COVID-19 nas prisões: validação de um inquérito de conhecimento, atitude e prática / COVID-19 en las cárceles: validación de un estudio de conocimiento, actitud y práctica / COVID-19 in prisons: validity of a knowledge, attitude and practice survey

Resumo Objetivo Validar um inquérito de conhecimento, atitude e prática sobre medidas preventivas da COVID-19 para os funcionários do sistema penitenciário, fundamentado na teoria ambientalista. Métodos Estudo metodológico desenvolvido em quatro etapas: estabelecimento da estrutura conceitual, elaboração do instrumento, validação do conteúdo por juízes e avaliação da aparência pelo público-alvo. O conteúdo de cada item foi validado quanto a objetividade, clareza e relevância. A aparência do inquérito foi avaliada quanto ao objetivo, a organização, ao estilo da escrita e a motivação. Utilizou-se o coeficiente de validação de conteúdo para avaliar a concordância entre os juízes e entre o público-alvo. Os dados foram analisados por meio de distribuições brutas, percentuais, medidas de posição e de dispersão. O índice alfa de Cronbach foi utilizado para analisar a consistência das avaliações dos juízes e do público-alvo. Resultados Quanto ao conteúdo e a aparência, os requisitos avaliados obtiveram concordância superior a 0,9. Na avaliação da consistência, obteve-se índice alfa de Cronbach > 0,9 e > 0,7, quanto ao conteúdo e à aparência, respectivamente, indicando que juízes e público-alvo tenderam a fazer avaliações similares. Conclusão O inquérito apresentou validade de conteúdo e aparência para a coleta de dados referentes a conhecimento, atitude e prática sobre prevenção da COVID-19, para os funcionários do sistema penitenciário, indicando que poderá contribuir para o planejamento e a avaliação de ações de educação em saúde.

Resumen Objetivo Validar un estudio de conocimiento, actitud y práctica sobre medidas preventivas de COVID-19 para los empleados del sistema penitenciario, fundamentado en la teoría ambientalista. Métodos Estudio metodológico llevado a cabo en cuatro etapas: establecimiento de la estructura conceptual, elaboración del instrumento, validación del contenido por jueces y evaluación de la apariencia por el público destinatario. Se validó el contenido de cada ítem respecto a la objetividad, claridad y relevancia. Se evaluó la apariencia del estudio respecto al objetivo, la organización, el estilo de escritura y la motivación. Se utilizó el coeficiente de validez de contenido para evaluar la concordancia entre los jueces y entre el público destinatario. Los datos se analizaron mediante distribuciones brutas, porcentajes, medidas de posición y de dispersión. Se utilizó el índice alfa de Cronbach para analizar la consistencia de las evaluaciones de los jueces y del público destinatario. Resultados Respecto al contenido y a la apariencia, los requisitos evaluados obtuvieron concordancia superior a 0,9. En la evaluación de la consistencia, se obtuvo un índice alfa de Cronbach > 0,9 respecto al contenido y > 0,7 respecto a la apariencia, lo que indica la tendencia de los jueces y del público destinatario a realizar evaluaciones similares. Conclusión El estudio presentó validez de contenido y apariencia para la recopilación de datos referentes a conocimiento, actitud y práctica sobre prevención de COVID-19 para empleados del sistema penitenciario, lo que indica que podrá contribuir a la planificación y evaluación de acciones de educación para la salud.

Abstract Objective To validate a knowledge, attitude and practice survey on preventive measures against COVID-19 for penitentiary system staff based on environmental theory. Methods This is a methodological study developed in four stages: conceptual structure establishment; instrument elaboration; content validity by judges; and appearance assessment by the target audience. The content of each item was validated for objectivity, clarity and relevance. Survey appearance was assessed regarding objective, organization, writing style and motivation. Content validity coefficient was used to assess agreement among judges and the target audience. Data were analyzed using gross distributions, percentages, position and dispersion measures. Cronbach's alpha index was used to analyze the consistency of judges' and target audience's assessments. Results Regarding content and appearance, the assessed requirements achieved agreement greater than 0.9. In consistency assessment, a Cronbach's alpha index > 0.9 and > 0.7 was obtained for content and appearance, respectively, indicating that judges and target audiences tended to make similar assessments. Conclusion The survey presented content and appearance validity for collecting data regarding knowledge, attitude and practice regarding COVID-19 prevention for penitentiary system staff, indicating that it could contribute to health education action planning and assessment.

Atención a la paciente obstétrica en el contexto de la pandemia de COVID-19 / Obstetric patient care in the context of COVID-19 pandemic

La infección causada por el SARS-CoV-2, tuvo una repercusión negativa en la evolución clínica de un número importante de gestantes y puérperas en todo el mundo. Este trabajo tiene como objetivo, exponer los principales resultados de la organización del proceso de atención a la paciente obstétrica en el contexto de la pandemia por la COVID-19. Está basado en la organización y elementos fundamentales seguidos con las pacientes que ingresaron, por afecciones relacionadas con el aborto, embarazo o puerperio, con sospecha de COVID-19 o con RT-PCR para SARS-CoV-2 positivo, en el año 2020, y las positivas al SARS-CoV-2 en 2021, de las provincias La Habana, Mayabeque y Artemisa, que fueron atendidas en el Hospital Militar Central Dr. Luis Díaz Soto. Se tuvo en cuenta el total de casos ingresados, pacientes confirmadas, ingresos en unidad de cuidados intensivos obstétricos, en servicio de vigilancia intensiva obstétrica, y la evolución clínica Con la organización de la atención médica a las pacientes obstétricas con la COVID-19, se logró el cumplimiento de los protocolos establecidos y la integración multidisciplinaria en el seguimiento de los casos, lo cual contribuyó a la evolución favorable de la mayoría de las pacientes(AU)

The infection caused by SARS-CoV-2 had a negative impact on the clinical evolution of a significant number of pregnant and puerperal women worldwide. The aim of this work is to present the main results of the organization of the obstetric patient care process in the context of the COVID-19 pandemic. It is based on the organization and fundamental elements followed with the patients who were admitted, for conditions related to abortion, pregnancy or puerperium, with suspicion of COVID-19 or with positive RT-PCR for SARS-CoV-2, in the year 2020, and those positive to SARS-CoV-2 in 2021, from Havana, Mayabeque and Artemisa provinces, who were attended at the Central Military Hospital Dr. Luis Díaz Soto. The total number of cases admitted, confirmed patients, admissions to the obstetric intensive care unit, obstetric intensive surveillance service, and clinical evolution were taken into account. With the organization of medical care for obstetric patients with COVID-19, compliance with established protocols and multidisciplinary integration in the follow-up of cases was achieved, which contributed to the favorable evolution of most patients(AU)

Impacto psicológico de la pandemia de la COVID-19 en personal sanitario / Psychological impact of the COVID-19 pandemic on health professionals

Introducción: La rápida propagación de la COVID-19 a escala mundial ocasionó el colapso de los sistemas sanitarios, lo cual contribuyó a que el personal sanitario incrementara el agotamiento sufrido, tanto físico como mental. Objetivo: Determinar el impacto psicológico de la pandemia de la COVID-19 en el personal sanitario. Métodos: Estudio multicéntrico transversal, en 145 sujetos que se desempeñaron como personal sanitario en el periodo de enero a diciembre de 2021. La información se recopiló a través de un formulario online, precisando edad, sexo, antecedentes patológicos personales, institución, categoría laboral, acceso diario a información sobre la COVID-19, asistencia directa a pacientes infectados y muerte de personas cercanas. Se aplicó el Cuestionario de Salud General. Se utilizó la prueba de U de Mann-Whitney para buscar diferencias en la puntuación general reportada. Resultados: Presentaron un impacto psicológico alto el 62,1 por ciento de los encuestados; el 70,0 por ciento eran médicos y enfermeras; el 62,2 por ciento accedía más de 2 h al día a información sobre la COVID; el 64,4 por ciento participó directamente en la atención a pacientes infectados y el 35,6 por ciento había perdido a personas cercanas por la pandemia. Ser mujer (p= 0,008), acceder a información sobre la COVID-19 más de 2 h al día (p= 0,026), asistir directamente a pacientes infectados (p= 0,033) y la muerte de personas cercanas (p= 0,018) tuvo diferencias estadísticamente significativas en el impacto psicológico. Conclusiones: La pandemia de la COVID-19 se asocia a un impacto psicológico alto en el personal sanitario(AU)

Introduction: The fast spread of COVID-19 around the world caused health systems collapse, which contributed to increase fatigue suffered by health workers, physical as well as mental. Objective: To determine psychological impact of COVID-19 pandemic on health professionals. Methods: A multicenter cross-sectional study was carried out in 145 subjects who worked as health professionals from January to December 2021. This information was collected in an online form. Age, sex, medical record, institution, work category, daily access to COVID-19 information, direct assistance to infected patients and close people death was considered parameters in the applied form. Mann-Whitney U test was applied to find differences in the overall reported score. Results: 62.1 percent of health workers presented a High Psychological Impact, 70.0 percent were medical and nursing staff; 62.2 percent accessed to information about COVID-19 for more than 2 hours daily, 64.4 percent assisted infected patients directly, and 35.6 percent experienced close people death due to the pandemic. Being a woman (p= 0,008), accessing information about COVID-19 for more than 2 hours daily (p= 0,026), directly assisting infected patients (p= 0,033), and the death of close people (p= 0,018) had statistically significant differences in psychological impact. Conclusions: The COVID-19 pandemic is associated with a high psychological impact in health workers(AU)

Adicción a los teléfonos inteligentes en adolescentes tras la pandemia por la COVID-19 / Smartphone addiction in adolescents after the COVID-19 pandemic

Introducción: La pandemia por la COVID-19 trajo consigo cambios en el comportamiento humano y afecciones psíquicas que afectan la salud mental. Objetivo: Estimar la adicción a los teléfonos inteligentes en adolescentes mujeres tras la pandemia por la COVID-19. Métodos: Estudio transversal realizado en noviembre y diciembre del 2022, en una institución educativa pública de Ica, Perú. Participaron 581 adolescentes que respondieron a un cuestionario con variables generales y la Escala de Adicción a los Teléfonos Inteligentes. Se aplicó un análisis estadístico descriptivo y multivariado mediante modelos lineales generalizados de la familia Poisson para evaluar la asociación entre las variables. Resultados: De las participantes, el 21,7 por ciento reveló adicción a los teléfonos inteligentes y el 48,7 por ciento se encuentra en riesgo alto de dependencia. Los conflictos familiares en el hogar (razón de prevalencia ajustada - RPa= 1,41; intervalo de confianza -IC 95 por ciento: 1,00-1,99) y los sentimientos de vergüenza (RPa= 1,44; IC 95 por ciento: 1,01-2,03), se asociaron a mayor adicción a los teléfonos inteligentes. No obstante, el sentimiento de tristeza, ansiedad o depresión y el hecho de sentirse rechazado por la sociedad presentaron asociación, no ajustada. Conclusiones: La adición a los teléfonos inteligentes y el riesgo de padecer este trastorno es alto en las adolescentes; existen variables generales susceptibles de ser modificadas que podrían mermar dicha afección comportamental inducida o potenciada por la pandemia de la COVID-19(AU)

Introduction: The COVID-19 pandemic brought with it changes in human behavior and psychic conditions that affect mental health. Objective: Estimate smartphone addiction in female adolescents after COVID-19 pandemic. Methods: Cross-sectional study, conducted during November to December 2022, in a public educational institution in Ica, Peru. A total of 581 adolescents participated and answered a questionnaire with general variables and the Smartphone Addiction Scale. A descriptive and multivariate statistical analysis was applied using Poisson family generalized linear models to evaluate the association between variables. Results: Of the participants, 21.7 percent revealed addiction to smartphones and 48.7 percent were at high risk of dependence on these devices. Family conflicts at home (adjusted prevalence ratio-RPa = 1.41; 95 percent confidence interval-CI: 1.00-1.99) and feelings of shame (RPa = 1.44; 95 percent CI: 1.01-2.03), were associated with higher smartphone addiction. However, feelings of sadness, anxiety or depression and feeling rejected by society showed an unadjusted association. Conclusions: Smartphone addiction and risk for this disorder is high in adolescent girls; there are general variables amenable to modification that could diminish such a behavioral condition induced or potentiated by the COVID-19 pandemic(AU)

Percepción de los universitarios sobre las repercusiones académicas originadas por la pandemia de COVID-19 / University Students' Perceptions of the Academic Impact of the COVID-19 Pandemic

Introducción: Durante la pandemia de la COVID-19, la educación superior ha enfrentado la transición a la educación no presencial, con importante repercusión tanto en el rendimiento académico como en otros aspectos de la vida de los estudiantes. Objetivo: Aportar validez a la escala ACAD-COVID-19 y evaluar la percepción de los universitarios limeños acerca de las repercusiones académicas originadas por la pandemia de la COVID-19. Métodos: El estudio fue de diseño descriptivo y transversal, durante el año 2021. Se obtuvo una muestra conformada por 608 estudiantes del primer año académico de diferentes carreras, de 5 universidades de Lima. Se aplicó la escala ACAD-COVID-19 de 8 ítems y alternativas en escala Likert. Se realizaron análisis descriptivos y factoriales, utilizando SPSS versión 26.0. Resultados: Se evidenció que el instrumento es confiable. Se determinaron 3 factores, que pueden asociarse a las dimensiones académica, económica y el temor propio hacia enfermedad o muerte generada por la COVID-19. El 61,3 por ciento de los estudiantes limeños manifiestan indiferencia respecto a la percepción sobre el impacto académico generado por el coronavirus, con un promedio general de los ítems de 3,21. La mayor media fue de la pregunta 5 (3,47). Conclusiones: Se aportó validez a la escala ACAD-COVID-19 con su aplicación a la población universitaria limeña en un período de cuarentena durante el 2021. Los estudiantes, en general, manifestaron indiferencia en su percepción sobre el impacto académico generado por el coronavirus, aunque dentro de las repercusiones percibidas, predomina el miedo a enfermar al volver a las clases presenciales(AU)

Introduction: During the COVID-19 pandemic, higher education has faced the transition to distance learning, with important repercussions on academic performance as well as on other aspects of students' lives. Objective: To provide validity to the ACAD-COVID-19 scale and to evaluate the perception of university students in Lima about the academic repercussions caused by the COVID-19 pandemic. Methods: The study was of descriptive and cross-sectional design, during the year 2021. A sample of 608 students in their first academic year of different careers from 5 universities in Lima was obtained. The ACAD-COVID-19 scale of 8 items and Likert scale alternatives was applied. Descriptive and factorial analyses were performed using SPSS version 26.0. Results: The instrument was found to be reliable. Three factors were determined, which can be associated with the academic, economic and fear of illness or death generated by the COVID-19. 61.3 percent of the students from Lima expressed indifference with respect to the perception of the academic impact generated by the coronavirus, with an overall average of 3.21 for the items. The highest mean was for question 5 (3.47). Conclusions: Validity was provided to the ACAD-COVID-19 scale with its application to the Lima university population in a quarantine period during 2021. Students, in general, expressed indifference in their perception of the academic impact generated by the coronavirus, although among the perceived repercussions, the fear of getting sick when returning to classes was predominant(AU)

La niebla mental, una manifestación neurocognitiva del síndrome post-COVID-19 / Brain fog, a neurocognitive manifestation of the post-COVID-19 syndrome

Introducción: La COVID-19, infección causada por el SARS-CoV-2, ocasiona daños a diferentes órganos y sistemas, como el sistema nervioso central. Entre las alteraciones neurológicas se describe la niebla mental como manifestación neurocognitiva frecuente en el síndrome post-COVID-19, con un impacto negativo en la calidad de vida de los pacientes. Se revisaron 104 artículos publicados desde junio 2020 a octubre del 2022, en las bases de datos Pubmed, Medline, Lilacs y Cumed. Objetivo: Actualizar conocimientos sobre las manifestaciones neurocognitivas de niebla mental en el síndrome post-COVID-19. Desarrollo: Se describen alteraciones neurocognitivas de niebla mental, trastornos de atención, concentración y memoria, asociados a otros síntomas neurológicos, como cefalea, insomnio, anosmia, ageusia, ansiedad, depresión, y otros síntomas persistentes, que caracterizan al síndrome post-COVID-19. Se hace referencia a elementos de la etiopatogenia, resaltando la respuesta inmune sistémica exagerada, generada por la liberación de citoquinas, aspectos a tener presentes para la conducta diagnóstica y terapéutica de los pacientes post-COVID-19. Conclusiones: Los síntomas neurocognitivos de niebla mental, constituyen las alteraciones neurológicas frecuentes del síndrome post-COVID-19, son variados, con combinación de diferentes síntomas en cada enfermo, más frecuentes en mujeres y en pacientes que presentaron enfermedad grave(AU)

Introduction: COVID-19, infection caused by SARS-CoV-2, causes damage to different organs and systems, such as the central nervous system. Among the neurological alterations, brain fog is described as a frequent neurocognitive manifestation in post-COVID-19 syndrome, with a negative impact on patients' quality of life; 104 articles published were reviewed from June 2020 to October 2022, in Pubmed, Medline, Lilacs and Cumed databases. Objective: To update knowledge on the neurocognitive manifestations of brain fog in post-COVID-19 syndrome. Development: Neurocognitive alterations of mental fog, attention, concentration and memory disorders, associated with other neurological symptoms, such as headache, insomnia, anosmia, ageusia, anxiety, depression, and other persistent symptoms, which characterize post-COVID-19 syndrome, are described. Reference is made to elements of the etiopathogenesis, highlighting the exaggerated systemic immune response, generated by the release of cytokines, aspects to keep in mind for the diagnostic and therapeutic conduct of post-COVID-19 patients. Conclusions: The neurocognitive symptoms of brain fog are frequent neurological alterations of post-COVID-19 syndrome, they are varied, with a combination of different symptoms in each patient, more frequent in women and in patients who presented severe disease(AU)

Salud mental de los docentes de educación básica durante el retorno a la educación presencial / Mental health of basic education teachers during the return to face-to-face education

Introducción: El retorno a la presencialidad luego de la emergencia sanitaria por la COVID-19 está provocando mucha preocupación en el ámbito laboral a los docentes, por ello, es necesario evaluar su salud mental. Objetivo: Describir la presencia de depresión, ansiedad y estrés de los docentes de educación básica al retorno a la educación presencial. Método: Estudio observacional, descriptivo, de corte transversal. La muestra estuvo conformada por 233 docentes a quienes se les aplicó la Escala de Depresión, Ansiedad y Estrés (DASS-21). Se utilizó la aplicación de mensajería Whatsapp para invitar a los docentes a participar. Se aplicaron métodos estadísticos descriptivos para categorizar las variables según los puntos de corte (leve, moderado y alto) y se utilizó la prueba no paramétrica ji cuadrado con el propósito de determinar si se asociaban con las variables sociodemográficas y laborales propuestas. Resultados: El 56,2 por ciento del total de docentes tenían niveles leves de depresión, el 45,1 por ciento tenían niveles moderados de ansiedad y el 42,9 por ciento también tenían niveles moderados de estrés. Asimismo, se determinó que el sexo se asociaba de manera significativa a las variables de estudio (p< 0,05). Conclusiones: Los docentes de educación básica presentan niveles leves de depresión y niveles moderados de ansiedad y estrés al retorno a la presencialidad. Por otro lado, las mujeres son las que presentan más síntomas de depresión, ansiedad y estrés que los hombres (AU)

Introduction: The return to face-to-face attendance after the health emergency caused by COVID-19 is causing a lot of concern in the workplace for teachers, therefore, it is necessary to evaluate their mental health. Objective: To describe the levels of depression, anxiety and stress of basic education teachers upon return to face-to-face education. Method: Observational, descriptive, cross-sectional study. The sample consisted of 233 teachers who were administered the Depression, Anxiety, and Stress Scale (DASS-21). The messaging application Whatsapp was used to invite teachers to participate. Descriptive statistical methods were applied to categorize the variables according to cutoff points (mild, moderate, and high), and the non-parametric Chi-square test was used to determine if they were associated with the proposed sociodemographic and work-related variables. Results: 56.2 percent of all teachers had mild levels of depression, 45.1 percent had moderate levels of anxiety and 42.9 percent also had moderate levels of stress. Likewise, it was determined that gender was significantly associated with the study variables (p< 0.05). Conclusions: Basic education teachers experience mild levels of depression and moderate levels of anxiety and stress upon returning to in-person instruction. On the other hand, women show more symptoms of depression, anxiety, and stress than men(AU)

Linfocitopenia como biomarcador de gravedad en pacientes pediátricos con la COVID-19 / Lymphocytopenia as a biomarker of severity in pediatric patients with COVID-19

Introducción: La COVID-19 en edades pediátricas presenta características singulares; un pequeño número de pacientes pediátricos desarrollan un estado clínico grave. Objetivos: Evaluar si la linfocitopenia es un predictor de gravedad en pacientes pediátricos con la COVID-19. Métodos: Se estudiaron en 706 pacientes, las variables edad, sexo, antecedentes patológicos personales de enfermedades crónicas de la infancia (asma bronquial, diabetes mellitus), comorbilidades, estado clínico, valores de linfocitos, conteo absoluto de linfocitos (≤ 1 x 109/L = linfocitopenia). De acuerdo con el estado clínico los pacientes se agruparon en 5 grupos, de asintomáticos a críticos. Se determinó la correlación entre el estado clínico y el conteo absoluto de linfocitos; de este se determinó su capacidad discriminativa para estimar el pronóstico. Resultados: La media de la edad fue 8,6 años; el 6,2 por ciento de los pacientes evolucionó al estado grave o crítico; 74,6 por ciento tuvo valores normales de linfocitos, el 16,14 por ciento altos y el 9,2 por ciento bajos. Linfocitopenia presentó el 4,2 por ciento; se correlacionó significativamente con estado grave, área bajo la curva de 0,711 (IC 95 por ciento: 0,595-0,827); 46 por ciento de sensibilidad y 98 por ciento de especificidad. Conclusiones: La linfocitopenia es un biomarcador que puede estimar el pronóstico en pacientes pediátricos con la COVID-19 que desarrollan un estado clínico grave (AU)

Introduction: COVID-19 in pediatric ages presents unique features; a small number of pediatric patients develop severe clinical status. Objectives: To evaluate whether lymphocytopenia is a predictor of severity in pediatric patients with COVID-19. Methods: In 706 patients were studied the variables age, sex, personal pathological history of childhood chronic diseases (bronchial asthma, diabetes mellitus), comorbidities, clinical status, lymphocyte values, absolute lymphocyte count (≤ 1 x 109/L = lymphocytopenia). According to clinical status patients were grouped into 5 groups, from asymptomatic to critical. The correlation between clinical status and absolute lymphocyte count was determined; its discriminative capacity to estimate prognosis was determined. Results: The mean age was 8.6 years; 6.2 percent of patients progressed to severe or critical condition; 74.6 percent had normal lymphocyte values, 16.14 percent high and 9.2 percent low. Lymphocytopenia presented 4.2 percent; it was significantly correlated with severe condition, area under the curve of 0.711 (95 percent CI: 0.595-0.827); 46 percent sensitivity and 98 percent specificity. Conclusions: Lymphocytopenia is a biomarker that can estimate prognosis in pediatric patients with COVID-19 who develop severe clinical status (AU)

Manifestaciones psicopatológicas en una adolescente debido al impacto de la COVID-19 / Psycho-Pathological Manifestations In An Adolescent Due to The Impact of COVID-19

Introducción: La adolescencia es una de las etapas más trascendentales de la vida; en ella el cerebro experimenta una serie de cambios y conexiones que suponen un antes y un después para la persona. Cada adolescente vive esta experiencia de una manera diferente. Muchos estudios muestran las devastadoras consecuencias que ha dejado el confinamiento generado por la pandemia de COVID-19 en este segmento poblacional y la importancia de aplicar un tratamiento adecuado. Objetivo: Identificar las manifestaciones psicopatológicas frente al impacto de la COVID-19. Presentación del caso: Adolescente femenina, de 13 años, de procedencia urbana, con antecedentes de salud mental previa, que convive con ambos padres y una hermana menor, en un ambiente familiar armónico. Acudió al cuerpo de guardia en compañía de su madre, por presentar manifestaciones depresivas y ansiosas dadas por miedo a contagiarse, a la muerte, a estar sola, a la oscuridad, a perder a sus familiares, deambulaba de un lado a otro sin ningún propósito y se negaba a ingerir alimentos. Todo comenzó al inicio de la pandemia por la COVID-19. Se decidió su ingreso en la sala de psiquiatría del Hospital Pediátrico Docente Sur Dr. Antonio María Béguez César Santiago de Cuba en abril de 2020. Conclusiones: La intervención psicoterapéutica y el tratamiento psicofarmacológico, resultaron efectivos para disminuir la ansiedad, el miedo a la muerte, la fobia y los elementos obsesivos, la depresión y el insomnio, generados por el confinamiento debido a la pandemia por COVID-19 (AU)

Introduction: Adolescence is one of the most transcendental stages of life. In it the brain undergoes a series of changes and connections that represent a before and after for the person. Every teenager lives this experience in a different way. Many studies show the devastating consequences left by the confinement generated by the COVID-19 pandemic in this population segment, and the importance of applying adequate treatment. Objective: To identify the psycho-pathological manifestations against the impact of COVID-19. Case presentation: Female adolescent, 13 years old, of urban origin, with a previous mental health history, who lives with both parents and a younger sister, in a harmonious family environment. She went to the emergency service in the company of her mother, after presenting depressive and anxious manifestations given by fears of being infected, of death, of being alone, of darkness, of losing her relatives; she wandered back and forth without any purpose and refused to eat food. It all started at the beginning of the COVID-19 pandemic. It was decided to admit her to the psychiatric service of Dr. Antonio María Béguez César South Teaching Pediatric Hospital, in Santiago de Cuba province in April 2020. Conclusions: Psychotherapeutic intervention and psycho-pharmacological treatment were effective in reducing anxiety, fear of death, phobia and obsessive elements, and depression and insomnia generated by the confinement due to the COVID-19 pandemic(AU)

Accidente cerebrovascular por COVID-19 en una lactante de 6 meses / Stroke due to COVID-19 in a Six-month-old infant

Introducción: En de la población adulta predomina la enfermedad pulmonar, pero el coronavirus infantil grave parece más tipificado por una respuesta inflamatoria inmunomediada, con o sin síndrome inflamatorio multisistémico asociado. Objetivo: Examinar un paciente pediátrico con accidente cerebrovascular, como consecuencia de la enfermedad producida por el coronavirus tipo 2. Presentación del caso: Lactante femenina de 6 meses, que se presentó a emergencia con historia de fiebre de 39 oC, sin predominio de horario, de 10 días de evolución que no cedió con antipiréticos tipo acetaminofén, y dificultad respiratoria en los 3 días previos a su presentación en emergencia del hospital. Antecedentes familiares patológicos positivos, por la enfermedad del coronavirus en su padre. En la radiografía de tórax se observó infiltrado alveolar derecho y se ingresó con diagnóstico de neumonía por síndrome respiratorio agudo grave por coronavirus tipo 2. La tomografía de cráneo registró foco isquémico frontal parasagital derecho y parietal izquierdo; posteriormente se confirmó con resonancia magnética, en cuyo informe se definió la presencia de infartos en fase aguda a nivel frontal derecho y parietal izquierdo. Conclusiones: Se expuso una manifestación infrecuente en población pediátrica asociada a la enfermedad por coronavirus. La tasa de eventos tromboembólicos en el curso de las infecciones virales no es baja, y por coronavirus no es la excepción. Se requieren mayores estudios y pruebas para determinar el papel del síndrome respiratorio agudo severo por coronavirus tipo 2 en el accidente cerebrovascular pediátrico(AU)

Introduction: Pulmonary disease predominates in the adult population, but severe infantile coronavirus appears more typified by an immune-mediated inflammatory response, with or without associated multisystem inflammatory syndrome. Objective: To examine a pediatric patient with stroke resulting from coronavirus type 2 disease. Case presentation: 6-month-old female infant presenting to emergency with history of fever of 39 ℃ with no hourly predominance, of 10 days of evolution that did not subside with acetaminophen-type antipyretics and respiratory distress in the three days prior to presentation to hospital emergency. Positive family history of coronavirus disease in his father. Chest X-ray showed right alveolar infiltrate and she was admitted with a diagnosis of severe acute respiratory syndrome pneumonia due to coronavirus type 2. The cranial tomography recorded a right frontal parasagittal and left parietal ischemic focus, later confirmed by magnetic resonance imaging whose report defined the presence of acute phase infarcts at the right frontal and left parietal levels. Conclusions: An infrequent manifestation in pediatric population associated with coronavirus disease is exposed. The rate of thromboembolic events in the course of viral infections is not low and coronavirus is no exception. Further studies and evidence are required to determine the role of severe acute respiratory syndrome due to coronavirus type 2 in pediatric stroke(AU)

Fatiga pandémica como secuela psicológica de la COVID-19 en la provincia Matanzas, Cuba / Pandemic fatigue as psychological sequel of COVID-19 in Matanzas province, Cuba

Introducción: El carácter prolongado de la actual pandemia hace que las personas tengan que adoptar un estilo diferente de afrontamiento al asumido en sus inicios, como resultado puede ser la fatiga y la desmotivación. Objetivo: Caracterizar las manifestaciones de la fatiga pandémica en población de la localidad de Santa Marta, provincia Matanzas. Métodos: Se realizó un estudio descriptivo observacional de corte transversal, del 7 al 10 de mayo del 2021 en 105 miembros de 51 familias seleccionadas aleatoriamente del Consultorio Médico de la Familia #27 de la localidad de Santa Marta. Las variables fueron agrupadas en sociodemográficas, clínicas y relacionadas con las características de la fatiga pandémica; exploradas a través de una encuesta. Los datos se almacenaron y procesaron en hojas de cálculo de Microsoft Excel. Resultados: El 38,1 por ciento se encontraba en el grupo etario 46-59 años de edad; el 36,2 por ciento de la población ha realizado viajes al menos una vez; el 22,9 por ciento refirió tener problemas esporádicos de convivencia; el 78,1 por ciento ha sentido preocupación por la salud de todos los miembros de su familia; el 40 por ciento experimentó cambios bruscos en su humor y el 28,6 por ciento no realizaba actividades físicas ni didácticas. Conclusiones: La fatiga pandémica se manifestó en la población estudiada mediante la presencia de estrés psicológico, descuido de las medidas higiénico sanitarias, desinformación sobre la situación epidemiológica y otros síntomas de desgaste(AU)

Introduction: The prolonged nature of the current pandemic means that people have to adopt a different style of coping than assumed at the beginning, and as a result it can be fatigue and demotivation. Objective: To characterize the manifestations of pandemic fatigue in the population of the town of Santa Marta, Matanzas province. Methods: A descriptive observational cross-sectional study was conducted from May 7 to 10, 2021 in 105 members of 51 randomly selected families from the Family Doctor´s Office #27 in the town of Santa Marta. The variables were grouped into socio-demographic, clinical and related to the characteristics of pandemic fatigue explored through a survey. The data was stored and processed in Microsoft Excel spreadsheets. Results: 38.1percent were in the age group 46-59 years of age; 36.2percent of the population has made trips at least once; 22.9percent reported having sporadic problems of coexistence; 78.1percent have felt concern for the health of all members of their family; 40percent experienced sudden changes in their mood and 28.6percent did not perform physical or didactic activities. Conclusions: Pandemic fatigue manifested itself in the population studied through the presence of psychological stress, neglect of hygienic-sanitary measures, misinformation about the epidemiological situation and other symptoms of attrition(AU)

Prevalence of COVID-19 in medical school and residency in Porto Alegre, RS

SUMMARY OBJECTIVE: A multicentric, cross-sectional study was carried out to determine the prevalence and risk factors for Coronavirus disease 2019 in medical students and residents from four universities and affiliated hospitals in Brazil. METHODS: A survey about contamination risk and symptoms was sent to all participants through email and WhatsApp. Prevalence was measured by the self-report of positive polymerase chain reaction or serological test. Univariate and multivariate analyses were performed, and odds ratio and 95% confidence interval were calculated. RESULTS: Prevalence of infection by Sars-CoV-2 was 14.9% (151/1011). The disease was more prevalent in residents and interns than in undergraduate students. Contact with an infected relative outside the hospital or with colleagues without using personal protective equipment was associated with higher contamination. Contact with patients without wearing goggles and higher weekly frequency of contact were the two factors independently associated with the infection by Coronavirus disease 2019 in the multivariate analysis. CONCLUSIONS: Medical students, interns, and residents have a higher prevalence of Coronavirus disease 2019 than the general population, in which the last two groups are significantly at higher risk. Contacting patients at a higher weekly frequency increases the risk for infection. The use of goggles should be reinforced when contacting patients.

Retrospective analysis on efficacy of convalescent plasma in acute respiratory distress syndrome due to COVID-19

ABSTRACT BACKGROUND: Coronavirus disease 2019 (COVID-19) is an ongoing global health threat. However, currently, no standard therapy has been approved for the disease. OBJECTIVES: To evaluate the clinical effectiveness of convalescent plasma (CP) in patients with acute respiratory distress syndrome (ARDS) due to COVID-19. DESIGN AND SETTING: Retrospective study conducted at Kayseri City Education and Research Hospital, Kayseri, Turkey. METHODS: The case group consisted of adult patients (> 18 years) with ARDS due to COVID-19 who received CP in combination with antiviral and supportive treatment. These patients were compared with others who only received antiviral and supportive treatment. RESULTS: During the study period, a total of 30 patients with ARDS due to COVID-19 were included. Eleven patients (36%) received CP in combination with antiviral and supportive treatment, whereas nineteen patients (64%) in the control group only received antiviral and supportive treatment. On admission, the median age, demographic and clinical data and initial laboratory test results were similar between the groups (P > 0.05). On the 14th day of treatment, the laboratory values remained similar between the groups (P > 0.05). The mortality rates were not significantly different between the groups. CONCLUSION: CP treatment did not affect mortality or lead to clinical improvement for COVID-19 patients with ARDS.

Ciência da disseminação em DOHaD para a promoção da saúde nas futuras gerações / Dissemination Science in DOHaD for health promotion in future generations

Após o reconhecimento de princípios evolutivos e da epigenética associada à plasticidade do desenvolvimento, a ciência de DOHaD (Origens Desenvolvimentistas da Saúde e Doença) floresceu. Segundo DOHaD, a exposição a condições adversas no início da vida, como a subnutrição, leva a respostas adaptativas para aumentar as chances de sobrevivência imediata e posterior, as quais podem aumentar o risco de doenças crônicas não transmissíveis (DCNT) no curso da vida. Outros insultos como obesidade (materna e paterna) na preconcepção e gestação, diabetes gestacional, aleitamento e a alimentação inadequada na infância podem induzir respostas não adaptativas e aumentar o risco de doenças, independentemente do ambiente posterior. A exposição à desreguladores endócrinos, substâncias tóxicas e poluentes também podem ter efeitos de longo prazo. Esses efeitos são mediados por alterações epigenéticas, as quais se tornam mais sensíveis nesse período crítico de desenvolvimento de intensa reorganização. Diante da transição nutricional e coexistência das diferentes formas de desnutrição nos países de baixa e média renda (PBMR); do aumento global das DCNT, cujo impacto social e econômico é maior nesses países; da fraca contribuição de fatores genéticos fixos na etiologia dessas doenças; e da ineficácia das atuais intervenções, a implementação de DOHaD representa uma estratégia potencial para beneficiar as futuras gerações. Considerando que a disseminação de DOHaD não têm acompanhado seu florescimento científico, esse trabalho teve como objetivo o desenvolvimento de um ebook direcionado para nutricionistas e um artigo relativo aos impactos da pandemia de COVID-19 na perspectiva de DOHaD, a fim de aproximar a ciência destes profissionais e fomentar sua implementação. Trata-se de uma revisão narrativa de literatura a partir artigos científicos em inglês e português, publicados nas bases de dados SciELO, PubMed e BVS, sem limite de data. O trabalho evidenciou que o desafio da dupla carga de doenças e das diferentes formas de desnutrição nos PBMR, foi agravado pela pandemia, tornando imperativo medidas de intervenção por seu provável impacto no ciclo intergeracional de DCNT e desenvolvimento dos países. A aproximação dessa ciência do nutricionista, propicia uma formação mais ampla e integrativa, através de capacitação técnica e habilidades interpessoais, capazes de acionar as fragilidades biopsicossociais, e melhor intervir, equacionando resultados de curto e longo prazo, a fim de interromper o ciclo intergeracional de DCNT, assim como otimizar o capital humano, a capacidade de produção e renda da futura geração. Conclui-se que o material desenvolvido é de grande valia, dado que a disseminação desse conhecimento deve se estender aos nutricionistas de todas as áreas e ser multiplicado

After evolutionary and epigenetics principles associated with the plasticity of development were recognized, DOHaD (Developmental Origins of Health and Disease) science flourished. According to DOHaD, the exposure to adverse conditions at the beginning of life, like undernutrition, leads to adaptive responses to increased immediate and later odds of survival, which may increase the risk of noncommunicable diseases (NCD) during life. Other conditions such as obesity (maternal and paternal) in preconception and pregnancy, gestational diabetes, lactation, and inadequate nourishment during infancy can induce non-adaptive responses and increased risk of diseases, regardless of the upcoming environment. The exposure to endocrine disruptors, and toxic and pollutant substances can also have long-term effects. Those effects are mediated by epigenetic changes, which become more sensitive during this critical period of development under intense reorganization. Considering the nutritional transition and coexistence of the different forms of undernutrition in the low- and middle-income countries (LMIC); the global increase of NCDs, with a higher social and economic impact in those countries; the weak contribution of fixed genetic factors in the etiology of those diseases; and the inefficacy of current interventions, the implementation of DOHaD represents a potential strategy to benefit future generations. Considering that the dissemination of DOHaD have not followed its scientific progress, the goal of the present work was to develop an e-book targeting nutritionists and an article about the impacts of the COVID-19 pandemic in the perspective of DOHaD, intended to drive the science closer to those professionals and foster its implementation. It is a narrative review of the literature regarding scientific articles published in English and Portuguese on the data bases SciELO, PubMed and BVS, with no date limit. The work has highlighted that the challenge of the double burden of the diseases and the several forms of undernutrition in the LMIC, was aggravated by the pandemic, making intervention measures imperative due to its likely impact on the intergenerational cycle of NCD and the development of countries. By inching closer to nutritionists this science provides larger and more integrative education through technical training and interpersonal abilities that help activate biopsychosocial fragilities, and better intervention; providing short- and long-term results aiming to interrupt the NCD intergenerational cycle, as well as optimize the human capital, the work and income capacity of the future generation. It is concluded that the material developed is of great value, given that the dissemination of this knowledge should reach all nutritionists from all areas and be multiplied

Resilient coping and future expectations in university students in Peru during the pandemic / Afrontamiento resiliente y expectativas de futuro en estudiantes universitarios de Perú durante la pandemia

Objective: To determine the relationship between resilient coping and future expectations. Methods: The approach was exclusively quantitative, observational, prospective, cross-sectional, and correlational in design. The participants were 2202 students from the (UNHEVAL, Perú), and the instruments resilient coping scale and the future expectations scale were used, which were digitized to be applied. A correlation analysis was performed using Spearman's Rho non-parametric statistical test. Results: The level of future expectations where the largest number of students is located was high, with 55.6 percent, and at the same time, 53.4 percent of the students manifested medium-level resilient coping. The main finding is that university students obtained a significant relationship between resilient coping and future expectations (rs=0.39; p=0.000), as in future expectations with the three dimensions of resilient coping, personal resilient coping (rs=0.36; p=0.000), social resilient coping (rs=0.38; p=0.000) and spiritual resilient coping (rs=0.18; p=0.000). Conclusions: There is a statistically significant and positive relationship between resilient coping and future expectations in students (UNHEVAL, Perú) (AU)

Objetivo: Determinar la relación entre el afrontamiento resiliente y las expectativas de futuro. Métodos: El enfoque fue exclusivamente cuantitativo, observacional, prospectivo, transversal y de diseño correlacional. Participaron 2202 estudiantes de la (UNHEVAL, Perú), y se utilizaron los instrumentos Escala de Afrontamiento Resiliente y Escala de Expectativas de Futuro, los cuales fueron digitalizados para su aplicación. Se realizó un análisis de correlación mediante la prueba estadística no paramétrica Rho de Spearman. Resultados: El nivel de expectativas de futuro donde se ubica la mayor cantidad de estudiantes fue alto con un 55,6 percent, y a su vez el 53,4 percent de los estudiantes manifestaron un afrontamiento resiliente de nivel medio. El principal hallazgo es que los estudiantes universitarios obtuvieron una relación significativa entre el afrontamiento resiliente y las expectativas de futuro (rs=0,39; p=0,000), así como en las expectativas de futuro con las tres dimensiones del afrontamiento resiliente, afrontamiento resiliente personal (rs=0,36; p=0,000), afrontamiento resiliente social (rs=0,38; p=0,000) y afrontamiento resiliente espiritual (rs=0,18; p=0,000). Conclusiones: Existe una relación estadísticamente significativa y positiva entre el afrontamiento resiliente y las expectativas de futuro en los estudiantes (UNHEVAL, Perú)(AU)

COVID-19, aterosclerosis y la respuesta inflamatoria en la enfermedad reumática / COVID - 19, atherosclerosis and the inflammatory response in rheumatic disease

Introducción: La enfermedad por el coronavirus 2019 (COVID-19) es causada por el síndrome respiratorio agudo severo coronavirus-2 (SARS-CoV-2). Además de la invasión tisular directa, el SARS-CoV-2 también puede provocar una respuesta inmune exagerada del huésped, que con frecuencia conduce a una tormenta de citocinas, que contribuye, significativamente, a la disfunción multiorgánica. Las enfermedades autoinmunes se caracterizan por un estado proinflamatorio, aterosclerosis acelerada e incremento de la incidencia de complicaciones vasculares por lo que en estos pacientes existe un alto riesgo de complicaciones ante la presencia del SARS-CoV-2. La alteración en la regulación del sistema inmunológico, el aumento de la demanda metabólica y la actividad procoagulante probablemente explican parte del mayor riesgo de resultados adversos en las personas con enfermedad aterosclerótica relacionada con la COVID-19. Objetivo: Actualizar los conocimientos del personal de salud en el manejo de estas enfermedades. Método: Se realizó una búsqueda de artículos en PubMed, SciELO y Google Scholar con estrategia de vocabulario controlado, de diciembre 2019 a noviembre 2020. Se seleccionaron un total de 50 artículos. Desarrollo: La elevada producción de autoanticuerpos ya sea secundaria a la enfermedad reumática o por una infección intercurrente, puede estar implicada en el desarrollo de la disfunción endotelial, la progresión y la ruptura de la placa aterosclerótica. Conclusiones: Se ha demostrado que estas enfermedades crónicas autoinmunitarias se asocian a una elevada morbimortalidad cardiovascular por lo que el médico de estos tiempos tiene que ser capaz de reconocer estos pacientes(AU)

Introduction: Coronavirus disease 2019 (Covid-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In addition to direct tissue invasion, SARS-CoV-2 can also elicit an exaggerated host immune response, often leading to a cytokine storm, significantly contributing to multi-organ dysfunction. Autoimmune diseases are characterized by a pro-inflammatory state, accelerated atherosclerosis and an increased incidence of vascular complications, which is why there is a high risk of complications in the presence of SARS-CoV-2 in these patients. Altered immune system regulation, increased metabolic demand, and procoagulant activity likely explain part of the increased risk of adverse outcomes in people with Covid-19-related atherosclerotic disease. Objective: To update the knowledge of health personnel in the management of these diseases. Method: We reviewed articles in PubMed, SciELO and Google Scholar with a controlled vocabulary strategy, from December 2019 to November 2020. We selected a total of 50 articles. Findings: The high production of autoantibodies, whether secondary to rheumatic disease or due to intercurrent infection, may be involved in the development of endothelial dysfunction, the progression and rupture of the atherosclerotic plaque. Discussion: It has been shown that these autoimmune chronic diseases are associated with high cardiovascular morbidity and mortality, so the doctor of these times must be able to recognize these patients(AU)

Protocolo para realizar la traqueostomía en pacientes con COVID-19 / A Protocol for Performing Tracheostomy in Patients with COVID-19

Introducción: Los cirujanos pueden desempeñar un papel valioso en la realización de traqueostomía para apoyar a los equipos de cuidados críticos durante la pandemia global de la COVID-19. Objetivo: Diseñar un protocolo para realizar la traqueostomía en pacientes con la COVID-19. Métodos: Se realizó un estudio descriptivo durante el periodo de marzo a diciembre del año 2020 en el Hospital "Comandante Manuel Fajardo Rivero", de Santa Clara, Villa Clara. Se emplearon como métodos teóricos: el análisis-síntesis e inductivo-deductivo; y como empíricos: análisis documental, grupo nominal y el criterio de especialistas para la valoración del producto diseñado. Resultados: El protocolo fue estructurado en: título, propósito, normas organizativas institucionales, indicaciones, procedimiento de actuación y evaluación. Según el criterio de los especialistas consultados el protocolo diseñado, es pertinente, factible y válido. Conclusiones: Para el diseño del protocolo fue fundamental aplicar y adaptar cuidadosamente la mejor evidencia existente sobre la realización de la traqueostomía. Su estructura permite brindar la mejor atención al paciente con la COVID-19 al tiempo que protege al equipo quirúrgico(AU)

Introduction: Surgeons can play a valuable role in performing tracheostomy, as a support for critical care teams during the global COVID-19 pandemic. Objective: To design a protocol for performing the tracheostomy in patients with COVID-19. Methods: A descriptive study was carried out, during the period from March to December 2020, at Comandante Manuel Fajardo Rivero Hospital, in Santa Clara City, Villa Clara Province. The following theoretical methods were used: analysis-synthesis and inductive-deductive; as well as empirical ones: documentary analysis, nominal group and criteria of specialists for the evaluation of the designed product. Results: The protocol was structured into title, purpose, institutional organizational norms, indications, procedure of action and evaluation. According to the criteria of the specialists consulted, the designed protocol is pertinent, feasible and valid. Conclusions: For the design of the protocol, it was essential to apply and adapt, carefully, the best existing evidence on tracheostomy performance. Its structure allows to provide the best care to the patient with COVID-19 while protecting the surgical team(AU)

Manifestaciones extrapulmonares de COVID-19. Una revisión / Extrapulmonary manifestations of covid-19. A review

La enfermedad por coronavirus 2019 (covid-19) se presenta en una amplia variedad de cuadros clínicos que van desde formas completamente asintomáticas o leves hasta una enfermedad rápidamente progresiva, incluidas manifestaciones pulmonares y extrapulmonares. El SARSCoV-2, el agente etiológico del covid-19, accede a sus células diana a sistema renina-angiotensina. Esta enzima se expresa en células endoteliales vasculares, epitelio tubular renal, células de Leydig en los testículos, pulmones, riñones, cerebro, corazón, vasculatura y tracto gastrointestinal. ,,,,,, Como tal, las manifestaciones clínicas del covid-19 se explican por la distribución tisular de la ECA-2. Más allá de la afectación tisular "per se", otra característica patológica es el fenómeno de la "tormenta de citocinas" (CS). El CS es una respuesta inmune exagerada caracterizada por un alto nivel de citocinas inflamatorias circulantes sostenidas en el tiempo. Es rápidamente progresivo y tiene una alta mortalidad. El CS se ha detectado en pacientes críticos con covid-19 y se considera una de las principales causas de síndrome de dificultad respiratoria aguda (SDRA) e insuficiencia multiorgánica. Los niveles séricos de citocinas proinflamatorias aumentan significativamente en pacientes con causar inflamación y lesión del sistema nervioso central (SNC). Respaldando este punto de vista, los niveles de IL-6 se correlacionan positivamente con la gravedad del covid-19. Este síndrome se ha descrito en sepsis, síndrome hemofagocítico y en otras infecciones por coronavirus como el síndrome respiratorio agudo severo (SARS) o el síndrome respiratorio de Oriente Medio (MERS). Aunque la afectación pulmonar se ha descrito bien en muchos informes, las manifestaciones extrapulmonares todavía están mal descritas. Este artículo revisará las manifestaciones no pulmonares del covid-19. Los principales síntomas extrapulmonares comprenden los neurológicos, cardíacos, oftalmológicos, musculares, hematológicos, cutáneos y gastrointestinales, así como la afectación hepática y renal. Cada una de estas manifestaciones puede surgir durante la evolución de la enfermedad o construir su manifestación inicial

Coronavirus disease 2019 (covid-19) presents in a wide variety of clinical pictures ranging from completely asymptomatic or mild forms to rapidly progressive disease, including pulmonary and extrapulmonary manifestations. SARS-CoV-2 ­the etiological agent of covid-19- access to their target cells via a transmembrane protein, the angiotensin-converting enzyme II (ACE2). ACE-2 is a type-I metallocarboxypeptidase with homology to ACE, an essential enzyme in the Renin-Angiotensin System. [1] This enzyme is expressed in vascular endothelial cells, renal tubular epithelium, Leydig cells in the testes, lungs, kidneys, brain, heart, vasculature, and gastrointestinal tract.[2-7] As such, the clinical manifestations of covid-19 are explained by the tissular distribution of ACE-2. Beyond the tissular affectation "per se", another pathological feature is the "cytokine storm" phenomenon (CS). CS is an exaggerated immune response characterized by a high level of circulating inflammatory cytokines sustained over time. It is rapidly progressive and has a high mortality. CS has been detected in critical patients with covid-19 and it is considered a major cause of acute respiratory distress syndrome (ARDS) and multiorgan failure. Serum levels of proinflammatory cytokines are significantly increased in patients with ARDS, and their levels are positively correlated with mortality.[8, 9] CS may also cause inflammation and injury of the Central Nervous System (CNS) Supporting this view, IL-6 levels positively correlate with covid-19 severity.[10] This syndrome has been described in sepsis, hemophagocytic syndrome and in other coronavirus infections like the severe acute respiratory syndrome (SARS) or the Middle East respiratory syndrome (MERS). Although lung involvement has been well described in many reports, extra-pulmonary manifestations are still poorly described. This paper will review the non-pulmonary manifestations of covid-19. Main extra-pulmonary symptoms comprise the neurologic, cardiac, ophthalmologic, muscular, hematologic, cutaneous, and gastrointestinal ones, as well as hepatic and renal involvement. Each one of these manifestations can arise during the disease evolution or constitute their initial manifestation.

Estados emocionales de adultos mayores en aislamiento social durante la COVID-19 / Emotional states of older adults in social isolation during COVID-19 / Estados emocionais de idosos em isolamento social durante COVID-19

RESUMEN Introducción: La alta contagiosidad de la COVID-19, el crecimiento de casos confirmados, las muertes y el aislamiento social han ocasionado que las emociones y pensamientos negativos se extiendan, con amenaza a la salud mental de la población adulta mayor. Objetivo: Identificar los estados emocionales de adultos mayores en aislamiento social durante la COVID-19. Método: Se realizó un estudio descriptivo, transversal, entre mayo y junio de 2020, en el área de salud perteneciente al Policlínico Universitario "Dr. Rudesindo Antonio García del Rijo", Sancti Spíritus. La población de estudio fue de 100 adultos mayores. Se evaluaron las variables: edad, sexo, estado civil, convivencia, ocupación, comorbilidad, ansiedad, depresión, irritabilidad, estrés. La información se obtuvo mediante la entrevista semiestructurada, la observación y test psicológicos. Resultados: El 61,0 % correspondió al sexo femenino; el 57,0 % pertenecía al grupo de 70-79 años; la mayoría de los ancianos vivía acompañado con su pareja, un menor de edad o un discapacitado (64,0 %), solo el 36,0 % vivía efectivamente solo. El 65,0 % no tenía vínculo laboral. El 89,0 % presentaba patologías consideradas de riesgo para la COVID-19. Predominó un nivel de irritabilidad normal, tanto externa (68,0 %) como interna (70,0 %), un nivel leve de ansiedad (73,0 %) y un nivel leve de depresión (50,0 %). El 47,0 % mostró alteración en los niveles de estrés. Conclusiones: El aislamiento social como medida para evitar el contagio por COVID-19 ha repercutido en la salud mental de los adultos mayores.

ABSTRACT Introduction: The high contagiousness of COVID-19, the increase of confirmed cases and deaths, and the social isolation have caused negative emotions and thoughts, threatening the mental health of the elderly population. Objective: To identify the emotional states of seniors in social isolation during COVID-19. Method: A descriptive, cross-sectional study was carried out between May to June 2020, in the health area part of the Policlínico Universitario "Dr. Rudesindo Antonio García del Rijo", in Sancti Spíritus. The study population was made of 100 seniors. The variables evaluated were: age, gender, marital status, coexistence, occupation, comorbidity, anxiety, depression, irritability, stress. The information was obtained through semi-structured interview, observation and psychological tests. Results: 61.0% were female; 57.0% in the 70-79 age group; most of them lived with their partner, a minor or a disabled person (64.0%), only 36.0% actually lived alone. 65.0% had no employment relationship. 89.0% had pathologies considered risky for COVID-19. A normal level of irritability prevailed, both external (68.0%) and internal (70.0%), a mild level of anxiety (73.0%) and a mild level of depression (50.0%). 47.0% showed alteration in stress levels. Conclusions: Social isolation as a measure to avoid contagion by COVID-19 has had an impact on the mental health of the elderly.

RESUMO Introdução: a alta contagiosidade do COVID-19, o crescimento de casos confirmados, mortes e isolamento social têm causado a disseminação de emoções e pensamentos negativos, ameaçando a saúde mental da população idosa. Objetivo: identificar os estados emocionais de idosos em isolamento social durante o COVID-19. Método: estudo descritivo, transversal, realizado entre maio e junho de 2020, na área de saúde pertencente ao Policlínico Universitario "Dr. Rudesindo Antonio García del Rijo", Sancti Spíritus. A população do estudo foi de 100 idosos. As variáveis avaliadas foram: idade, sexo, estado civil, convivência, ocupação, comorbidade, ansiedade, depressão, irritabilidade, estresse. As informações foram obtidas por meio da entrevista semiestruturada, observação e testes psicológicos. Resultados: 61,0% corresponderam ao sexo feminino; 57,0% pertenciam à faixa dos 70-79 anos; A maioria dos idosos morava com o companheiro, menor de idade ou com deficiência (64,0%), apenas 36,0% morava realmente sozinho. 65,0% não tinham vínculo empregatício. 89,0% tinham patologias consideradas de risco para COVID-19. Prevaleceu nível normal de irritabilidade, tanto externa (68,0%) quanto interna (70,0%), nível leve de ansiedade (73,0%) e nível leve de depressão (50,0%). 47,0% apresentaram alteração nos níveis de estresse. Conclusões: o isolamento social como medida para evitar o contágio pelo COVID-19 tem repercussões na saúde mental dos idosos.