Descripción de las intervenciones broncoscópicas en estenosis traqueales posterior a infección por COVID-19 / Description of Bronchoscopic Interventions in Post-COVID Tracheal Stenosis

Introducción: La infección por SARS-CoV-2 puede presentar síndrome de distrés res-piratorio agudo con requerimiento de ventilación mecánica prolongada y retraso en la realización de traqueostomía. Esto trae como consecuencia un incremento en casos de estenosis traqueal y la necesidad de métodos menos invasivos para su abordaje. Métodos: Estudio descriptivo de corte transversal, desde marzo 2020 hasta diciem-bre 2021 en el Hospital Universitario Nacional de Colombia, en adultos con estenosis traqueal postintubación asociado SARS-CoV-2. Se realizó análisis univariado entre los grupos con infección o no por SARS-CoV-2 como control, y reintervención, grado de estenosis, uso de inyección intramucosa con dexametasona intratraqueal o múltiples estenosis como desenlaces de importancia. Se usó test exacto de Fisher, t Student y Man-Whitney según la naturaleza de variables. Se consideró p estadísticamente significativo menor a 0.05.Resultados: Se identificaron 26 pacientes, 20 tenían COVID-19 y 6 no. Se encontraron diferencias en edad (p=0,002), epilepsia (p=0,007) y estenosis múltiple (p= 0,04). En 85% de los casos se utilizó láser blue más dilatación con balón pulmonar, en 35% inyección intramucosa con dexametasona intratraqueal y reintervención en 35%, sin diferencias significativas entre grupos. Conclusiones: Se observó un incremento tres veces mayor de pacientes con estenosis múltiple en el grupo de infección por COVID-19, así mismo se encontró que el método más utilizado en este grupo para la recanalización fue el uso de láser blue más dilatación con balón pulmonar y la innovación en el uso de inyección intramucosa.

Introduction: SARS-CoV-2 infection can lead to acute respiratory distress syndrome with a prolonged need for mechanical ventilation and delayed tracheostomy, resulting in an increase in cases of tracheal stenosis and the necessity for less invasive approaches.Methods: A descriptive cross-sectional study was conducted from March 2020 to December 2021 at the Hospital Universitario Nacional de Colombia, focusing on adults with post-intubation tracheal stenosis associated with SARS-CoV-2. Univariate analysis was performed between groups with or without SARS-CoV-2 infection as a control, considering reintervention, degree of stenosis, use of intratracheal steroids, or multiple stenoses as important outcomes. Fisher's exact test, Student's t-test, and Mann-Whit-ney test were employed based on the nature of variables. A p-value less than 0.05 was considered statistically significant.Results: A total of 26 patients were included, with 20 having COVID-19 and 6 without. Significant differences were found in age (p=0.002), epilepsy (p=0.007), and multiple stenosis (p=0.04). In 85% of cases, laser blue plus balloon pulmonary dilation was used, intratracheal dexamethasone in 35%, and reintervention in 35%, with no significant differences between groups.Conclusions: A threefold increase in subglottic stenosis was observed during the SARS-CoV-2 pandemic, with more instances of multiple stenosis and predominantly the use of laser blue plus balloon pulmonary dilation as a successful recanalization technique. There was a higher use of intratracheal dexamethasone in this group compared to oth-er pathologies causing tracheal stenosis.

Hipertensión arterial sistémica posterior a COVID-19 / Systemic arterial hypertension after COVID-19

Introducción: un nuevo tipo de coronavirus que se nombró SARSCoV-2, responsable de la enfermedad por COVID-19, tuvo esparcimiento rápido en el mundo, por alta transmisión que resultó en pandemia. Se registraron 2'397,216 casos confirmados, con 162,956 defunciones en el mundo, de acuerdo con la Organización Mundial de la Salud (OMS), en abril de 2020. Sin embargo, la hipertensión afecta a 40% de adultos, lo que significa que alrededor de 250 millones de personas padecen de presión alta. La OMS, de acuerdo con sus reportes, refiere que la hipertensión es el factor de riesgo número uno de muerte. Uno de cada cuatro mexicanos padece hipertensión arterial. Objetivos: establecer la incidencia de la hipertensión arterial sistémica posterior a padecer COVID-19 en pacientes de la Unidad de Medicina Familiar (UMF) No. 48. Material y métodos: es un estudio transversal, observacional y descriptivo, conformado por 3,238 pacientes con diagnóstico de COVID-19 positivo, de ambos sexos, con edades entre 18 y 70 años. Por medio de la fórmula para poblaciones infinitas se obtiene una muestra de 348 pacientes. Se realizó revisión de expedientes en el Sistema de Información de Medicina Familiar, versión 6.2, para obtención de la información correspondiente. Resultados: 27 pacientes diagnosticados con hipertensión arterial posterior al diagnóstico de COVID-19, 52% del sexo masculino y 48% del femenino, con media de edad de 39 años, 74% correspondió a enfermedad leve por COVID-19 y 26% a enfermedad moderada. Se documenta mediana de ocho días por periodo de infección por COVID-19. En el círculo femenino el promedio de la aparición de hipertensión arterial fue de 13 meses y en el masculino la media de desarrollo de hipertensión arterial posterior a COVID-19 fue de seis meses (AU)

Introduction: a new type of coronavirus that was named SARSCoV-2, responsible for the COVID-19 disease, with rapid spread in the world, due to high transmission that resulted in pandemic. There were 2'397,216 confirmed cases, with 162,956 deaths in the world, according to the WHO in April 2020. However, hypertension affects 40% of adults and means that around 250 million people suffer from high blood pressure. The WHO, according to its reports, refers that hypertension is the number one risk factor for death. One in four Mexicans suffers from high blood pressure. Objectives: to establish the incidence of systemic arterial hypertension after suffering from COVID-19 in patients of the UMF No. 48. Material and methods: it is a cross-sectional, observational and descriptive study, consisting of 3,238 patients with a positive COVID-19 diagnosis of both sexes, aged 18-70 years. Through the formula for infinite populations a sample of 348 patients is obtained. Will proceed with review of files in the Family Medicine Information System, version 6.2, to obtain the corresponding information. Results: 27 patients diagnosed with hypertension after the diagnosis of COVID-19, 52% of the male sex and 48% of the female sex, with a mean age of 39 years; 74% corresponds to a mild illness by COVID-19 and 26% to moderate disease. A median of 8 days per period of infection by COVID-19 is documented. In the female circle, the average onset of hypertension was 13 months and as for the male sex, the mean development of hypertension after COVID-19 was six months (AU)

Corneal transplantation and concomitant SARS-CoV-2 infection: a case report / Transplante de córnea e infecção concomitante por SARS-CoV-2: relato de caso

ABSTRACT This report was aimed at presenting a case of neurotrophic keratitis and concomitant SARS-CoV-2 infection in a patient who has recently undergone a corneal DALK transplant. One month after corneal transplantation with adequate corneal epithelialization, the patient presented neurotrophic keratitis with a torpid course of the corneal transplant coinciding with a SARS-CoV-2 infection, with an excessive host immune response. In addition, the patient presented a re-positivization of nasopharyngeal polymerase chain reaction of SARS-CoV-2 with past disease after starting treatment with autologous serum eye drops. The implications at the ophthalmological level of SARS-CoV-2 infection may be clarified as the time the illness progresses and we learn more about how it acts. In this case, the disparity of signs and symptoms, the antecedent of corneal surgery, and the possibility of a herpetic infection as a cause of the primary leukoma suggested neurotrophic keratitis. Nonetheless, the involvement of systemic SARS-CoV-2 infection in the process, triggering an excessive host immune response at the corneal level with an increase in inflammatory cytokines must be taken into account. No relationship was found between treatment with autologous serum and re-positivization of nasopharyngeal polymerase chain reaction, presenting the patient a favorable response to treatment.

RESUMO O objetivo deste relato foi apresentar um caso de ceratite neurotrófica e infecção concomitante por SARS-CoV-2 em paciente submetido recentemente a transplante de córnea DALK. Um mês após o transplante de córnea com adequada epitelização da córnea, o paciente apresentou ceratite neurotrófica com curso tórpido do transplante de córnea, coincidindo com infecção por SARS-CoV-2, com resposta imune excessiva do hospedeiro. Além disso, o paciente apresentou repositivização da reação em cadeia da polimerase nasofaríngeo de SARS-CoV-2, com doença pregressa após iniciar tratamento com colírio de soro autólogo. As implicações a nível oftalmológico da infecção por SARS-CoV-2, podem ser esclarecidas à medida que a doença progride e aprendemos mais sobre sua forma de atuação. Neste caso, a disparidade de sinais e sintomas, o antecedente de cirurgia de córnea e a possibilidade de infecção herpética como causa do leucoma primário sugeriram ceratite neurotrófica. No entanto, deve-se levar em consideração o envolvimento da infecção sistêmica por SARS-CoV-2 no processo, desencadeando uma resposta imune excessiva do hospedeiro no nível da córnea, com aumento de citocinas inflamatórias. Não foi encontrada relação entre o tratamento com soro autólogo e a repositivização da reação em cadeia da polimerase nasofaríngea, apresentando ao paciente uma resposta favorável ao tratamento.

Índice de massa corporal e desfechos clínicos: um estudo retrospectivo durante a pandemia de Covid-19 / Body mass index and clinical outcomes: a retrospective study in Covid-19 / Índice de masa corporal y resultado clínico: un estudio retrospectivo durante la pandemia de Covid-19

A COVID-19 é uma doença respiratória aguda provocada pela infecção do vírus SARS-CoV-2, que pode causar uma grave insuficiência respiratória hipoxêmica, complicações e mortes, principalmente na população com condições crônicas de saúde. Os mecanismos pelos quais a obesidade pode aumentar a gravidade da COVID-19 incluem mecanismos físicos, inflamação crônica e uma função imunológica prejudicada. Além disso, o índice de massa corporal elevado é um fator de risco para várias condições médicas que têm sido sugeridas para aumentar o risco de gravidade da COVID-19. Objetivo: analisar a associação entre o índice de massa corporal e desfechos clínicos dos casos confirmados de COVID-19. Metodologia: Estudo transversal, com coleta de dados de prontuários, conduzido de março de 2020 a dezembro 2021. Foram analisados os registros de prontuários, exames bioquímicos e de imagem de pacientes internados com COVID-19 em três hospitais da cidade de Francisco Beltrão (PR). As variáveis analisadas foram o diagnóstico nutricional, idade, sexo, necessidade de internação em UTI, comorbidades, dias de hospitalização, complicações, exames laboratoriais e desfecho. Os critérios para inclusão no estudo foram, pacientes hospitalizados com diagnóstico para COVID-19, com presença de diagnóstico nutricional relatado. Resultados: No ano de 2020 foram analisados 292 prontuários e no ano de 2021 foram 860 prontuários. Destes, somente 413 possuíam diagnóstico nutricional, sendo assim incluídos no presente estudo. Foram classificados como peso normal 78 (18,9%), com sobrepeso 153 (37%)e como obeso 182 (44,1%) participantes. A maior prevalência de obesidade foi encontrada no sexo feminino (52,5%), portadores de diabetes (27,6%), pacientes com estado geral comprometido (67,9%), que apresentaram complicações pulmonares (54,5%) e arritmias (23%). A média de idade encontrada em pacientes com obesidade foi mais jovem (55,54) em comparação com os classificados com sobrepeso (59,08) e normal (62,51). Observou-se que quanto maior o IMC menor foram os valores encontrados para idade (rho = -0,190), leucócitos (rho = -0,109), ureia (rho = -0,145) e D-dímero (rho = -0,155). Conclusão: Este estudo fornece evidências de que o sobrepeso e/ou obesidade então associadas a um pior quadro clínico durante a internação dos pacientes com COVID-19. Em relação a frequência de óbito, não houve diferença estatística em relação ao diagnóstico nutricional.

COVID-19 is an acute respiratory disease caused by SARS-CoV-2 virus infection, which can cause severe hypoxemic respiratory failure, complications, and deaths, especially in the population with chronic health conditions. The mechanisms by which obesity may increase the severity of COVID-19 include physical mechanisms, chronic inflammation, and impaired immune function. In addition, high body mass index is a risk factor for several medical conditions that have been suggested to increase the risk of COVID-19 severity. Objective: to analyze the association between body mass index and clinical outcomes of confirmed cases of COVID-19. Methodology: Cross-sectional study, with data collection from medical records, conducted from March 2020 to December 2021. The records of medical records, biochemical and imaging tests of patients hospitalized with COVID-19 in three hospitals in the city of Francisco Beltrão (PR) were analyzed. The variables analyzed were nutritional diagnosis, age, gender, need for ICU admission, comorbidities, days of hospitalization, complications, laboratory tests and outcome. The inclusion criteria for the study were, hospitalized patients with diagnosis for COVID-19, with presence of nutritional diagnosis reported. Results: In the year 2020, 292 medical records were analyzed and in the year 2021 there were 860 medical records. Of these, only 413 had nutritional diagnosis, thus being included in this study. Were classified as normal weight 78 (18.9%), overweight 153 (37%), and obese 182 (44.1%) participants. The highest prevalence of obesity was found in females (52.5%), patients with diabetes (27.6%), patients with impaired general condition (67.9%), who presented pulmonary complications (54.5%) and arrhythmias (23%). The mean age found in obese patients was younger (55.54) compared to those classified as overweight (59.08) and normal (62.51). It was observed that the higher the BMI the lower were the values found for age (rho = -0.190), leukocytes (rho = -0.109), urea (rho = -0.145) and D-dimer (rho = -0.155). Conclusion: This study provides evidence that overweight and/or obesity then associated with a worse clinical picture during hospitalization of patients with COVID-19. Regarding the frequency of death, there was no statistical difference in relation to nutritional diagnosis.

COVID-19 es una enfermedad respiratoria aguda causada por la infección por el virus SARS-CoV-2, que puede provocar insuficiencia respiratoria hipoxémica grave, complicaciones y muertes, especialmente en poblaciones con enfermedades crónicas. Los mecanismos por los cuales la obesidad puede aumentar la gravedad de la COVID-19 incluyen mecanismos físicos, inflamación crónica y función inmune deteriorada. Además, un índice de masa corporal alto es un factor de riesgo para varias afecciones médicas que, según se ha sugerido, aumentan el riesgo de gravedad del COVID-19. Objetivo: analizar la asociación entre el índice de masa corporal y los resultados clínicos de casos confirmados de COVID-19. Metodología: Estudio transversal, con recolección de datos de historias clínicas, realizado de marzo de 2020 a diciembre de 2021. Se analizaron historias clínicas, exámenes bioquímicos y de imagen de pacientes hospitalizados con COVID-19 en tres hospitales de la ciudad de Francisco Beltrão (PR). Las variables analizadas fueron diagnóstico nutricional, edad, sexo, necesidad de ingreso a UCI, comorbilidades, días de internación, complicaciones, exámenes de laboratorio y evolución. Los criterios de inclusión en el estudio fueron pacientes hospitalizados con diagnóstico de COVID-19, con presencia de diagnóstico nutricional informado. Resultados: En 2020 se analizaron 292 historias clínicas y en 2021 se analizaron 860 historias clínicas. De ellos, sólo 413 tenían diagnóstico nutricional, por lo que fueron incluidos en el presente estudio. 78 (18,9%) participantes fueron clasificados como normopeso, 153 (37%) como sobrepeso y 182 (44,1%) como obesidad. La mayor prevalencia de obesidad se encontró en el sexo femenino (52,5%), pacientes con diabetes (27,6%), pacientes con estado general comprometido (67,9%), quienes presentaron complicaciones pulmonares (54,5%) y arritmias (23%). La edad promedio encontrada en los pacientes con obesidad fue menor (55,54) en comparación con los clasificados como con sobrepeso (59,08) y normales (62,51). Se observó que a mayor IMC, menores son los valores encontrados para edad (rho = -0,190), leucocitos (rho = -0,109), urea (rho = -0,145) y dímero D (rho = -0,155). Conclusión: Este estudio proporciona evidencia de que el sobrepeso y/u obesidad se asocia con una peor condición clínica durante la hospitalización de pacientes con COVID-19. En cuanto a la frecuencia de muerte, no hubo diferencia estadística en relación al diagnóstico nutricional.

Prevalência de casos graves de covid-19 e fatores associados em um hospital pediátrico / Prevalencia de casos graves de covid-19 y factores asociados en un hospital pediátrico / Prevalence of severe covid-19 cases and associated factors in a pediatric hospital

Objetivo: descrever a prevalência de casos graves pelo SARS-Cov-2 e fatores associados à ocorrência em crianças e adolescentes. Método: estudo transversal, num hospital pediátrico, com 236 crianças e adolescentes com COVID-19 entre março-2020 até fevereiro-2022. Resultados: a prevalência de casos graves da COVID-19 foi de 37%. A maior frequência foram do sexo masculino (41%), até 1 ano de idade (41,8%) e municípios circunvizinhos (46,5%). As manifestações clínicas em até 72 horas após hospitalização, associados aos casos graves foram: desconforto respiratório (RPb: 1,91; IC 95% 1,36 - 2,67), saturação de O2 < 92% (RPb: 9,27 IC 95% 5,99 - 14,35), necessidade de cuidados intensivos (RPb: 5,25; IC 95% 3,87 - 7,12) e comorbidades (RPb: 1,73 IC 95% 1,25 - 2,40). Os desfechos, óbito/transferência, associaram-se com maior proporção de casos graves. Conclusão: conhecer o perfil de casos de COVID-19 na população pediátrica e fatores associados pode contribuir para revisar processos a fim de manejo adequado dos casos.

Objetivo: describir la prevalencia de casos graves por el SARS-Cov-2 y factores asociados a la ocurrencia en niños y adolescentes. Método: estudio transversal, en un hospital pediátrico, con 236 niños y adolescentes con COVID-19 entre marzo-2020 hasta febrero-2022. Resultados: la prevalencia de casos graves de COVID-19 fue del 37%. La mayor frecuencia fueron del sexo masculino (41%), hasta 1 año de edad (41,8%) y municipios circundantes (46,5%). Las manifestaciones clínicas en hasta 72 horas después de la hospitalización, asociados a los casos graves fueron: malestar respiratorio (RPb: 1,91; IC 95% 1,36 - 2,67), saturación de O2 < 92% (RPb: 9,27 IC 95% 5,99 - 14,35), necesidad de cuidados intensivos (RPb: 5,25; IC 95% 3,87 - 7,12) y comorbilidades (RPb: 1,73 IC 95% 1,25 - 2,40). Los resultados, muerte/transferencia, se asociaron con mayor proporción de casos graves. Conclusión: conocer el perfil de casos de COVID-19 en la población pediátrica y factores asociados puede contribuir para revisar procesos a fin de manejo adecuado de los casos.

Objective: to describe the prevalence of severe cases by SARS-Cov-2 and factors associated with the occurrence in children and adolescents. Method: cross-sectional study, in a pediatric hospital, with 236 children and adolescents with COVID-19 between March 2020 and February 2022. Results: the prevalence of severe cases of COVID-19 was 37%. The highest frequency was male (41%), up to 1 year of age (41.8%) and surrounding cities (46.5%). Clinical manifestations within 72 hours of hospitalization, associated with severe cases, were respiratory distress (PRc: 1.91; 95% CI 1.36 -2.67), O2saturation < 92% (PRc: 9.27 95% CI 5.99 - 14.35), need for intensive care (PRc: 5.25; 95% CI 3.7 - 87) and comorbidities (PRc: 1.73 95% CI 1.25 - 2.40). The outcomes death/transfer were associated with a higher proportion of severe cases. Conclusion: knowing the profile of COVID-19 cases in the pediatric population and associated factors can contribute to review processes for proper management of cases.

Clinical analysis of 11 cases multisystem inflammatory syndrome associated with SARS-CoV-2 Omicron variant infection in children / 中华儿科杂志

Objective: To explore the clinical characteristics, diagnosis, treatment, and follow-up of multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 Omicron variant infection. Methods: A retrospective analysis was conducted on clinical data of 11 children with MIS-C, who were admitted to the Department of Pediatrics of Peking University First Hospital from December 2022 to January 2023. Clinical characteristics, treatment, and follow-up of MIS-C were summarized in this study. Results: The 11 cases contained 7 boys and 4 girls, with an age of 4.4 (2.0, 5.5) years on admission. All the patients had fever, with a duration of 7(5, 9) days. Other clinical manifestations included rash in 7 cases, conjunctival hyperemia in 5 cases, red lips and raspberry tongue in 3 cases, lymphadenopathy in 3 cases, and swollen fingers and toes in 2 cases. There were 8 cases of digestive symptoms, 8 cases of respiratory symptoms, and 3 cases of nervous system symptoms. Eight patients had multi-system injuries, and one of them had shock presentation. All 11 patients were infected with SARS-CoV-2 Omicron BF.7 variant. The laboratory examination results showed that all cases had elevated inflammatory indicators, abnormal coagulation function and myocardial damage. Six patients had elevated white blood cell counts, 5 cases had liver function abnormalities, 3 cases had kidney function abnormalities, and 8 cases had coronary artery involvement. All 11 patients received anti-infection treatment, of which 3 cases received only 2 g/kg intravenous immunoglobulin (IVIG), while the remaining 8 cases received a combination of IVIG and 2 mg/(kg·d) methylprednisolone. Among the 8 cases with coronary artery disease, 6 cases received low molecular weight heparin anticoagulation therapy. All patients were followed up in 2 weeks after being discharged, and their inflammatory markers had returned to normal by that time. The 8 cases with coronary artery disease and 3 cases with pneumonia showed significant improvement or back to normal at the 4-week follow-up. All patients had no new complications or comorbidities during follow-up of more than 3 months. Conclusions: MIS-C may present with Kawasaki disease-like symptoms, with or without gastrointestinal, neurological, or respiratory symptoms. Elevated inflammatory markers, abnormal coagulation function, and cardiac injury contribute to the diagnosis of MIS-C. IVIG and methylprednisolone were the primary treatments for MIS-C, and a favorable short-term prognosis was observed during a follow-up period of more than 3 months.

Eficácia da ivermectina e atazanavir no tempo de recuperação dos sintomas de covid-19: uma coorte prospectiva / Effectiveness of ivermectin and atazanavir on time to resolution from covid-19 symptoms: a prospective cohort / Eficacia de ivermectina y atazanavir en el tiempo hasta lá resolución de los síntomas de covid-19: una cohorte prospectiva

Objetivo: avaliar a eficácia da Ivermectina e do Atazanavir em comparação com placebo no tempo de resolução dos sintomas e no tempo de duração da doença por COVID-19. Método: estudo observacional, de coorte prospectivo, longitudinal, descritivo e analítico com pacientes sintomáticos ambulatoriais, acompanhados por 06 meses em duas Unidades Básicas de Saúde para atendimento de COVID-19 em Teresina- Piauí, Brasil, no período de novembro a abril de 2021 identificados por amostragem aleatória 1:1:1. Foram realizados exames Reverse transcription polymerase chain reaction (RT-PCR) para confirmação laboratorial da suspeita de infecção pelo novo coronavírus e avaliação sociodemográfica e clínica. Resultados: dos 87 pacientes randomizados, 62,1% (n=54) eram do sexo masculino, com média de idade de 35,1 anos, possuíam companheira (53,9%), baixa renda (50,6%), eutróficos (40,7%) e sem comorbidades de saúde (78,2%). Não houve diferença entre o tempo médio para resolução dos sintomas, que foi de 21 dias (IQR, 8-30) no grupo atazanavir, 30 dias (IQR, 5-90) no grupo ivermectina em comparação com 14 dias (IQR, 9-21) no grupo controle. No dia 180, houve resolução dos sintomas em 100% no grupo placebo, 93,9% no grupo atazanavir e 95% no grupo ivermectina. A duração mediana da doença foi de 08 dias em todos os braços do estudo. Conclusão: o tratamento com atazanavir (6 dias) e ivermectina (3 dias) não reduziu o tempo de resolução dos sintomas e nem o tempo de duração da doença entre os pacientes ambulatoriais com COVID-19 leve em comparação com o grupo placebo. Os resultados não suportam o uso de ivermectina e atazanavir para tratamento de COVID-19 leve a moderado.

Objective: to evaluate the effectiveness of Ivermectin and Atazanavir compared to placebo in the time to resolution of symptoms and duration of illness due to COVID-19. Method: observational, prospective, longitudinal, descriptive and analytical cohort study with symptomatic outpatients, followed for 06 months in two Basic Health Units for COVID-19 care in Teresina-Piauí, Brazil, from November to April 2021 identified by 1:1:1 random sampling. Reverse transcription polymerase chain reaction (RT-PCR) tests were performed for laboratory confirmation of suspected infection with the new coronavirus and sociodemographic and clinical evaluation. Results: of the 87 randomized patients, 62.1% (n=54) were male, with a mean age of 35.1 years, had a partner (53.9%), low income (50.6%), eutrophic (40.7%) and without health comorbidities (78.2%). There was no difference between the median time to resolution of symptoms, which was 21 days (IQR, 8-30) in the atazanavir group, 30 days (IQR, 5- 90) in the ivermectin group compared with 14 days (IQR, 9- 21) in the control group. At day 180, there was resolution of symptoms in 100% in the placebo group, 93.9% in the atazanavir group, and 95% in the ivermectin group. The median duration of illness was 8 days in all study arms. Conclusion: Treatment with atazanavir (6 days) and ivermectin (3 days) did not reduce the time to symptom resolution or the duration of illness among outpatients with mild COVID-19 compared to the placebo group. The results do not support the use of ivermectin and atazanavir for the treatment of mild to moderate COVID-19.

Objetivo: evaluar la efectividad de Ivermectina y Atazanavir en comparación con placebo en el tiempo de resolución de los síntomas y duración de la enfermedad por COVID-19. Método: estudio de cohorte observacional, prospectivo, longitudinal, descriptivo y analítico con pacientes ambulatorios sintomáticos, seguidos durante 06 meses en dos Unidades Básicas de Salud para atención de COVID-19 en Teresina-Piauí, Brasil, de noviembre a abril de 2021 identificados por 1:1:1 muestreo aleatorio. Se realizaron pruebas de reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR) para confirmación de laboratorio de sospecha de infección por el nuevo coronavirus y evaluación sociodemográfica y clínica. Resultados: de los 87 pacientes aleatorizados, 62,1% (n=54) eran del sexo masculino, con una edad media de 35,1 años, tenían pareja (53,9%), bajos ingresos (50,6%), eutróficos (40,7%) y sin comorbilidades de salud (78,2%). No hubo diferencia entre la mediana de tiempo hasta la resolución de los síntomas, que fue de 21 días (RIC, 8-30) en el grupo de atazanavir, 30 días (RIC, 5- 90) en el grupo de ivermectina en comparación con 14 días (RIC, 9 - 21) en el grupo control. En el día 180, hubo una resolución de los síntomas del 100 % en el grupo de placebo, del 93,9 % en el grupo de atazanavir y del 95 % en el grupo de ivermectina. La mediana de duración de la enfermedad fue de 8 días en todos los brazos del estudio. Conclusión: El tratamiento con atazanavir (6 días) e ivermectina (3 días) no redujo el tiempo de resolución de los síntomas ni la duración de la enfermedad entre los pacientes ambulatorios con COVID-19 leve en comparación con el grupo placebo. Los resultados no respaldan el uso de ivermectina y atazanavir para el tratamiento de la COVID-19 de leve a moderada.

Reinfección por SARS-CoV-2 en pacientes con antecedentes de MIS-C. Presentación de dos casos / MIS-C patients who were reinfected with SARS-CoV-2. Report of 2 cases

El síndrome inflamatorio multisistémico pediátrico (MIS-C, por su sigla en inglés) es una enfermedad rara. Se desconoce si los niños que se recuperaron del MIS-C tienen riesgo de recurrencia de MIS-C cuando presentan reinfección por SARS-CoV-2. El objetivo de este estudio es describir los casos de dos niñas que se recuperaron del MIS-C y presentaron reinfección por SARS-CoV-2 sin recurrencia de MIS-C.

Multisystem inflammatory syndrome in children (MIS-C) is a rare condition. It is still unknown if children who have recovered from MIS-C are at a risk of recurrence of MIS-C when they are reinfected with SARS-CoV-2. In this study, we aimed to report 2 children who recovered from MIS-C and reinfected with SARS-CoV-2 without recurrence of MIS-C.

Puntaje APP como predictor de mortalidad en pacientes con síndrome de dificultad respiratoria agudo grave por COVID-19 en un hospital referencial del norte del Perú / APP score as a predictor of mortality in patients with severe acute respiratory distress syndrome due to COVID-19 in a reference hospital in northern of Peru

INTRODUCCIÓN: La mortalidad por pacientes por COVID-19 grave que desarrollaban neumonía grave y síndrome de dificultad respiratoria agudo (SDRA) grave ha sido significativa a pesar del tratamiento oportuno. Es importante determinar predictores tempranos de enfermedad que nos ayuden a estratificar aquellos pacientes con mayor riesgo de fallecer. Se pretende estudiar el comportamiento del puntaje APP (APPS) como predictor de ello, basados en algunos reportes de uso y utilidad en el SDRA. no COVID-19. OBJETIVO: Determinar si el APPS es útil como predictor de mortalidad en SDRA. por COVID-19 grave. PACIENTES Y MÉTODO: Se realizó un estudio tipo cohorte retrospectivo, incluyendo pacientes de la Unidad de Cuidados Intensivos (UCI), con SDRA. por COVID-19 grave, que ingresaron a la UCI del Hospital Regional Docente de Trujillo (HRDT) en el período abril 2020- abril 2021. Se evalúo la utilidad del APPS como predictor de mortalidad em dicha población. RESULTADOS: El APPS demostró ser un factor asociado a mortalidad en pacientes con SDRA. y COVID-19 grave (RPa 1,34; IC 95% 1,16 a 1,56; p < 0,001). Además, encontramos que, al realizar un modelo de predicción ajustado por edad, sexo, SOFA, APPS, shock, Indice de Charlson (ICh), se comportan como factores asociados a mortalidad el APPS, el sexo masculino (RPa: 1,48; IC 95% 1,09 a 2,049; p < 0,05) y el ICh (RPa: 1,11; IC 95% 1,02 a 1,21; p < 0,05). CONCLUSIÓN: El APPS, el sexo masculino y el ICh son predictores de mortalidad en SDRA. por COVID-19 grave.

BACKGROUND: Mortality in patients with severe COVID-19 who developed severe pneumonia and severe Acute Respiratory Distress Syndrome (ARDS) has been significant despite timely treatment. It is important to determine early predictors of disease that help us to stratify those patients with a higher risk of death. It is intended to study the behavior of the APPS score as a predictor of this, based on some reports of use and usefulness in non-COVID-19 ARDS. AIM: To determine if the APP score is useful as a predictor of mortality in ARDS due to severe COVID-19. METHOD: A retrospective cohort study was carried out, including patients from the Intensive Care Unit (ICU) with ARDS due to severe COVID-19 who were admitted to the ICU of the Trujillo Regional Teaching Hospital (HRDT) in the period March 2020 to March 2021. The usefulness of the APP score as a predictor of mortality in mentioned population was evaluated. RESULTS: The APP score proved to be a factor associated with mortality in patients with ARDS and severe COVID-19 (APR 1.34; 95% CI 1.16 to 1.56; p < 0.001). We also found that when performing a prediction model adjusted for age, sex, SOFA, APP score, shock and Charlson Index (ICh) we found that the APP score, male sex (APR: 1.48; 95% CI 1.09 to 2.049; p < 0.05) and the ICh behave as factors associated with mortality (RPa: 1.11; 95% CI 1.02 to 1.21; p < 0.05). CONCLUSION: The APP score, male sex, and ICh are predictors of mortality in ARDS due to severe COVID-19.

Caracterização sociodemográfica e clínica de pessoas idosas com sequelas da COVID-19 / Sociodemographic and clinical characterization of elderly people with sequelae of COVID-19 / Caracterización sociodemográfica y clínica de personas mayores con secuelas de COVID-19

Objetivo: descrever as características sociodemográficas e clínicas de pessoas idosas com sequelas da COVID-19. Método: estudo documental quantitativo, observacional, descritivo, compôs-se a amostra 204 prontuários de pessoas idosas com registros de sequelas da COVID-19. Realizados testes de Qui-quadrado de Pearson e Fisher. Resultados: prevaleceram mulheres, entre 60 a 69 anos (66,7%), casadas (50,5%), com filhos (92,9%), aposentadas (47,6%), com renda de dois a quatro salários-mínimos (50,7%). Verificou-se como comorbidades a hipertensão arterial (65,2%), obesidade (40%), diabetes mellitus (23,5%), doenças cardíacas (13,7%) e respiratórias (7,8%) e como comportamentos de risco o sedentarismo (59,4%) e sobrepeso (52,2%). A hospitalização foi mais prevalente entre portadores de diabetes mellitus (56,3%), obesidade (68,8%) e câncer (83,3%). Conclusão: o envelhecimento, a presença de comorbidades e hospitalização são condições associadas a mortalidade por COVID-19. Ressalta-se a importância de uma assistência individualizada e multidimensional(AU)

Objective: to describe the sociodemographic and clinical characteristics of elderly people with sequelae of COVID-19. Method: quantitative, observational, descriptive documentary study, the sample consisted of 204 medical records of elderly people with records of COVID-19 sequelae. Pearson and Fisher Chi-square tests were performed. Results: women prevailed, between 60 and 69 years old (66.7%), married (50.5%), with children (92.9%), retired (47.6%), with income of two to four salaries- minimum (50.7%). Comorbidities were arterial hypertension (65.2%), obesity (40%), diabetes mellitus (23.5%), heart disease (13.7%) and respiratory diseases (7.8%) and as health behaviors. risk of sedentary lifestyle (59.4%) and overweight (52.2%). Hospitalization was more prevalent among patients with diabetes mellitus (56.3%), obesity (68.8%) and cancer (83.3%). Conclusion: aging, the presence of comorbidities and hospitalization are conditions associated with mortality from COVID-19. The importance of individualized and multidimensional assistance is highlighted(AU)

Objetivo: describir las características sociodemográficas y clínicas de personas mayores con secuelas de COVID-19. Método: estudio documental cuantitativo, observacional, descriptivo, la muestra estuvo compuesta por 204 historias clínicas de personas mayores con antecedentes de secuelas de COVID-19. Se realizaron pruebas de Chi-cuadrado de Pearson y Fisher. Resultados: predominaron las mujeres, entre 60 y 69 años (66,7%), casadas (50,5%), con hijos (92,9%), jubiladas (47,6%), con ingresos de dos a cuatro salarios mínimos (50,7%). Las comorbilidades fueron hipertensión arterial (65,2%), obesidad (40%), diabetes mellitus (23,5%), enfermedades cardíacas (13,7%) y enfermedades respiratorias (7,8%) y, en cuanto a conductas de riesgo, el sedentarismo (59,4%) y el sobrepeso (52,2%). La hospitalización fue más prevalente entre los pacientes con diabetes mellitus (56,3%), obesos (68,8%) y con cáncer (83,3%). Conclusión: el envejecimiento, la presencia de comorbilidades y la hospitalización son condiciones asociadas a la mortalidad por COVID-19. Destacan la importancia de la asistencia individualizada y multidimensional(AU)

Evaluation of chest computed tomography alterations of patients hospitalized by Covid-19 / Avaliação de alterações em tomografia computadorizada de tórax de pacientes internados por Covid-19

Introduction: SARS-CoV-2 has rapid dissemination and high infectivity and can evolve into Severe Respiratory Distress Syndrome (SARS), which led to a high number of deaths and hospitalizations in the recent pandemic. Computed tomography (CT) of the chest has demonstrated an essential role in the initial evaluation and evolution of these patients. Methodology: This was a retrospective observational study at a single center, University Hospital in Northeastern Brazil, evaluating 97 patients hospitalized for COVID-19 with laboratory confirmation to evaluate and quantify the chest CT findings, comparing the findings with the severity of the case and relating them to the morbidities presented. The CT scans were performed by radiologists from the hospital and the data were evaluated by the university's statistics laboratory. Results: Among the main alterations, ground-glass opacities were present in more than 90% of the patients. The study observed that the magnitude of the pulmonary involvement of this finding had a relationship with the outcome of higher hospitalization. Conclusion: In this sense, the relevance of chest CT to suggest the diagnosis of Covid-19 and establish the prognosis of the disease is observed. However, further studies are still needed to confirm these finding (AU).

Introdução: O SARS-CoV-2 possui rápida disseminação e alta infectividade, podendo evoluir com Síndrome da Angústia Respiratória Grave (SARS), o que levou a um número elevado de mortes e internações na recente pandemia. A Tomografia Computadorizada (TC) de tórax demonstrou um papel essencial na avaliação inicial e evolução desses pacientes. Metodologia: Este foi um estudo observacional retrospectivo em centro único - Hospital Universitário no Nordeste do Brasil - avaliando 97 pacientes internados por COVID-19 com confirmação laboratorial, a fim de avaliar e quantificar os achados de TC de tórax, comparando os achados com a gravidade do caso e relacionando-os com as morbidades apresentadas. As TCs foram laudadas por radiologistas do próprio hospital. Após isso, os dados foram avaliados pelo laboratório de estatística da universidade para serem analisados e discutidos. Resultados: Dentre as principais alterações, o vidro fosco estava presente em mais de 90% dos pacientes. Foi observado que a magnitude do comprometimento pulmonar deste achado apresentou relação desfavorável com o desfecho da internação. Conclusão: Neste sentido, observa-se a relevância da TC de tórax para sugerir o diagnóstico de Covid-19 e estabelecer o prognóstico da doença. No entanto, ainda são necessários mais estudos para destrinchar estes achado (AU).

Sintomatología de pacientes hospitalizados por SARS-CoV-2 en un hospital de segundo nivel / Symptoms of SARS-CoV-2 patients in a second level hospital

Introduction: T he COVID-19 p andemic caused by t he SARS-CoV-2 coronavirus h as shaken the world since the beginning of 2020, causing a huge number of patient deaths. Objective: To evaluate the main symptoms of patients hospitalized for SARS CoV-2 in th e H.G.Z No.1 of the IMSS in Nayarit. Methodology: It is a retrospective, observational and cross-sectional study, with information collected from the clinical records of patients admitted through the respiratory triage area with a diagnosis of SARS Cov-2, confirmed with PCR. Results: 433 patients were included, of these 267 male patients (62%) and 166 female patients (38%), with an average age of 62 years. Within the main symptomatology is dyspnea (96%), fever (78%), attack to the general state (78%), cough (76%) and headache (67%). In addition, 102 (23.6%) patients required advanced airway management, of whom 89 died (87%). Of the total number of patients, 208 (48%) died and 225 (54%) showed improvement. Conclusions: The main symptoms of patients hospitalized for SARS CoV-2 are dyspnea, fever, general condition attack, cough and headache.

Introducción: la pandemia de COVID-19 provocada por el coronavirus SARS-CoV-2 ha sacudido al mundo desde el comienzo del año 2020, provocando un número ingente de fallecimientos de pacientes. Objetivo: evaluar la principal sintomatología de los pacientes hospitalizados por SARS-CoV-2 en el Hospital General de Zona No.1 del IMSS. Metodología: estudio retrospectivo, observacional y transversal, con información recabada de los expedientes clínicos de pacientes que ingresaron por área de triage respiratorio con diagnóstico de SARS-CoV-2 confirmado mediante prueba PCR. Resultados: se incluyeron 433 pacientes, de estos 267 pacientes de sexo masculinos (62%) y 166 pacientes del femenino (38%), con una edad promedio de 62 años. Dentro de la principal sintomatología se encuentra la disnea (96%), fiebre (78%), ataque al estado general (78%), tos (76%) y cefalea (67%). Además, 102 (23.6%) pacientes necesitaron manejo avanzado de la vía aérea, de los cuales 89 fallecieron (87%). Del total de pacientes, 208 (48%) fallecieron y 225 (54%) mostraron mejoría. Conclusiones: los principales síntomas de pacientes hospitalizados por SARS CoV-2 son disnea, fiebre, ataque del estado general, tos y cefalea.

Ataxia cerebelosa aguda y COVID-19: presentación de un caso clínico / Ataxia cerebelosa aguda y COVID-19: presentación de un caso clínico

COVID-19 es una enfermedad viral principalmente respiratoria y/o gastrointestinal. Las manifestaciones neurológicas tienen una frecuencia variable en pediatría. Presentamos un varón de 10 años de edad, previamente sano, que presentó una ataxia cerebelosa durante un cuadro agudo de COVID-19. El SARS-CoV-2 fue detectado por hisopado nasofaríngeo por antígeno y RPC. El LCR fue normal y el cultivo bacteriológico y estudio viral fueron negativos. La TC y RM encefálica fueron normales. No requirió tratamiento específico y tuvo una evolución favorable, con resolución completa de los síntomas neurológicos al mes. Debe considerarse la infección por SARS-CoV-2 como un diagnóstico diferencial entre las causas de ataxia cerebelosa aguda, según la situación epidemiológica.

COVID-19 is a disease that mainly produces respiratory and/or gastrointestinal symptoms. Neurological manifestations occur with a variable frequency in children. We present a previously healthy 10-year-old boy who presented acute cerebellar ataxia during an acute COVID-19. SARS-CoV-2 was detected in a nasopharyngeal sample by antigen and PCR. The CSF was normal, the bacteriological culture and the viral PCR were negative. CT of the brain and gadolinium MRI of the brain were normal. He did not require specific treatment and had a favorable evolution, with complete resolution of neurological symptoms at one month. SARS-CoV-2 infection should be considered as a differential diagnosis between the causes of acute cerebellar ataxia, according to the epidemiological situation.

Structural Brain Alterations in Individuals Post-COVID-19: A Systematic Review / Alteraciones Estructurales Cerebrales en Individuos Post COVID-19: Una Revisión Sistemática

SUMMARY: Although COVID-19 is primarily considered a respiratory pathology, it has been observed to impact other bodily systems, including the nervous system. While several studies have investigated anatomical changes in brain structures, such as volume or thickness post-COVID-19, there are no comprehensive reviews of these changes using imaging techniques for a holistic understanding. The aim of this study was to systematically analyze the literature on brain changes observed through neuroimaging after COVID-19. We conducted a systematic review according to PRISMA guidelines using Web of Science, Scopus, Medline, Pubmed, Sciencedirect, and LitCOVID. We selected studies that included adult patients during or after COVID-19 development, a control group or pre-infection images, and morphometric measurements using neuroimaging. We used the MSQ scale to extract information on sample characteristics, measured anatomical structures, imaging technique, main results, and methodological quality for each study. Out of 1126 identified articles, we included 19 in the review, encompassing 1155 cases and 1284 controls. The results of these studies indicated a lower volume of the olfactory bulb and variable increases or decreases in cortical and limbic structures' volumes and thicknesses. Studies suggest that brain changes occur post-COVID-19, primarily characterized by a smaller olfactory bulb. Additionally, there may be variations in cortical and limbic volumes and thicknesses due to inflammation or neuroplasticity, but these findings are not definitive. These differences may be attributed to methodological, geographical, and temporal variations between studies. Thus, additional studies are required to provide a more comprehensive and quantitative view of the evidence.

Aunque el COVID-19 se considera principalmente una patología respiratoria, se ha observado que afecta otros sistemas corporales, incluido el sistema nervioso. Si bien varios estudios han investigado los cambios anatómicos en las estructuras cerebrales, como el volumen o el grosor posteriores a la COVID-19, no hay revisiones exhaustivas de estos cambios que utilicen técnicas de imágenes para una comprensión holística. El objetivo de este estudio fue analizar sistemáticamente la literature sobre los cambios cerebrales observados a través de neuroimagen después de COVID-19. Realizamos una revisión sistemática de acuerdo con las pautas PRISMA utilizando Web of Science, Scopus, Medline, Pubmed, Sciencedirect y LitCOVID. Seleccionamos estudios que incluyeron pacientes adultos durante o después del desarrollo de COVID-19, un grupo de control o imágenes previas a la infección y mediciones morfométricas mediante neuroimagen. Utilizamos la escala MSQ para extraer información sobre las características de la muestra, las estructuras anatómicas medidas, la técnica de imagen, los principales resultados y la calidad metodológica de cada estudio. De 1126 artículos identificados, incluimos 19 en la revisión, que abarca 1155 casos y 1284 controles. Los resultados de estos estudios indicaron un menor volumen del bulbo olfatorio y aumentos o disminuciones variables en los volúmenes y espesores de las estructuras corticales y límbicas. Los estudios sugieren que los cambios cerebrales ocurren después del COVID-19, caracterizados principalmente por un bulbo olfatorio más pequeño. Además, pueden haber variaciones en los volúmenes y grosores corticales y límbicos debido a la inflamación o la neuroplasticidad, pero estos hallazgos no son definitivos. Estas diferencias pueden atribuirse a variaciones metodológicas, geográficas y temporales entre estudios. Por lo tanto, se requieren estudios adicionales para proporcionar una visión más completa y cuantitativa de la evidencia.

Efeito da infecção por COVID-19 na via auditiva até tronco encefálico / Effect of COVID-19 infection on the auditory pathway to the brainstem / Efecto de la infección por COVID-19en la vía auditiva hacia el tronco del encéfalo

Introdução: A COVID-19 pode afetar o sistema auditivo, justificando a avaliação da audição de indivíduos infectados. Objetivo: analisar a via auditiva até o tronco encefálico de indivíduos acometidos por COVID-19 comparados ao grupo controle. Método: Estudo observacional transversal analítico realizado em uma amostra não probabilística de adultos que tiveram COVID-19, que foram comparados com um grupo controle, sem queixa auditiva. A avaliação consistiu em: medidas de imitância acústica, audiometria tonal liminar (ATL), emissões otoacústicas evocadas por estímulo transiente (EOET) e potencial evocado auditivo de tronco encefálico (PEATE). Resultados: Foram avaliados 77 indivíduos, sendo, 41 participantes do grupo COVID-19 (idade média de 26,3) e 36 do grupo controle (idade média de 25,8). Os limiares auditivos estavam dentro dos padrões da normalidade para todos os indivíduos do grupo COVID-19, sendo significativamente maiores para as frequências de 1000, 2000 e 3000 Hz à direita. A amplitude das EOET foi significativamente menor na banda de frequência de 1500 à direita. Houve correlação significativa e negativa para as frequências de 1000 Hz e 3000 Hz à direita e para as frequências de 1000, 2000 e 3000 Hz à esquerda, entre EOET e ATL. Foi verificado aumento da latência absoluta da onda I, do PEATE, na orelha esquerda. Conclusão: a COVID-19 afetou locais específicos do sistema auditivo. Houve diminuição da acuidade auditiva e do funcionamento das células ciliadas externas da cóclea, bem como aumento do tempo de condução neural do som na porção distal do VII par craniano à esquerda. (AU)

Introduction: COVID-19 can affect the auditory system, justifying the evaluation of the hearing of infected individuals. Objective: to analyze the auditory pathway to the brainstem of individuals affected by COVID-19 compared to the control group. Method: Analytical cross-sectional observational study carried out in a non-probabilistic sample of adults who had COVID-19, who were compared with a control group, without hearing complaints. The evaluation consisted of: acoustic immittance measurements, pure tone audiometry (PTA), transient stimulus-evoked otoacoustic emissions (TEOAE) and brainstem auditory evoked potential (BAEP). Results: 77 individuals were evaluated, 41 participants in the COVID-19 group (average age of 26.3) and 36 in the control group (average age of 25.8). Hearing thresholds were within normal limits for all individuals in the COVID-19 group, being significantly higher for the frequencies of 1000, 2000 and 3000 Hz on the right. TEOAE amplitude was significantly lower in the 1500 frequency band on the right. There was a significant and negative correlation for the frequencies of 1000 Hz and 3000 Hz on the right and for the frequencies of 1000, 2000 and 3000 Hz on the left, between TEOAE and PTA. An increase in the absolute latency of wave I, of the BAEP, was observed in the left ear. Conclusion: COVID-19 affected specific locations in the auditory system. There was a decrease in auditory acuity and the functioning of the outer hair cells of the cochlea, as well as an increase in the neural conduction time of sound in the distal portion of the VII cranial nerve on the left. (AU)

Introducción: COVID-19 puede afectar el sistema auditivo, justificando la evaluación de la audición de individuos infectados. Objetivo: analizar la vía auditiva hacia el tronco encefálico de individuos afectados por COVID-19 en comparación con el grupo control. Método: Estudio observacional analítico transversal realizado en una muestra no probabilística de adultos que padecieron COVID-19, quienes fueron comparados con un grupo control, sin escuchar quejas. La evaluación consistió en: mediciones de inmitancia acústica, audiometría de tonos puros (ATP), otoemisiones acústicas provocadas por estímulos transitorios (OAET) y potenciales evocados auditivos del tronco encefálico (PEATE). Resultados: Se evaluaron 77 individuos, 41 participantes en el grupo COVID-19 (edad promedio de 26,3 años) y 36 en el grupo control (edad promedio de 25,8 años). Los umbrales de audición estaban dentro de los límites normales para todos los individuos del grupo de COVID-19, siendo significativamente más altos para las frecuencias de 1000, 2000 y 3000 Hz de la derecha. La amplitud de OAET fue significativamente menor en la banda de frecuencia de 1500 de la derecha. Hubo correlación significativa y negativa para las frecuencias de 1000 Hz y 3000 Hz a la derecha y para las frecuencias de 1000, 2000 y 3000 Hz a la izquierda, entre OAET y ATP. Se observó un aumento de la latencia absoluta de la onda I, del PEATE, en el oído izquierdo. Conclusión: COVID-19 afectó ubicaciones específicas del sistema auditivo. Hubo una disminución de la agudeza auditiva y del funcionamiento de las células ciliadas externas de la cóclea, así como un aumento del tiempo de conducción neural del sonido en la porción distal del VII par craneal izquierdo. (AU)

Enfermedad renal crónica agudizada como causa de mortalidad en paciente con COVID-19 / Exacerbated Chronic Kidney Disease as a Cause of Mortality in a Patient with COVID-19

Introducción: La infección por SARS-CoV-2 en pacientes con enfermedad renal crónica se asocia a larga estadía hospitalaria, aparición de complicaciones y mortalidad. Objetivo: Describir el caso clínico de un paciente con enfermedad renal crónica agudizada como causa de mortalidad en presencia de la infección por la COVID-19. Presentación del caso: Paciente masculino de 69 años con antecedentes de enfermedad renal crónica estadio 3a que ingresó a la institución hospitalaria con diagnóstico de COVID-19 y que durante su estadía presentó cifras elevadas de creatinina sérica con el consiguiente desarrollo de injuria renal aguda. Después de cinco sesiones de hemodiálisis mejoró el estado general del paciente y las cifras de creatinina disminuyeron parcialmente. A pesar de la mejoría clínica, el paciente progresó hacia el último estadio de la enfermedad renal crónica. Luego de tres semanas bajo terapia hemodialítica crónica falleció a causa de síndrome coronario agudo con elevación del segmento ST. Conclusiones: El pronóstico de los pacientes con daño renal que desarrollan la COVID-19 es desfavorable. La infección por SARS-CoV-2 favorece la progresión hacia los estadios finales de la enfermedad renal crónica con riesgo incrementado de la mortalidad(AU)

Introduction: SARS-CoV-2 infection in patients with chronic kidney disease is associated with a long hospital stay, the appearance of complications and mortality. Objective: To describe the clinical case of a patient with exacerbated chronic kidney disease as a cause of mortality in the presence of COVID-19 infection. Clinical case: A 69-year-old male patient with a history of stage 3a chronic kidney disease who was admitted to a hospital with a diagnosis of COVID-19 and who during his stay presented elevated serum creatinine levels with the subsequent development of acute kidney injury. After five hemodialysis sessions, the patient's general condition improved and the creatinine levels partially decreased. Despite clinical improvement, the patient progressed to the last stage of chronic kidney disease. After three weeks under chronic hemodialytic therapy, the patient died due to ST-segment elevation acute coronary syndrome. Conclusions: The prognosis of patients with kidney damage who develop COVID-19 is unfavorable. SARS-CoV-2 infection favors progression to the final stages of chronic kidney disease with an increased risk of mortality(AU)

Morbilidad de las fracturas vertebrales osteoporóticas durante el aislamiento social en la pandemia COVID-19 / Osteoporotic vertebral fractures morbidity during social isolation on COVID-19 pandemic

Introducción: la pandemia por COVID-19 afectó negativamente los sistemas de salud. Las fracturas vertebrales osteoporóticas y el aislamiento social se relacionan con mayor morbimortalidad. Objetivos: caracterizar la morbilidad de las fracturas vertebrales osteoporóticas y evaluar una posible relación entre morbilidad y nivel de aislamiento social se-cundario al estado de pandemia. Material y métodos: estudio observacional, analítico y transversal. Resultados: se incluyeron en el estudio 45 adultos. La fractura fue mayorita-riamente lumbar con una evolución superior de 3 meses. El 35% presentaba seguimiento, el 48% había recibido tratamiento para osteoporosis y el 48% presentaba fracturas previas documentadas. El 46% refirió falta de accesibilidad al sistema. Se evaluó el aisla-miento social con la escala sociofamiliar de Gijón, que evidenció una situación buena en el 75% y un deterioro social intermedio/severo en el 24%. El Índice de Oswestry mostró una discapacidad mínima/moderada en el 66% y severa o mayor en el 33%. Se evaluó el dolor por la Escala análoga visual (VAS) y se obtuvo un VAS mayor de 5 en el 57%. Al comparar el grupo de situación sociofamiliar buena con el de deterioro social intermedio/severo se observó una diferencia en multipli-cidad de fracturas (p 0,030), hipovitaminosis D (p 0,045) y falta de accesibilidad (p 0,029). En discapacidad y dolor no hubo diferencias. Conclusión: el grupo con mayor aislamiento presentó una enfermedad más severa en términos de multiplicidad de fracturas e hipovitaminosis D; esto podría indicar una asociación entre aislamiento social secundario al estado de pandemia y morbilidad por las fracturas vertebrales. (AU)

Introduction: the COVID-19 pandemic had a negative impact on healthcare systems. Osteoporotic vertebral fractures and social isolation have a significant morbidity in our setting. Objectives: to characterize the morbidity of osteoporotic vertebral fractures and evaluate a potential relationship between morbidity and the level of social isolation secondary to the pandemic. Material and methods: observational, analytical and cross-sectional study. Results: forty-five adults were included. Fractures were mostly lumbar with a history of over 3 months. Thirty-five percent (35%) had been followed-up, 48% had been treated for osteoporosis and 48% had previous documented fractures. Forty-six percent (46%) reported lack of accessibility to healthcare. Social isolation was measured using Gijón ́s social-familial evaluation scale, which showed a good situation in 75% of cases and an intermediate/severe social deterioration in 24%. According to the Oswestry index, disability was minimal/moderate in 66% of cases and severe or worse in 33%. Pain was assessed using the Visual Analogue Scale (VAS), with a score greater than 5 recorded in 57% of patients. When comparing the group with a good social-familial situation vs. the group with intermediate/severe social deterioration, differences were found in multiplicity of fractures (p 0.030), hypovitaminosis D (p 0.045) and lack of accessibility (p 0.029). No differences were found in disability and pain. Conclusion: the group with higher levels of isolation exhibited more severe disease in terms of multiplicity of fractures and hypovitaminosis D, which might suggest an association between social isolation secondary to the pandemic and morbidity due to vertebral fractures. (AU)

Manifestações orais e Covid-19: Revisão Sistemática da literatura / Oral Manifestations and Covid-19: Systematic literature review

A doença COVID-19, que se tornou uma pandemia em pouco espaço de tempo, apresenta uma ameaça grave para a saúde global. As condições bucais de pacientes com COVID-19 foram analisadas em vários estudos. Diante disso, observou-se que diversas manifestações bucais foram encontradas nesses pacientes. O objetivo deste trabalho foi realizar uma revisão de literatura sistemática sobre as manifestações bucais que podem estar associadas à doença COVID-19. A pesquisa foi realizada por meio de uma revisão sistemática nas bases de dados Bireme, PubMed e SciELO, no período de 30 de abril de 2021 a 11 de maio de 2023. A busca utilizou os descritores "COVID-19", "coronavirus" e "oral manifestations". Foram utilizados como critério de inclusão a presença do artigo completo disponível na íntegra e publicado nos anos de 2020 a 2023 e excluídos aqueles que não relatavam alguma manifestação da COVID-19 ou que não abordavam formas de tratamento. Foram incluídos 19 artigos. As informações foram compiladas de forma a compreender a importância de se investigar as manifestações orais em decorrência dessa doença, devido a sua importância internacional dadas às suas circunstâncias devastadoras. Concluiu-se que é notável a importância da anamnese e o exame intraoral para diagnosticar as manifestações orais nos pacientes sob suspeita ou confirmados com a COVID-19, e o diagnóstico precoce das alterações é fundamental para assegurar um suporte adequado ao paciente acometido. Mais estudos são necessários para comprovar a associação direta entre a COVID-19 e as manifestações orais relatadas.

COVID-19, which has become a pandemic in a short time, poses a serious threat to global health. The oral conditions of patients with COVID-19 have been analyzed in several studies. Therefore, it was observed that several manifestations were found in these patients. The objective of the work is to carry out a systematic literature review on the oral manifestations that may be associated with the disease COVID-19. The research was carried out through a systematic review in the databases Bireme, PubMed and SciELO, from April 30, 2021 o May 11, 2023. The search using the descriptors "COVID-19", "coronavirus" and "Oral manifestations". Inclusion criteria were the presence of the full article available in full and published in 2020 and 2023. Articles that did not report any manifestation of COVID-19 or those that did not address forms of treatment were excluded. 19 articles were included. The information was compiled in order to understand the importance of investigating oral manifestations as a result of this disease, due to its international importance given to its devastating entities. It was concluded that the importance of anamnesis and intraoral examination for the diagnosis of oral manifestations in patients suspected or confirmed with COVID-19 is remarkable, and the early diagnosis of alterations is essential to ensure adequate support for the affected patient. Further studies are needed to prove the direct association between COVID-19 and the reported oral manifestations.

Bruxismo como consequência do estresse pandêmico: revisão integrativa / Bruxism as a consequence of pandemic stress: integrative review

O período pandêmico com todas as suas implicações possibilitou um aumento dos níveis de estresse em parte da população, que teve como consequência a obtenção ou o agravamento do bruxismo. Objetivo: O objetivo deste artigo foi realizar uma revisão integrativa sobre como o estresse causado pela pandemia de COVID-19 influenciou no desenvolvimento do bruxismo, considerando o perfil dos indivíduos acometidos. Realizou-se uma revisão integrativa da literatura a partir da seleção de artigos publicados nas bases de dados BVS, PubMed e EBSCOhost. Para isto, a seguinte questão de pesquisa foi formulada: "Existe relação entre o bruxismo e a pandemia de COVID-19?". A busca objetivou encontrar artigos publicados em português, espanhol e inglês, durante os anos de 2019 a 2023, utilizando os descritores "bruxismo", "COVID-19" e "estresse psicológico" e as suas respectivas versões em inglês, juntamente com a estratégia de busca AND. Revisão de literatura: Vinte estudos foram incluídos, ficando evidente uma prevalência do bruxismo como consequência do estresse pandêmico em pessoas jovens, do sexo feminino, além de estudantes/profissionais da área da saúde. Considerações finais: Acredita-se que a pandemia de COVID-19 vivenciada entre os anos de 2019 e 2023 tenha causado e/ou exacerbado estresse, sendo este um importante fator causador do bruxismo.(AU)

The pandemic period with all its implications allowed an increase in stress levels in part of the population, which resulted in the obstruction or worsening of bruxism. Objective: The aim of this article was to carry out an integrative review on how the stress caused by the COVID-19 pandemic influenced the development of bruxism, considering the profile of affected individuals. Method: An integrative literature review was carried out based on the selection of articles published in the VHL, PubMed and EBSCOhost databases. For this, the following research question was formulated: "Is there a relationship between bruxism and the COVID-19 pandemic?". The search aimed to find articles published in Portuguese, Spanish and English, during the years 2019 to 2023, using the descriptors "bruxism", "COVID-19" and "psychological stress" and their respective versions in English, together with the strategy of search AND. Integratve review: Twenty studies were included, revealing a prevalence of bruxism as a consequence of pandemic stress in young, females, in addition to students/health professionals. Final considerations: It is believed that the COVID-19 pandemic experienced between 2019 and 2023 caused and/or exacerbated stress, which is an important factor causing bruxism.(AU)

Validación de la reacción de polimerasa en cadena en tiempo real como herramienta diagnóstica en la aspergilosis asociada a COVID-19 en pacientes hospitalizados en Clínica Dávila de Santiago, Chile, durante los años 2020 y 2021 / Validation of real-time PCR as a diagnostic tool in aspergillosis associated with COVID-19 in patients hospitalized at Clínica Dávila at Santiago, Chile, during the years 2020 and 2021

INTRODUCCIÓN: Desde el inicio de la pandemia por COVID-19 se han registrado casos de infecciones de aspergilosis pulmonar asociada a esta infección, la cual tiene características diferentes a la aspergilosis pulmonar clásica y, por lo tanto, han significado un desafío diagnóstico. OBJETIVO: Validar una reacción de polimerasa en cadena (RPC) en tiempo real (sigla en inglés RT-PCR) comercial, como herramienta diagnóstica alternativa a la técnica de galactomanano (GM) en el diagnóstico de aspergilosis pulmonar asociada a COVID-19 (sigla en inglés CAPA). PACIENTES Y MÉTODO: Se analizaron resultados de RT-PCR de Aspergillus spp y GM en lavado bronco-alveolar (LBA) de 72 pacientes, hospitalizados por COVID-19 de Clínica Dávila entre los años 2020 y 2021. De estos pacientes, 33 presentaron CAPA. RESULTADOS: La RT-PCR de Aspergillus y GM presentaron una correlación positiva (r = 0,6351, valor p < 0,0001). La técnica de RT-PCR presentó una sensibilidad (S), especificidad (E), valor predictor positivo (VPP) y valor predictor negativo (VPN) de 100, 44, 66 y 100%, respectivamente, mientras que en GM fueron de 64, 89, 84 y 73%, respectivamente para LBA. Al utilizar ambas técnicas en combinación se obtuvo una S, E, VPP y VPN de 100, 82, 88 y 100%, respectivamente. CONCLUSIÓN: Este estudio concluyó que usar una técnica de RT-PCR de Aspergillus y GM en conjunto en LBA mejoraron los parámetros de desempeño de ambas técnicas usadas de manera individual para diagnosticar CAPA. Se requieren más estudios para evaluar el desempeño de técnicas combinadas en otros tipos de aspergilosis.

BACKGROUND: Since the beginning of the COVID-19 pandemic, there have been cases of pulmonary aspergillosis infections associated with this infection, which has different characteristics from classical pulmonary aspergillosis and therefore, have been diagnostic challenges. AIM: To validate a commercial real-time PCR (RT-PCR) method as an alternative diagnostic tool to the galactomannan (GM) technique in the diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA). METHODS: Results of RT-PCR of Aspergillus spp and GM in broncho-alveolar lavage (BAL) of 72 patients hospitalized for COVID-19 at Clínica Dávila between 2020 and 2021 were analyzed. Of these patients, 33 presented CAPA. RESULTS: The RT-PCR for Aspergillus and GM showed a positive correlation (r = 0.6351, p-value < 0.0001). The RT-PCR for Aspergillus technique presented a sensitivity (S), specificity (S), positive predictive value (PPV) and negative predictive value (NPV) of 100, 44, 66 and 100% respectively, while the GM technique presented 64, 89, 84 and 73%, respectively for BAL. Using both techniques in combination a S, E, PPV and NPV of 100, 82, 88 and 100% were obtained respectively. CONCLUSION: This study concluded that using RT-PCR and GM techniques in combination in BAL improved the performance parameters of both techniques from those used individually to diagnose CAPA. Further studies are required to evaluate the performance of combined techniques in other aspergillosis focus.