. El paciente manifestó fiebre y dolor en ambas pantorrillas. Con sospecha de miositis se realizó análisis de CPK, encontrando valores de 4460 UI/L. Asimismo se realizó hisopado nasofaríngeo para SARS-CoV 2, confirmando la infección. El paciente recibió hiperhidratación, presentando resolución de su cuadro clínico en menos de 5 días
This case report describes a 4 year old child with COVID-19. He presented with fever and pain in both calves. Under the suspicion of myositis a CPK analysis was performed, which showed CPK: 4460 UI/L. Nasopharyngeal RT - PCR was also performed, which was positive. As a treatment, the patient received hyperhydration, achieving full recovery after five days
Subject(s)
Humans , Male , Child, Preschool , COVID-19/complications , Myositis/etiology , Acute Disease , COVID-19/diagnosis , Glucose/therapeutic use , Myositis/diagnosis , Myositis/drug therapyABSTRACT
Background and objectives: COVID-19 is a life-threatening disease. Recognizing the main characteristics of the disease and its main complications will help future interventions, care, and management of health services since territorial and population diversities directly influence health outcomes. Our main objective is to describe the clinical characteristics, outcomes, and factors associated with mortality of patients with COVID-19 admitted to the intensive care unit of a public and tertiary hospital. Methods: Cohort study, conducted from March 1 to September 30, 2020. Poisson regression was performed to investigate the variables of hospital treatment as potential risk factors for in-hospital mortality. Results: Of the 283 eligible patients in this study, the hospital mortality rate was of 41.7% (n=118). The most common outcomes were acute respiratory distress syndrome, nosocomial infection, and septic shock. Factors independently associated with increased risk of death were age greater than 51 years old (RR=1.7, 95%CI=1.0-2.8), especially over 70 years old (RR=2.9, 95%CI=1.7-2.8), current smoker (RR=1.8, 95%CI=1.1-2.9), requiring the use of inotrope (RR=1.4, 95%CI=1.0-2.0), and presenting potassium greater than 5.0 mEq/l on admission (RR=1.3, 95%CI=1.0-1.7). Conclusion: Mortality was associated with older age, being a current smoker, inotrope use, and presenting potassium greater than 5.0 on hospital admission.(AU)
Justificativa e objetivos: A COVID-19 é uma doença ameaçadora à vida. Reconhecer as características da doença e suas principais complicações nesta população auxiliará em futuras intervenções, cuidados e gestão dos serviços de saúde, uma vez que a diversidade territorial e populacional influencia diretamente nos resultados de saúde. O objetivo principal do presente estudo é descrever as características clínicas, desfechos e fatores associados à mortalidade de pacientes com COVID-19 internados na unidade de terapia intensiva de um hospital público e terciário. Métodos: Estudo de coorte, realizado de 1º de março a 30 de setembro de 2020. Foi realizada regressão de Poisson para investigar variáveis de apresentação hospitalar como potenciais fatores de risco para mortalidade intra-hospitalar. Resultados: Dos 283 pacientes elegíveis neste estudo, o dado de mortalidade hospitalar foi de 41,7% (n=118). Os desfechos mais comuns foram síndrome do desconforto respiratório agudo, infecção hospitalar e choque séptico. Os fatores independentemente associados ao aumento do risco de morte foram idade superior a 51 anos (RR=1,7, IC 95%=1,0-2,8), principalmente acima de 70 anos (RR=2,9, IC 95%=1,7-2,8), tabagismo atual (RR=1,8, IC 95%=1,1-2,9), necessidade de inotrópico (RR=1,4, IC 95%=1,0-2,0) e potássio maior que 5,0 mEq/l (RR=1,3, IC 95%=1,0- 1.7) na admissão. Conclusão: A mortalidade esteve associada à idade avançada, tabagismo atual, uso de inotrópicos e potássio maior que 5,0 na admissão hospitalar.(AU)
Justificación y objetivos: La COVID-19 es una enfermedad potencialmente mortal. Reconocer las características de la enfermedad y sus principales complicaciones en esta población ayudará a futuras intervenciones, atención y gestión de los servicios de salud, ya que las diversidades territoriales y poblacionales influyen directamente en los resultados de salud. El objetivo principal de este estudio es describir las características clínicas, los resultados y los factores asociados a la mortalidad de los pacientes con COVID-19 ingresados en la unidad de cuidados intensivos de un hospital público y de tercer nivel. Métodos: Estudio de cohorte, realizado del 1 de marzo al 30 de septiembre de 2020. Se realizó regresión de Poisson para investigar variables en la presentación hospitalaria como potenciales factores de riesgo para la mortalidad intrahospitalaria. Resultados: De los 283 pacientes elegibles en este estudio, el 41,7% (n=118) tuvo mortalidad hospitalaria. Los desenlaces más comunes fueron síndrome de dificultad respiratoria aguda, infección nosocomial y shock séptico. Los factores independientemente asociados a mayor riesgo de muerte fueron edad mayor de 51 años (RR=1,7, IC95%=1,0-2,8), especialmente mayores de 70 años (RR=2,9, IC95%=1,7-2,8), tabaquismo actual (RR=1,8, IC95%=1,1-2,9), necesidad de inotrópico (RR=1,4, IC95%=1,0-2,0) y potasio mayor que 5,0 mEq/l (RR=1,3, IC95%=1,0-1,7). Conclusión: La mortalidad estuvo asociada a la edad avanzada, tabaquismo actual, uso de inotrópico y potasio mayor a 5,0 en la admisión hospitalaria.(AU)
Subject(s)
Humans , COVID-19/complications , COVID-19/mortality , Health Profile , Risk Factors , Hospital Mortality , Intensive Care UnitsABSTRACT
Introducción: La proporción de casos reportados de niños y adolescentes con COVID-19 aumenta progresivamente. La hospitalización relacionada con COVID-19 en niños es infrecuente, pero causa morbilidad y sobrecarga al sistema de salud. Objetivos: Describir las características clínicas y evolutivas de los niños con diagnóstico de COVID-19 en un hospital pediátrico de alta complejidad. Comparar los pacientes que requirieron internación y los que no. Material y métodos: Cohorte prospectiva. Se incluyeron todos los pacientes con diagnóstico virológico de COVID-19 desde 1.1.2022 a 1.3.22 en un hospital pediátrico de alta complejidad. Se compararon los antecedentes, características clínicas y evolutivas de los pacientes según requirieran o no internación. Se utilizó STATA 16. Resultados: n: 1764 pacientes, de ellos 958 eran varones (54%). La mediana de edad fue 56 meses (RIC 17-116). Tenían enfermedad de base 789 pacientes (46%). Las más frecuentes fueron: enfermedad oncohematológica 215 (12%), neurológica 103 pacientes (6%) , enfermedad pulmonar crónica 68 (4%), cardiopatías congénitas 65 (4%) y síndrome genético 57 pacientes (3%). Eran inmunosuprimidos: 292 (17%). Presentaron síntomas relacionados con COVID-19 1319 pacientes (79%). Requirieron internación 591 (34%). Tuvieron coinfección con otros virus respiratorios 33 pacientes (2%). Ingresaron a Cuidados intensivos en relación a la COVID-19 22 pacientes (1.3%) y fallecieron en relación con la infección 8 (0.5%). En el análisis univariado, la presencia de comorbilidades, la coinfección viral y la inmunosupresión se asociaron estadísticamente con el requerimiento de internación. El antecedente de 2 o más dosis de vacuna para SARS-CoV-2 fue un factor protector para la internación en los mayores de 3 años. En el modelo multivariado, los pacientes menores de 3 años (OR 6.5, IC95% 1.2-36.8, p 0.03), con comorbilidades (OR 2.04, IC 95% 1.7- 3.3, p 0.00) y los huéspedes inmunocomprometidos (OR 2.89, IC95% 2.1-4.1, p 0.00) tuvieron más riesgo de internación. Ajustado por el resto de las variables, haber recibido dos o más dosis de vacuna fue un factor protector para la internación (OR 0.65, IC 95% 0.49-0.87, p<0.01). Conclusiones: En este estudio de cohorte prospectivo de niños con diagnóstico confirmado de COVID-19 predominó la enfermedad sintomática. Fueron admitidos en relación con el COVID-19, 34% de los pacientes. La vacunación con dos o más dosis fue un factor protector para la internación en el modelo multivariado. Además, se asociaron estadísticamente con la hospitalización, la edad menor de 3 años, las comorbilidades previas y la inmunosupresión (AU)
Introduction: The rate of reported cases of children and adolescents with COVID-19 is progressively increasing. COVID-19-related hospital admission in children is uncommon, but leads to morbidity and places a burden on the healthcare system. Objectives: To describe the clinical characteristics and outcome of children diagnosed with COVID-19 in a pediatric tertiary-care hospital and to compare patients who required hospital admission with those who did not. Material and methods: A prospective cohort study. All patients with a virological diagnosis of COVID-19 seen between 1.1.2022 and 1.3.22 in a tertiary-care pediatric hospital were included. We compared patient history, clinical characteristics, and outcome according to whether or not they required hospital admission. STATA 16 was used. Results: n: 1764 patients, 958 of whom were male (54%). The median age was 56 months (IQR, 17- 116). Overall, 789 patients had an underlying disease (46%), the most frequent of which were hematology-oncology disease in 215 patients (12%), neurological disease in 103 (6%), chronic lung disease in 68 (4%), congenital heart disease in 65 (4%), and a genetic syndrome in 57 (3%); 292 were immunosuppressed (17%). Overall, 1319 patients (79%) had COVID-19-related symptoms and 591 (34%) required hospital admission. A coinfection with other respiratory viruses was observed in 33 patients (2%). Intensive care admission due to COVID-19 was required in 22 patients (1.3%) and 8 (0.5%) died with COVID-19. In univariate analysis, the presence of comorbidities, viral coinfecton, and immunosuppression were statistically significantly associated with the need for hospitalization. A history of two or more doses of the SARSCoV2 vaccine was a protective factor against hospital admission in children older than 3 years. In the multivariate model, patients younger than 3 years (OR 6.5, 95% CI 1.2-36.8, p 0.03), with comorbidities (OR 2.04, 95%CI 1.7-3.3, p 0.00) and immunocompromised hosts (OR 2.89, 95% CI 2.1-4.1, p 0.00) had a higher risk of hospital admission. When adjusting for the remaining variables, having received two or more doses of the vaccine was found to be a protective factor against hospital admission (OR 0.65, 95% CI 0.49-0.87, p<0.01). Conclusions: In this prospective cohort study of children with a confirmed diagnosis of COVID-19, symptomatic disease predominated. Thirty-four percent of the patients were admitted for COVID-19. Vaccination with two or more doses was a protective factor against hospitalization in the multivariate model. In addition, age younger than 3 years, previous comorbidities, and immunosuppression were statistically associated with hospital admission (AU)
Subject(s)
Child, Preschool , Child , Adolescent , Argentina/epidemiology , Child, Hospitalized , COVID-19/complications , COVID-19/epidemiology , Hospitals, Pediatric/statistics & numerical data , Prospective Studies , Cohort Studies , Immunocompromised Host , SARS-CoV-2/isolation & purificationABSTRACT
Desde abril de 2020, em vários países da Europa, América do Norte e inclusive no Brasil, foram identificados casos de crianças e adolescentes com uma nova apresentação clínica associada à Covid-19 e caracterizada por um quadro inflamatório tardio e exacerbado, denominada em português como Síndrome Inflamatória Multissistêmica Pediátrica (SIM-P). Evidências posteriores mostram que, em casos raros, indivíduos adultos (acima dos 20 anos) também podem desenvolver uma síndrome semelhante, associada à infecção atual ou anterior pelo SARS-CoV-2.1-3. Relatos desses pacientes destacam o reconhecimento de uma síndrome hiperinflamatória multissistêmica em adultos, com heterogeneidade de sinais e sintomas clínicos.4 A maioria dos pacientes apresenta febre e hipotensão e uma pequena parcela pode apresentar sintomas similares à síndrome de Kawasaki, síndrome de ativação macrofágica e síndrome do choque tóxico.5 No Brasil, a síndrome foi nomeada de Síndrome Inflamatória Multissistêmica em Adultos (SIM-A). Alguns casos suspeitos dessa condição já foram identificados no país e notificados voluntariamente pelos profissionais de saúde da assistência.
Subject(s)
Humans , Adult , Systemic Inflammatory Response Syndrome/etiology , COVID-19/complications , Respiratory Tract Diseases , Syndrome , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/drug therapyABSTRACT
Introducción. El compromiso renal (CR) en niñosinternados con enfermedad por coronavirus2019 (COVID-19, por su sigla en inglés) varía entre el 1,2 % y el 44 %. Dado que existe limitada información local, el objetivo primario de este estudio fue estimar la prevalencia de CR en nuestro medio. Población y métodos. Estudio transversalrealizado en 13 centros de Argentina entre marzo y diciembre de 2020. Se incluyeron pacientes internados con COVID-19, de 1 mes a 18 años y que tuvieran al menos una determinación de creatinina sérica y/o de orina completa.Se excluyeron aquellos con enfermedad renal conocida. Se consideró CR la presencia de lesión renal aguda (LRA), proteinuria, hematuria, leucocituria y/o hipertensión arterial (HTA). Resultados. De 528 historias clínicas elegibles, seincluyeron las de 423 pacientes (el 55,0 % de sexo masculino, mediana de edad 5,3 años). El cuadro clínico fue asintomático en el 31 %, leve en el 39,7 %, moderado en el 23,9 %, grave en el 1,2 %, crítico en el 0,7 %, y el 3,5 % presentó síndrome inflamatorio multisistémico pediátrico (SIMP). Dos pacientes (0,47 %) fallecieron. La prevalencia de CR fue del 10,8 % (intervalo de confianza 95% 8,2-14,2), expresada por leucocituria (16,9 %), proteinuria (16,0 %), hematuria (13,2 %), HTA (3,7 %) y LRA (2,3 %). Ninguno requirió diálisis. Presentar CR se asoció (p <0,0001) con formas graves de enfermedad. Conclusión. La prevalencia de CR en pacientes pediátricos internados con COVID-19 en 13 centros de nuestro país fue del 10,8 % y predominó en las formas clínicas graves.
Introduction. Renal involvement among pediatric patients with coronavirus disease 2019 (COVID-19) ranges between 1.2% and 44%. Given the limited information available locally, the primary objective of this study was to estimate the prevalence of renal involvement in our setting. Population and methods. Cross-sectional study conducted in 13 Argentine sites between March and December 2020. Patients aged 1 month to 18 years hospitalized due to COVID-19 and with at least one measurement of serum creatinine and/or a urinalysis were included. Those with a known kidney disease were excluded. Renal involvement was defined as the presence of acute kidney injury (AKI), proteinuria, hematuria, leukocyturia and/or arterial hypertension (HTN). Results. Among 528 eligible medical records, 423 patients were included (55.0% were males; median age: 5.3 years). The clinical presentation was asymptomatic in 31%; mild, in 39.7%; moderate, in 23.9%; severe, in 1.2%; critical, in 0.7%; and 3.5% had multisystem inflammatory syndrome in children (MIS-C). Two patients (0.47%) died. The prevalence of renal involvement was 10.8% (95% confidence interval: 8.214.2); it was described as leukocyturia (16.9%), proteinuria (16.0%), hematuria (13.2%), HTN (3.7%), and AKI (2.3%). No patient required dialysis. Renal involvement was associated with severe forms of disease (p < 0.0001). Conclusion. The prevalence of renal involvement among pediatric patients hospitalized due to COVID-19 in 13 Argentine sites was 10.8%; severe forms of disease prevailed.
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Acute Kidney Injury/etiology , Acute Kidney Injury/epidemiology , COVID-19/complications , COVID-19/epidemiology , Hypertension/epidemiology , Proteinuria/epidemiology , Prevalence , Cross-Sectional Studies , Retrospective Studies , Systemic Inflammatory Response Syndrome , Creatinine , SARS-CoV-2 , Hematuria/etiology , Hematuria/epidemiologyABSTRACT
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.
Subject(s)
Child , Communicable Diseases/complications , Communicable Diseases/mortality , Coronavirus Infections/complications , Coronavirus Infections/mortality , COVID-19/complications , Patients , Libraries, Digital/statistics & numerical data , Fever/prevention & control , Mucocutaneous Lymph Node Syndrome/nursingABSTRACT
Objetivo: Comparar os desfechos clínicos de pessoas com e sem Diabetes Mellitus tipo 2 (DM 2), infectadas pelo SARS-CoV-2, que desenvolveram Síndrome Respiratória Aguda Grave (SRAG) no Brasil. Métodos: Trata-se de um estudo transversal realizado a partir de análise da ficha de notificação compulsória de Síndrome Respiratória Aguda Grave Hospitalizado, obtidas no DATASUS. Foram analisados homens e mulheres com e sem DM2, infectados pelo SARS-CoV-2 e notificados como SRAG no período de fevereiro de 2020 a maio de 2021. Foram identificados os desfechos: hospitalização, admissão em Unidade de Terapia Intensiva (UTI) e óbito. Em seguida, a porcentagem de cada desfecho entre pessoas com DM2 foi comparada com a de pessoas não-diabéticas infectadas no mesmo período, utilizando o teste de Qui-Quadrado, com intervalo de confiança de 95%. Resultados: De um total de 384.805 pacientes, 111.046 eram diabéticos e 273.759 não diabéticos. Entre os diabéticos, 98.2% foram hospitalizados, 43.7% admitidos em UTI e 44.6% evoluíram a óbito. Enquanto entre os não-diabéticos, 97.3% necessitaram de hospitalização, 37.2% foram admitidos em UTI e 35.7% evoluíram a óbito. Após a análise com o teste de Qui-Quadrado, nos desfechos analisados foi encontrada uma diferença estatística significante (p<0.001) entre os grupos. Conclusão: A presença de DM 2 esteve associada a um pior prognóstico da COVID-19, quando comparada a pessoas sem DM2 na população brasileira. Entretanto, são necessários mais estudos para estabelecer a causalidade e elucidar a fisiopatologia dessa associação (AU)
Objective: Compare the clinical outcomes of people with and without Type 2 Diabetes Mellitus (DM2), infected by SARS-CoV-2, who developed Severe Acute Respiratory Syndrome (SARS) in Brazil. Methodology: This is a cross-sectional study. The research was carried out by analyzing the compulsory notification form Severe Acute Respiratory Syndrome of hospitalized patients, obtained from DATASUS. Type 2 diabetic and non-diabetic men and women infected with SARS-CoV-2 and notified as SARS in the period February 2020 to May 2021 were analyzed. The outcomes were identified as: hospitalization, Intensive Care Unit (ICU) admission, and death. The percentage of each outcome among diabetic patients was compared with that of the infected non-diabetic patients in the same period using the Chi-square test, with a 95% confidence interval. Results: From a total of 384,805 patients, 111,046 were diabetic and 273,759 non-diabetic. Among the diabetic patients, 98.2% were hospitalized, 43.7% were admitted to the ICU, and 44.6% died. While among non-diabetics, 97.3% required hospitalization, 37.2% were admitted to the ICU, and 35.7% died. After the analysis with the Chi-square test, a statistically significant difference was found between the groups (p<0.001). Conclusion: The presence of DM2 was associated with a worse prognosis for COVID-19 compared to people without DM2, in the Brazilian population. However, further studies are needed to establish causality and elucidate the pathophysiology of this association (AU)
Subject(s)
Chi-Square Distribution , Cross-Sectional Studies , Diabetes Mellitus/therapy , SARS-CoV-2 , COVID-19/complications , Intensive Care UnitsABSTRACT
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)
Subject(s)
Humans , Syndrome , Central Nervous System , Coronavirus Infections/complications , Impacts of Polution on Health , COVID-19/complications , Cardiovascular Diseases/etiology , Mental Health , Mast Cell Activation Syndrome/etiologyABSTRACT
The WHO COVID-19 Clinical management: living guidance contains the Organization's most up-to-date recommendations for the clinical management of people with COVID-19. Providing guidance that is comprehensive and holistic for the optimal care of COVID-19 patients throughout their entire illness is important. The latest version of this living guideline is available in pdf format (via the 'Download' button) and via an online platform, and is updated regularly as new evidence emerges. No further updates to the previous existing recommendations were made in this latest version. This updated (fifth) version contains 16 new recommendations for the rehabilitation of adults with post COVID-19 condition (see Chapter 24), which includes: strong recommendation that exertional desaturation and cardiac impairment following COVID-19 should be ruled out and managed before consideration of physical exercise training
Subject(s)
Humans , Male , Female , Pregnancy , Child , COVID-19/complications , Palliative Care , Pneumonia, Viral/etiology , Rehabilitation , Respiration, Artificial , Respiratory Distress Syndrome, Newborn/etiology , Shock, Septic , Patient Care Management/organization & administration , Breast Feeding , Pregnancy , Global Health , COVID-19/diagnosis , Hospitalization , MasksABSTRACT
Este relatório refere-se à análise crítica da Nota Técnica do Ministério da Saúde nº 38/2022-DEIDT/SVS/MS1 apresentada pela DIVE/SES/SC para a elaboração de um Protocolo Estadual de Atendimento para Casos Suspeitos ou Confirmados de Síndrome Inflamatória Multissistêmica em Adultos (SIM-A) associada à Covid-19. Na Nota Técnica emitida pelo Ministério da Saúde consta uma breve contextualização, objetivos da notificação, quadro clínico de SIM-A, definições de casos, exames complementares, exames específicos para COVID-19, manejo clínico, notificação e registro. Este relatório visa avaliar e emitir um parecer técnico embasado em evidências científicas sobre a disponibilização do medicamento Imunoglobulina Humana intravenosa (IGHIV) para o tratamento de SIM-A, fluxo de acesso ao medicamento e avaliação do impacto orçamentário, para posterior elaboração de um Protocolo Estadual para esta síndrome, destinado aos profissionais da saúde, pacientes e gestores do estado de Santa Catarina.
Subject(s)
Humans , Immunoglobulins, Intravenous/therapeutic use , Systemic Inflammatory Response Syndrome/virology , COVID-19/complications , State Government , Clinical Protocols , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/drug therapyABSTRACT
Introducción: debido a la pandemia desarrollada por COVID-19, el Gobierno argentino, adoptó a partir del 20 de marzo de 2020 medidas excepcionales de aislamiento social, preventivo y obligatorio (ASPO) o cuarentena, con el fin de proteger la salud pública. En esta etapa se manifestó un mayor uso de pantallas que, en exceso, constituye un factor de riesgo de enfermedades cardiovasculares y alteración en la calidad del sueño. El objetivo de estudio fue estimar el cambio de las horas de sueño y de uso de pantallas antes del inicio del ASPO, en comparación con la tercera y octava semana de cuarentena en personas de 13 a 80 años de la provincia del Neuquén y el Alto Valle Río Negro-Neuquén. Métodos: se realizaron dos Encuestas, en la tercera y octava semana de cuarentena, sobre conductas y hábitos de vida en personas entre 13-80 años. Fueron autoadministradas y enviadas por redes sociales. El muestreo fue aleatorio. Los datos se analizaron usando el paquete estadístico SPSS®. Las encuestas fueron anónimas y confidenciales. Resultados: se obtuvieron 3386 respuestas. De ellas se infirió que la cantidad de horas diarias frente a pantallas y las horas de sueño y el inicio del sueño fueron diferentes por grupos en los períodos precuarentena, y tercera y octava semana de la cuarentena. El grupo de adolescentes mostró mayores diferencias en todas las variables respecto del período precuarentena. La correlación entre las horas de pantalla y las horas de sueño fue baja, en las 3 etapas de la cuarentena. Conclusión: este estudio estimó el cambio de hábitos durante la cuarentena. En ese período se observó mayor cantidad de horas de sueño, un retraso en el tiempo de inicio del sueño y más horas frente a las pantallas; estas diferencias fueron significativas respecto del período precuarentena, y las mayores diferencias se registraron entre los adolescentes. (AU)
Introduction: due to the pandemic developed by COVID 19, the Argentine Government adopted, as of March 20, 2020, exceptional measures of social, preventive and mandatory isolation (ASPO) or quarantine in order to protect public health. In this stage, there was a greater use of screens that in excess, constitutes a risk factor for cardiovascular diseases and alteration in the quality of sleep. Methods: two Surveys were conducted, in the third and eighth week of quarantine, on behaviors and life habits in people between 13-80 years of age. They were self-administered and sent through social networks. The sampling was random. The data were analyzed using the SPSS® statistical package. The surveys were anonymous and confidential. Results: 3386 responses were obtained. It was obtained that the amount of daily hours in front of screens and the hours of sleep and the onset of sleep were different by groups of pre, third and eighth week of quarantine. The adolescent groups howed greater differences in all variables with respect to the pre-quarantine period. The correlation between the hours of screen and the hours of sleep was low, in the 3 stages of quarantine. Conclusion: this study estimated the change in habits during quarantine. In quarantine, longer hours of sleep, a delay in the time of onset of sleep and more hours in front of screens were observed, these differences being significant with respect to the pre-quarantine period, with the greatest differences being established in adolescents. (AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Sleep , Social Isolation , Quarantine , Screen Time , COVID-19/complications , Sleep Quality , Argentina , Cross-Sectional Studies , Surveys and Questionnaires , Adolescent Behavior , Sedentary Behavior , Data AnalysisABSTRACT
RESUMEN Fundamento: La COVID-19 es una pandemia causada por el virus SARS-CoV-2 y su asociación con la periodontitis podría tener resultados adversos. Objetivo: Evaluar la asociación entre la periodontitis y los resultados adversos de la COVID-19. Desarrollo: Se realizó una revisión bibliográfica en Google Académico, SciELO y PubMed Central con los descriptores SARS-CoV-2, COVID-19, periodontitis y enfermedad periodontal consultados en el DeCS. Se seleccionaron artículos a texto completo en español e inglés, principalmente de revistas arbitradas por pares. La periodontitis se asocia significativamente a la gravedad de la COVID-19. Los probables mecanismos que vinculan a la periodontitis con la COVID-19 grave son el favorecimiento de la replicación viral, la inflamación por disfunción inmune, la disbiosis con infección bacteriana sobreañadida y la presencia de comorbilidades. La toma de medidas de bioseguridad e higiene en la atención de los pacientes podría contribuir a un curso clínico más favorable de la COVID-19. Conclusiones: La periodontitis parece asociarse con resultados desfavorables de la COVID-19, lo que recalca la importancia de la atención estomatológica de estos pacientes.
ABSTRACT Background: COVID-19 is a pandemic caused by SARS-CoV-2 virus and its association with periodontitis could have adverse outcomes. Objective: To evaluate the association between periodontitis and adverse outcomes of COVID-19. Methodology: A literature review was performed in Google Scholar, SciELO and PubMed Central with the descriptors SARS-CoV-2, COVID-19, periodontitis and periodontal disease consulted in DeCS. Full-text articles in Spanish and English were selected, mainly from peer-reviewed journals. Results: Periodontitis is significantly associated with COVID-19 severity. Probable mechanisms linking periodontitis with severe COVID-19 are favoring viral replication, inflammation due to immune dysfunction, dysbiosis with superimposed bacterial infection, and the presence of comorbidities. Taking biosecurity and hygiene measures in patient care could favor a more favorable clinical course of COVID-19. Conclusions: Periodontitis appears to be associated with unfavorable COVID-19 outcomes, emphasizing the importance of stomatologic care of these patients.
Subject(s)
Humans , Periodontal Diseases , Periodontitis , SARS-CoV-2 , COVID-19/complicationsABSTRACT
Abstract Ischemic strokes secondary to occlusion of large vessels have been described in patients with COVID-19. Also, venous thrombosis and pulmonary thromboembolism have been related to the disease. Vascular occlusion may be associated with a prothrombotic state due to COVID-19-related coagulopathy and endotheliopathy. Intracranial hemorrhagic lesions can additionally be seen in these patients. The causative mechanism of hemorrhage could be associated with anticoagulant therapy or factors such as coagulopathy and endotheliopathy. We report on cases of ischemic, thrombotic, and hemorrhagic complications in six patients diagnosed with SARS-CoV-2 infection. Chest computed tomography (CT) showed typical SARS-CoV-2 pneumonia findings in all the cases, which were all confirmed by either serology or reverse transcription polymerase chain reaction (RT-PCR) tests.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Thromboembolism/complications , COVID-19/complications , Diagnostic Imaging/methods , Ischemic Stroke , HemorrhageABSTRACT
Las encefalitis son cuadros clínicos frecuentes en la edad pediátrica. Pueden dividirse en aquellas causadas por la infección del sistema nervioso central y en las de etiología inmunomediada (algunas de las cuales pueden ser para- o posinfecciosas). En marzo de 2020 la Organización Mundial de la Salud declaró la pandemia por el coronavirus de tipo 2 del síndrome respiratorio agudo grave (SARS-CoV-2, por su sigla en inglés). Los reportes pediátricos de enfermedad por dicho agente describen una amplia gama de manifestaciones clínicas: compromiso respiratorio, gastrointestinal, síntomas neurológicos, entre otros; y el síndrome inflamatorio multisistémico asociado a COVID-19 (SIM-C). Describimos el caso de un niño de 2 años con diagnóstico de encefalitis por anticuerpos antirreceptor N-metil-d-aspartato (anti-NMDAR), en quien se comprobó, mediante serología, una infección reciente por SARS-CoV-2. La presencia de marcadores serológicos positivos para SARS-CoV-2 en un paciente que presentó encefalitis por anticuerpos anti-NMDAR podría interpretarse como una asociación temporal, estableciéndose la posibilidad de que el virus haya actuado como gatillo de una enfermedad autoinmunitaria.
Encephalitis are frequent clinical pictures in pediatric age. They can be divided into those caused by infection of the central nervous system and those of immune-mediated etiology (some of which may be para- or post-infectious). In March 2020, the WHO declared a SARS-CoV-2 pandemic. Pediatric reports of disease caused by this agent describe a wide range of clinical manifestations: respiratory and gastrointestinal compromise, neurological symptoms, among others; and a multisystemic inflammatory syndrome in children associated with COVID-19 (MIS-C).We describe the case of a 2-year-old boy with a diagnosis of anti-NMDAR antibody encephalitis, in whom a recent SARSCoV-2 infection was serologically proven. The presence of positive serological markers for SARS-CoV-2 in a patient who presented encephalitis due to anti-NMDAR antibodies could be interpreted as a temporal association; establishing the possibility that the virus has acted as a trigger for an autoimmune disease
Subject(s)
Humans , Male , Child, Preschool , Encephalitis/diagnosis , COVID-19/complications , COVID-19/diagnosis , Systemic Inflammatory Response Syndrome , Pandemics , SARS-CoV-2ABSTRACT
La mucormicosis es una infección fúngica rara, con alta morbilidad y mortalidad. Se presenta principalmente en pa- cientes con diabetes mellitus no controlada, inmunocompro- metidos, con tratamiento crónicos con esteroides, entre otros. Actualmente, se cree que la pandemia de COVID-19 y los tratamientos con corticosteroides podrían estar implicados en el aumento de casos de esta micosis. Este hongo invade el sistema vascular, ocluyendo el flujo sanguíneo arterial y generando una rápida trombosis e isque- mia, lo que provoca la necrosis de los tejidos duros y blandos, con invasión rápida a los tejidos circundantes. Hay varias formas clínicas. En la cavidad bucal se presenta la variante rino-orbito-cerebral, que afecta el paladar en forma de lesión eritematosa o grisácea que puede progresar hacia la formación de una masa necrótica o ulceración con muy escaso sangrado de mucosa. Se manifiesta con síntomas típicos de una rinosinusitis con fiebre y dolor en las piezas dentarias superiores. El tratamiento consta de tres pilares fundamentales: el diagnóstico, un manejo adecuado de las comorbilidades y la combinación de las terapias antifúngica y quirúrgica. Desde el año 2020, la mucormicosis asociada a COVID-19 pasó a ser un evento de notificación obligatoria inmediata al Sistema Nacional de Vigilancia de la Salud (SNVS2.0) me- diante el Sistema Integrado de Información Sanitaria Argen- tina (SISA). Es importante destacar que se han reportado casos de mu- cormicosis luego de extracciones dentales; lo que impulsa a afianzar los conocimientos sobre esta enfermedad, extremar las medidas preventivas e incentivar el diagnóstico precoz en la atención odontológica, debido a la rapidez en la evolución de la patología (AU))
Mucormycosis is a rare fungal infection, with high mor- bidity and mortality. It occurs mainly in patients with uncon- trolled diabetes mellitus, immunocompromised, on chronic treatment with steroids, among others. Currently, it is believed that the COVID-19 pandemic and the corticosteroid treatments could be one of the causes of increased cases. This fungus invades the vascular system, occluding arteri- al blood flow and generating rapid thrombosis and ischemia, which causes necrosis of hard and soft tissues, with rapid in- vasion to the surrounding tissues. There are several clinical forms. In the oral cavity, the rhino-orbito-cerebral variant presents itself affecting the pal- ate in the form of an erythematous or grayish lesion that can progress towards the formation of a necrotic mass or ulcera- tion with very little mucosal bleeding. It manifests itself with typical symptoms of rhinosinusitis, with fever and pain in the upper teeth. The treatment consists of three fundamental pillars: diag- nosis, proper management of comorbidities and the combina- tion of antifungal and surgical therapies. Since 2020, COVID-19 associated mucormycosis became an event of mandatory immediate notification to the National Health Surveillance System (SNVS2.0,) through the Argentina Integrated Health Information System (SISA). It is important to emphasize that mucormycosis cases had been reported following tooth extractions, which drives to strengthen knowledge about this disease, extreme preventive measures and encourage early diagnosis in dental care, due to the speed of the evolution of the pathology (AU))