Salud mental: cuando la necesidad queda por fuera de la agenda sanitaria / Mental health: when the need is out of the health agenda

Introducción: Pos-pandemia COVID-19 los centros de salud vieron incrementados el número de consultas en salud mental (SM). Objetivos: -Evidenciar el aumento de la demanda en SM pos-pandemia. Pre y pos-pandemia: -Comparar las características de demanda en SM -Relevar las demandas del área judicial (DAJ) -Evaluar la dispensa de psicofármacos (PF) Material y Métodos: Trabajo descriptivo, retrospectivo, poblacional. Pacientes atendidos en SM del Área Programática del Hospital Penna. Se obtuvieron consultas de psicología (PSI) psiquiatría y psicopedagogía, motivo de consulta, edad, sexo, dispensa de psicofármacos (PF) desde el 1/01 al 31/12/2019 y mismo período 2022. Los datos se analizaron en frecuencia, porcentaje. Resultados: Las consultas pos-pandemia aumentaron un 8%, los pacientes atendidos aumentaron 37.91%. Las consultas PSI pediatría/adolescencia descendieron 6.5% en 2022 predominando niños en 2019 y niñas en 2022. En adultos aumentó 20.10%, predominando mujeres ambos períodos. Si bien consumo, violencia y angustia fueron nombrados en ambos periodos, pobreza apareció en 2022. Las DAJ aumentaron más del 1000%. La dispensa PF aumentó más del 100%. Conclusiones: En pos-pandemia aumentaron las consultas de PSI y los DAJ. El aumento en dispensa PF evidencia el deterioro y la complejidad de la SM pos-pandemia. Estos datos, plantea la necesidad de incorporar nuevos profesionales

Introduction: Post- COVID-19 pandemic, health care centers increased the number of mental health (MH) consultations. Objectives: - Evidence the increase in demand for SM post-pandemic. Pre and post-pandemic: -Compare the characteristics of demand in SM -Review the demands of the judicial area (DAJ) -Evaluate the dispensation of psychotropic drugs (PF) Material and Methods: Descriptive, retrospective, population-based study. Patients treated in SM at the Programmatic Area of the Penna Hospital. Consultations from psychology (PSI), psychiatry and psychopedagogy, reason for consultation, age, sex, dispensation of psychotropic drugs (PF) were obtained from 01/01 to 12/31/2019 and the same period 2022. The data was analized in frequency and percentage. Results: Post-pandemic consultations increased by 8%, patients treated increased by 37.91%. Pediatric/adolescent PSI consultations decreased 6.5% in 2022, with boys predominating in 2019 and girls in 2022. In adults it increased 20.10%, with women predominating in both periods. Although consumption, violence and distress were mentioned in both periods, poverty appeared in 2022. The DAJ increased more than 1000%. The PF dispensation increased more than 100%. Conclusions: In the post-pandemic, PSI and DAJ consultations increased. The increase in FP dispensation shows the deterioration and complexity of post-pandemic SM. These data raise the need to incorporate new professionals

Telemedicine for diagnosis or treatment during Covid-19: systematic review

OBJECTIVE: To describe the use of telemedicine by health professionals for diagnosis or treatment of patients during the Covid-19 pandemic. METHOD: This is a systematic literature review of observational studies. Five databases were used. The assessment of the studies methodological quality occurred individually among the revisors and the Joanna Briggs Institute (JBI) tool was used. RESULTS: The reviewers selected 22 articles from 6,180 works. The services provided through telemedicine were consultation/screening, consultation/follow-up or monitoring, test reports, medication prescriptions and case discussions. The technological resources used were platforms using video and telephone (audio and video). The use of telemedicine made it possible to reduce their exposure to Covid-19, reduce social panic and anxiety, quickly medical specialties access and the possibility of access to diagnosis and treatment of patients with chronic and acute diseases. CONCLUSION: Telemedicine can be an important tool in healthcare, keeping patients and healthcare professionals safe during the Covid-19 pandemic.

Cambio de la atención psicológica presencial a modalidad remota: facilitadores y obstáculos en la pandemia de COVID-19 / Changing face-to-face psychological care to remote mode: facilitators and obstacles in the COVID-19 pandemic / Mudança do atendimento psicológico presencial para modalidade remota: facilitadores e dificultadores na pandemia de COVID-19

Objetivo: verificar asociaciones entre variables sociodemográficas y factores que facilitan y dificultan la transición de la atención psicológica presencial a la modalidad remota en el primer año de la pandemia de COVID-19. Método: se trata de un estudio analítico, cuantitativo y de corte transversal. Después de la aprobación del Comité de Ética en Investigación, la recolección de datos se realizó mediante la aplicación de un formulario en línea que consta de 55 preguntas. Los datos fueron analizados utilizando técnicas de estadística descriptiva e inferencial. Resultados: la muestra de conveniencia estuvo compuesta por 385 psicólogos brasileños, en su mayoría mujeres (67,01%), jóvenes profesionales con hasta cinco años de actuación después de la graduación (44,16%) y predominio de actividades en la clínica privada. Se encontró que el tiempo de formación entre cinco y 10 años se asoció con una mayor percepción de dificultades y que la experiencia previa con la atención a distancia facilitó la adaptación en la transición de una modalidad a otra. Conclusión: considerando que la teleasistencia puede ser una poderosa herramienta en el escenario de la salud, se sugiere que los temas de la teleasistencia sean incluidos en la agenda de investigación y los contenidos programáticos en los currículos de los cursos de formación en salud.

Objective: to verify associations between sociodemographic variables and factors that facilitate and hinder the transition from face-to-face psychological care to remote mode in the first year of the COVID-19 pandemic. Method: this is an analytical, quantitative, cross-sectional study. After approval by the Research Ethics Committee, data collection was performed by applying an online form consisting of 55 questions. Data were analyzed using descriptive and inferential statistics techniques. Results: the intentional sampling consisted of a total of 385 Brazilian psychologists, mostly women (67.01%), young professionals with up to five years of graduation (44.16%) most of activities in the private clinic. It was found that training time between five and 10 years was associated with a greater perception of difficulties and that previous experience with remote care facilitated adaptation in the transition from one modality to another. Conclusion: considering that call center can be a powerful tool in the health scenario, it is suggested the inclusion of remote care issues in the research agenda and syllabus in the curricula of health training courses.

Objetivo: verificar associações entre variáveis sociodemográficas e fatores facilitadores e dificultadores da transição do atendimento psicológico presencial para a modalidade remota no primeiro ano da pandemia de COVID-19. Método: trata-se de um estudo analítico, quantitativo, de corte transversal. Após aprovação do Comitê de Ética em Pesquisa, a coleta foi realizada mediante aplicação de um formulário online composto por 55 questões. Os dados foram analisados por meio de técnicas de estatística descritiva e inferencial. Resultados: a amostra de conveniência foi composta por 385 psicólogos brasileiros, majoritariamente mulheres (67,01%), jovens profissionais com até cinco anos de ofício após a graduação (44,16%) e com predomínio de atividades na clínica privada. Constatou-se que o tempo de formação entre cinco e 10 anos foi associado com uma maior percepção de dificuldades e que a experiência prévia com atendimento remoto foi facilitadora da adaptação na transição de uma modalidade à outra. Conclusão: considerando que o teleatendimento pode ser uma ferramenta potente no cenário da saúde, sugere-se a inclusão das questões do atendimento remoto na agenda de pesquisa e conteúdos programáticos das grades curriculares dos cursos de formação em saúde.

Larrea divaricata a native Argentine plant with potential activity against SARS-CoV-2? / ¿Larrea divaricata una planta nativa argentina con actividad potencial sobre SARS-CoV-2?

Larrea divaricata Cav. is an autochthonous South American plant popularly used in inflammatory and infectious diseases with reported anti - inflammatory, immunomodulatory, antimicrobial and antioxidant activities. Covid - 19 is an infection ca used by the severe acute respiratory syndrome coronavirus 2 (SARS - CoV - 2). This virus can cause pneumonia and even death in about 5% of the cases. The objective of the article was to demonstrate, through a literature review, that L. divaricata has sufficie nt attributes to be assayed against SARS - CoV - 2. For this, the chemical composition, reported activities and docking studies were taken into account. This review demonstrated that the plant extracts are capable of inhibiting the proliferation of fungi, bact eria and viruses and that they exert anti - inflammatory and immunomodulatory actions in different " in vitro " and " in vivo " models. These results suggest that the plant is a good candidate to be studied for the prevention and/or treatment of SARS - CoV - 2.

Larrea divaricata Cav. es una planta autóctona Sudamericana, utilizada popularmente en enfermedades inflamatorias e infecciosas, con activida d anti - inflamatoria, inmunomoduladora, antimicrobiana y antioxidante reportada. El Covid - 19 es una infección causada por una cepa de coronavirus, SARS - CoV - 2 (coronavirus tipo 2 causante del síndrome respiratorio agudo severo). Este virus puede originar neu monía e incluso la muerte en alrededor del 5% de los casos. Nuestro objetivo fue demostrar, a través de una revisión bibliográfica, que esta planta tiene atributos suficientes para ser ensayada en estudios contra SARS - CoV - 2. Se tuvo en cuenta la composici ón química, los antecedentes científicos y los estudios de acoplamiento molecular. Esta revisión permitió demostrar que extractos de la planta son capaces de inhibir la proliferación de hongos, bacterias y virus y que presentan acción anti - inflamatoria en diferentes modelos " in vitro " e " in vivo ", lo que los hace candidatos a ser estudiados en la prevención y/o tratamiento de la infección contra SARS - CoV - 2.

Factores asociados a mortalidad en pacientes críticos con COVID-19 en un centro universitario de Paraguay / Factors associated with mortality in critical patients with COVID-19 in an university center in Paraguay

INTRODUCCIÓN: La pandemia por COVID-19 es un problema de salud mundial. Habitualmente cursa con sintomatología leve y 5% de los afectados evoluciona a cuadros graves que requieren de cuidados intensivos. OBJETIVO: Determinar el perfil clínico, la mortalidad y factores asociados a la misma en pacientes con COVID-19 ingresados al Departamento de Cuidados Intensivos de Adultos, del Hospital de Clínicas de la Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Paraguay, entre agosto de 2020 a agosto de 2021. PACIENTES Y MÉTODO: Se realizó un estudio observacional analítico de corte transverso. Los datos se obtuvieron a partir de las historias clínicas de los pacientes. RESULTADOS: Se incluyeron 214 pacientes críticos entre 21 y 85 años de edad (mediana 54 años), 57,9% del sexo masculino, 85% provenientes del Departamento Central y Asunción. La mortalidad global fue de 38,3%. Se asociaron significativamente con la mortalidad una edad ≥ 60 años, las comorbilidades (diabetes mellitus, cardiopatía, enfermedad renal crónica), los índices de gravedad (APACHE II, SOFA, inicial), procalcitonina elevada, utilización de vasopresor, asistencia respiratoria mecánica y utilización del decúbito prono; así como la presencia de SDRA y el requerimiento de depuración extrarenal. En el análisis multivariado (por regresión logística) los factores de riesgo de mortalidad independientes fueron: la edad mayor de 60 años, la utilización de noradrenalina y depuración extra-renal durante la hospitalización. CONCLUSIÓN: Nuestra mortalidad es similar a la reportada internacionalmente. Los factores de riesgo de mortalidad identificados muestran una población con mayores posibilidades de un desenlace desfavorable.

BACKGROUND: The COVID-19 pandemic is a world health issue. Generally, it is with mild and around 5% evolves to a severe disease that requires intensive care. AIM: To determine the clinical profile, mortality and associated factors in COVID-19 patients admitted at the Adult Intensive Care Department at the Hospital de Clinicas, between August 2020 and August 2021. METHODS: Cross-section observational analytic study. Data was obtained from clinical charts. RESULTS: 214 patients were included, with an average age of 54 years, 57.9% male. Overall mortality was 38.3%. Factors associated significantly with mortality were: ≥60 years of age, comorbidity (diabetes mellitus, heart disease, chronic renal disease), severity index (APACHE II, initial SOFA), high procalcitonin, use of vasopressor, mechanical respiratory assistance and prone decubitus; as well as the presence of acute respiratory distress syndrome and hemodialysis. Multi varied analysis identified as mortality risk factors: ≥60 years of age, noradrenaline use and hemodialysis. CONCLUSION: Mortality rate is similar to that reported worldwide. Mortality risk factors identified show a population with higher possibilities for unfavorable outcome.

Uso de plasma de convalecientes de COVID-19 en pacientes hospitalizados por SARS-CoV-2 de moderada grave-dad en la Región de Los Ríos, Chile / Assessing Convalescent Plasma Efficacy in Moderate COVID-19 Hospitalizations: A Bicentric Retrospective Study

INTRODUCCIÓN: COVID-19 cobró millones de vidas especialmente en la era pre-vacunas. Estudios preliminares mostraban eficacia promisoria del plasma de personas convalecientes anti SARS-CoV-2 (PPC). Objetivo: evaluar la eficacia del PPC en hospitalizados por COVID-19 de moderada gravedad. MATERIAL Y MÉTODOS: Estudio retrospectivo, bicéntrico, en adultos hospitalizados por COVID-19 moderado (no crítico) que requirieron oxigenoterapia. Al plasma donado por sobrevivientes de cuadros leves (600 cc) se les realizó búsqueda de IgG anti SARS-CoV-2. Se evaluó su impacto en mortalidad, estadía hospitalaria (días) y necesidad de ventilación mecánica (VMI). RESULTADOS: De los 119 pacientes incluidos, 58% eran hombres (edad mediana 60 años), 88% poseía comorbilidad y 43% tenía "CALL score" de alto riesgo. 43 pacientes (36%) recibieron PPC, sólo 15 (12,6%) precozmente (< 7 días). 22 pacientes debieron trasladarse a unidad intensiva, 18 recibieron VMI y 15 fallecieron (12,6%). El uso de PPC no se asoció a cambios en la mortalidad (p = 0,16), necesidad de VMI (p = 0,79) ni en la estadía hospitalaria (p = 0,24). Su administración en forma precoz (< 7 días de síntomas) tampoco demostró asociación significativa. La presencia de cardiopatía y el requerir posteriormente VMI fueron factores independientes asociados a mortalidad. CONCLUSIONES: El uso de PPC en pacientes hospitalizados por COVID-19 de moderada gravedad no se asoció a menor mortalidad, estadía hospitalaria ni necesidad de VMI.

INTRODUCTION: COVID-19 claimed millions of lives, mainly in the pre-vaccine era. Preliminary studies showed promising efficacy of convalescent plasma against SARS-CoV-2 (CP). Objective: To evaluate the efficacy of CP in patients hospitalized for COVID-19 with moderate severity. METHODS: Retrospective, bicentric study including adults hospitalized for moderate (non-critical) COVID-19 who required oxygen therapy. CP donated by survivors of mild cases (600 cc) were searched for IgG anti-SARS-CoV-2. Its impact on mortality, hospital stay (days), and need for mechanical ventilation (IMV) was evaluated. RESULTS: Of the 119 patients included, 58% were men (median age 60 years), 88% had comorbidity, and 43% had a high-risk CALL score. Forty-three patients (36%) received CP, only 15 (12.6%) early (< 7 days). Twenty-two patients had to be transferred to the intensive care unit; 18 received IMV, and 15 died (12.6%). The use of CP was not associated with changes in mortality (p = 0.16), need for IMV (p = 0.79), or hospital stay (p = 0.24). Its early administration (< 7 days of symptoms) did not show a significant association either. The presence of heart disease and subsequently requiring IMV were independent factors of mortality. CONCLUSIONS: The use of CP in patients hospitalized for moderately severe COVID-19 was not associated with lower mortality, hospital stay, or the need for IMV.

Efecto del ejercicio aeróbico sobre la capacidad cardiorrespiratoria en pacientes sobrevivientes de covid-19: meta-análisis / Effect of aerobic exercise on the cardiorespiratory capacity in survivors of covid-19: a meta-analysis

El propósito del estudio fue cuantificar el tamaño de efecto (TE) del ejercicio aeróbico sobre la capacidad cardiorrespiratoria en sobrevivientes de la enfermedad COVID-19, producida por el virus SARS-CoV 2. Se revisaron dos bases de datos (EBSCO host y PubMed) entre los meses de agosto a noviembre del año 2021. Se encontraron 142 656 posibles artículos y, luego de varios filtros, se incluyeron 9 estudios que cumplían los requisitos de inclusión. Se usó el modelo de efectos aleatorios. Se obtuvieron 12 TE en un primer meta-análisis que tuvo sesgo (según prueba de Egger). Tras identificar y eliminar grupos con TE extremo, se obtuvo un modelo corregido y sin sesgo con 7 estudios y 9 TE, donde se encontró que el ejercicio aeróbico tiene un efecto significativo, positivo y de magnitud grande sobre la condición cardiorrespiratoria en sobrevivientes a la enfermedad de COVID-19 (TE = 0.849; IC95%: 0.715 - 0.982; . = 7.13; . = 0.522; I. = 0.87%; Egger . = 0.205). Las intervenciones con ejercicio aeróbico favorecen la mejora de la capacidad cardiorrespiratoria en pacientes sobrevivientes de COVID-19. Dos estudios aplicaron solo ejercicio aeróbico, mientras que los otros siete combinaban aeróbico con ejercicio de fuerza y otras modalidades. En todos los casos se tuvo TE significativo. Finalmente, estos resultados fueron relativamente homogéneos, sin evidenciar la influencia de posibles variables moderadoras.

The purpose of this study was to quantify the effect size (TE) of aerobic exercise on cardiorespiratory capacity in survivors of the COVID-19 disease caused by the SARS-CoV 2 virus. Two data bases (EBNSCO host and PubMed) were reviewed over the months of August through November, 2021. A total 142 656 potential articles were reviewed and, after applying several filters, 9 studies that met the requirements for inclusion were included. The random effect model was used. A first meta-analysis that was biased (according to Egger test) obtained 12 TE. After identifying and eliminating groups with an extreme TE, a corrected, unbiased model was obtained with 7 studies and 9 TE was obtained, where it was found that aerobic exercise has a significant, positive and large-magnitude effect on the cardiorespiratory condition on survivors of the COVID-19 disease (TE = 0.849; IC95%: 0.715 - 0.9 82; Q = 7.13; p = 0.522; I2 = 0.87%; Egger p = 0.205). Interventions with aerobic exercise foster an improvement in cardiorespiratory capacity in patients who survived COVID-19. Two studies applied aerobic exercise only, whereas the other seven combined aerobic exercise with strength exercise and other modes. In all cases, a significant TE was obtained. Finally, these results were relatively homogeneous, with no evidence for the influence of possible moderating variables.

O objetivo do estudo foi quantificar o tamanho do efeito (TDE) do exercício aeróbico na aptidão cardiorrespiratória em sobreviventes da doença COVID-19, produzida pelo vírus SARS-CoV 2. Foram revisadas duas bases de dados (EBSCO host e PubMed) entre agosto e novembro de 2021. Foi encontrado um total de 142.656 artigos em potencial e, após vários filtros, foram incluídos 9 estudos que atendiam aos requisitos de inclusão. Foi usado o modelo de efeitos aleatórios. Foram obtidos 12 TDE em uma primeira metanálise que era tendenciosa (de acordo com o teste de Egger). Depois de identificar e eliminar os grupos com TDE extremo, foi obtido um modelo corrigido e imparcial com 7 estudos e 9 TDE, no qual se constatou que o exercício aeróbico tem um efeito significativo, positivo e de grande magnitude sobre a aptidão cardiorrespiratória em sobreviventes da doença COVID-19 (TDE = 0,849; IC95%: 0,715 - 0,982; . = 7,13; . = 0,522; I. = 0,87%; Egger . = 0,205). As intervenções com exercícios aeróbicos melhoram o condicionamento cardiorrespiratório em sobreviventes da COVID-19. Dois estudos usaram apenas exercícios aeróbicos, enquanto os outros sete combinaram exercícios aeróbicos com exercícios de força e outras modalidades. Em todos os casos, houve um TDE significativo. Por fim, esses resultados foram relativamente homogêneos, sem evidências da influência de possíveis variáveis moderadoras.

Comparação dos marcadores de alteração na deglutição entre pacientes com e sem Covid-19 pós-intubação orotraqueal / Comparison of swallowing alteration markers between patients with and without Covid-19 post-orotracheal intubation

RESUMO Objetivo comparar os marcadores de alteração na deglutição de pacientes com e sem COVID-19 e estudar as variáveis preditivas de contraindicação da alimentação por via oral em pacientes com necessidade de intubação orotraqueal prolongada. Métodos estudo caso-controle, retrospectivo, com coleta de prontuário de variáveis clínicas e demográficas e da avaliação clínica da deglutição. As variáveis coletadas foram comparadas estatisticamente entre pacientes com COVID-19 (grupo estudo -GE) e sem COVID-19 (grupo-controle - GC). A análise de regressão de robusta de Poisson foi utilizada para avaliar o efeito da COVID-19 e das demais variáveis na contraindicação da alimentação por via oral. Resultados foram incluídos 351 pacientes, 269 no GE e 82 no GC. Pacientes do GE apresentaram menor idade, quando comparados ao GC (50,7 ± 12,8). O tempo total de intubação orotraqueal foi significativamente maior no GE. Os pacientes do GE apresentaram maior prevalência de tosse fraca, disfonia, piores graus de disfagia e maior ocorrência de contraindicação da alimentação por via oral. Na análise bivariada, verificou-se que os pacientes com COVID-19 apresentaram 65% maior probabilidade dessa contraindicação. Entretanto, quando a COVID-19 foi ajustada com outras variáveis clínicas e demográficas, verificou-se que as estas apresentaram maior influência sobre a contraindicação de alimentação por via oral do que a COVID-19. Conclusão a intubação orotraqueal prolongada teve pior efeito nos marcadores de alteração na deglutição e na reintrodução da via oral de pacientes com COVID-19. A idade maior que 60 anos, tempo de intubação orotraqueal maior que cinco dias, reintubação e delirium demonstraram ser preditivas de contraindicação da alimentação por via oral em pacientes intubados.

ABSTRACT Purpose To compare the swallowing alteration markers in patients with and without COVID-19 and to study the predictive variables of oral feeding contraindication in patients requiring prolonged orotracheal intubation. Methods Retrospective case-control study, with medical record data collection of clinical and demographic variables and the clinical evaluation of swallowing. The collected variables were statistically compared between patients with COVID-19 (SG) and without COVID-19 (CG). Robust Poisson regression analysis was used to evaluate the effect of COVID-19 and other variables on oral feeding contraindication. Results 351 patients were included, 269 in the SG and 82 in the CG. Patients in the SG were younger when compared to the CG (50.7 ± 12.8). The total time of orotracheal intubation was significantly longer in the SG. The patients in the SG had a higher prevalence of weak cough, dysphonia, worse degrees of dysphagia and higher occurrence of contraindication of oral feeding. In the bivariate analysis, it was found that patients with COVID-19 were 65% more likely to have oral feeding contraindication. However, when COVID-19 was adjusted with other clinical and demographic variables, it was found that these variables had a greater influence on the contraindication of the oral feeding than the COVID-19. Conclusion Prolonged orotracheal intubation had a worse effect on alteration markers in swallowing and reintroduction of the oral feeding in COVID-19 patients. Age over 60 years, orotracheal intubation time greater than 5 days, reintubation, and delirium were shown to be predictive of oral feeding contraindication in intubated patients.

Estudio de sobrevida a largo plazo en pacientes adultos con enfermedades respiratorias crónicas atendidos por infección respiratoria aguda por coronavirus SARS-CoV-2 / Study of long-term survival in adult patients with chronic respiratory diseases treated for acute respiratory infection by coronavirus SARS-CoV-2

La enfermedad respiratoria aguda por coronavirus SARS-CoV-2 (COVID-19) se ha convertido en un grave problema de salud pública a nivel mundial. Objetivos: Examinar el uso de recursos sanitarios, riesgo de complicaciones y muerte en pacientes adultos con enfermedades respiratorias crónicas atendidos por COVID-19. Métodos: Estudio clínico descriptivo prospectivo realizado en pacientes adultos atendidos por COVID-19 en la Red de Salud UC Christus entre el 1 de abril y 31 de diciembre de 2020. Resultados: Se evaluaron 2.160 pacientes adultos, edad: 47 ± 17 años (rango: 18-100), 51,3% sexo masculino, 43,8% tenía comorbilidades, especialmente hipertensión (23,2%), diabetes (11,7%) y enfermedades respiratorias crónicas: asma (5%), EPOC (1,4%) y enfermedad pulmonar difusa (EPD: 0,8%). Los pacientes adultos con enfermedades respiratorias crónicas tuvieron mayor riesgo de hospitalización y uso de oxígeno suplementario; sin embargo, la evolución de los pacientes asmáticos y la sobrevida a los doce meses fue similar a los pacientes sin comorbilidades atendidos por COVID-19, mientras que en los pacientes con EPOC y EPD la admisión a la unidad de paciente crítico y riesgo de muerte fueron más elevados. En el análisis multivariado, los principales predictores clínicos asociados al riesgo de muerte en el seguimiento a doce meses en pacientes adultos con COVID-19 fueron la edad y admisión al hospital, mientras que el asma fue un factor protector. Conclusión: Los pacientes asmáticos tuvieron bajo riesgo de complicaciones y muerte asociados a COVID-19; mientras que los pacientes con EPOC y EPD tuvieron mayor riesgo de complicaciones y muerte en el seguimiento a largo plazo.

The acute respiratory disease associated to coronavirus SARS-CoV-2 (COVID-19) has become a serious public health problem worldwide. Objectives: To examine the use of healthcare resources, risk of complications and death in adult patients with chronic respiratory diseases treated for COVID-19. Methods: Prospective descriptive clinical study conducted in adult patients treated for COVID-19 in the UC Christus Healthcare Network between April 1 and December 31, 2020. Results: 2,160 adult patients were evaluated, age: 47 ± 17 years-old (range: 18-100), 51.3% male, 43.8% had comorbidities, especially hypertension (23.2%), diabetes (11.7%), and chronic respiratory diseases: asthma (5%), COPD (1,4%) and interstitial lung disease (ILD: 0.8%). Adult patients with chronic respiratory diseases were at higher risk for hospitalization and use of supplemental oxygen; however, the evolution of asthmatic patients and survival at twelve months was similar to that of adult patients without comorbidities treated for COVID-19, while in patients with COPD and ILD admission to the critical care unit and risk of death were higher. In the multivariate analysis, the main clinical predictors associated to 12-month mortality risk in adult patients with COVID-19 were age and hospital admission, while asthma was a protective factor. Conclusion: Asthmatic patients had minor risk of complications and mortality associated with COVID-19; while patients with COPD and ILD had a significant higher risk of complications and 12-month mortality.

Fatores de risco para óbito e tempo de internação em pacientes com COVID-19 em uso de cloroquina e hidroxicloroquina: estudo de coorte retrospectivo / Risk factors for death and length of stay in patients with covid-19 using chloroquine and hydroxychloroquine: a retrospective cohort study

Objetivos: Comparar os desfechos clínicos e a sobrevida de pacientes adultos com COVID-19 expostos e não expostos a tratamento medicamentoso com cloroquina e hidroxicloroquina. Método: Trata-se de um estudo de coorte retrospectiva com dados coletados em um hospital de Vitória. Foram incluídos todos os pacientes de enfermarias e Unidade de Terapia Intensiva (UTI) com idade igual ou superior a 18 anos, com diagnóstico confirmado de COVID-19, ou seja, com PCR positivo para a infecção, atendidos no hospital entre 26 de fevereiro a 31 de dezembro de 2020, e com registro de alta hospitalar por motivo de óbito ou não óbito. Aplicou-se a estatística descritiva (frequência absoluta e relativa) e teste do Qui-quadrado e Exato de Fisher para verificar associação entre as variáveis dependentes e independentes, considerando o índice de confiança (IC) de 95%. As variáveis contínuas foram analisadas por meio de medidas de tendência central (mínimo, máximo, média, mediana e desvio padrão). Para avaliar a existência de diferença nas médias com relação ao desfecho do tratamento medicamentoso para as variáveis contínuas, utilizou-se o teste não paramétrico de Mann-Whitney. Aplicou-se o método de Kaplan Meier para comparar o tempo de tratamento e demais variáveis independentes de interesse. Por fim, para analisar o tempo de internação até a ocorrência de óbito, utilizou-se o modelo de regressão de Cox com os respectivos riscos bruto e ajustado. As análises foram realizadas no programa R versão 4.1.2. e, em todas, considerado o nível de significância de 5% e intervalo de confiança de 95% (IC95%). Resultados: A amostra foi composta por 896 indivíduos; a maioria com idade média de 53,4 anos, do sexo feminino, etnia parda, casada, com ensino médio completo, não tabagista. O tempo médio de internação foi de 9,77 dias e 7,13 dias de tratamento medicamentoso para COVID-19. Cerca de 42,1% apresentaram mais de duas comorbidades e as mais prevalentes foram diabetes mellitus tipo 2 (45%), hipertensão arterial (44,9%) e doença pulmonar obstrutiva crônica (14,6%). Durante a internação, 16,4% dos indivíduos precisaram de ventilação mecânica e 51,3% utilizaram cloroquina ou hidroxicloroquina durante a internação. Evoluíram para óbito 99 indivíduos. Ainda, houve a utilização de mais de três medicamentos por 873 pessoas. Na análise bivariada, estiveram associados ao tratamento com cloroquina ou hidroxicloroquina a idade (p=0,0045), ventilação mecânica (p=0,0010), parada cardiorrespiratória (p=0,0010), hipoglicemia (p=0,0310), polifarmácia (p=0,0010) e número de comorbidades (p=0,0010). A taxa de ocorrência de óbitos em pessoas divorciadas (OR: 2,4904; p=0,398; IC 95% 0,9125-0,4438) e viúvas (OR: 1,9823; p=0,0277; IC 95% 0,6842-0,3108) foi maior do que em pessoas casadas. A taxa de ocorrência de óbito entre pessoas com escore qSOFA positivo foi 2,70 (OR: 2,7018; p=0,0009; IC 95% 0,9939-0,2981) vezes maior do que as com escore qSOFA negativo. Na análise de associação entre ventilação mecânica e demais variáveis independentes, entre os indivíduos que não faziam o uso da ventilação mecânica, os viúvos e os que apresentavam qSOFA positivo apresentaram mais chance de óbito. O índice de massa corporal (IMC) elevado apresentou-se como fator protetor, tido que a chance de óbito reduziu em 10,97% para cada aumento de 1 unidade no IMC entre os indivíduos em ventilação mecânica. Por fim, no modelo completo do ajuste de efeitos principais com base nos estratos de ventilação mecânica, para analisar a homogeneidade dos grupos, os resultados encontrados acerca do risco em divorciados, viúvos e qSOFA positivo permaneceram conforme análises anteriores. Conclusão: dos 11% dos pacientes com COVID-19 que evoluíram para o óbito, 6,8% fizeram uso de cloroquina ou hidroxicloroquina. As taxas de sobrevivência apresentaram-se menores em pacientes indígenas, do sexo masculino, viúvos e que fizeram uso de ventilação mecânica. Ainda, o baixo IMC foi considerado fator de risco para a mortalidade em pacientes com COVID-19 em ventilação mecânica, já o estado civil destacou-se como fator protetor em pessoas casadas

Objectives: To compare clinical outcomes and survival of adult patients with COVID19 exposed and not exposed to drug treatment with chloroquine and hydroxychloroquine. Method: This is a retrospective cohort study with data collected in a hospital in Vitória. All patients in wards and Intensive Care Units (ICU) aged 18 years or over, with a confirmed diagnosis of COVID-19, that is, with a positive PCR for the infection, treated at the hospital between February 26th and December 31, 2020, and with a record of hospital discharge due to death or non-death. Descriptive statistics (absolute and relative frequency) and the Chi-square test and Fisher's exact test were applied to verify the association between the outcome and independent variables, considering the confidence index (CI) of 95%. Continuous variables were analyzed using measures of central tendency (minimum, maximum, mean, median and standard deviation). To assess the existence of a difference in means in relation to the outcome of drug treatment for continuous variables, the non-parametric Mann-Whitney test was used. The Kaplan Meier method was applied to compare treatment time and other independent variables of interest. Finally, to analyze the length of hospital stay until death, the Cox regression model was used with the respective crude and adjusted risks. The analyzes were carried out using the R program version 4.1.2. and, in all cases, a significance level of 5% and a confidence interval of 95% (95% CI) were considered. Results: The sample consisted of 896 individuals; the majority with an average age of 53.4 years, female, mixed race, married, with completed high school, non-smokers. The average length of stay was 9.77 days and 7.13 days of drug treatment for COVID-19. Around 42.1% had more than two comorbidities and the most prevalent were type 2 diabetes mellitus (45%), hypertension (44.9%) and chronic obstructive pulmonary disease (14.6%). During hospitalization, 16.4% of individuals required mechanical ventilation and 51.3% used chloroquine or hydroxychloroquine during hospitalization. 99 individuals died. Furthermore, more than three medications were used by 873 people. In the bivariate analysis, age (p=0.0045), mechanical ventilation (p=0.0010), cardiorespiratory arrest (p=0.0010), hypoglycemia (p=0.0310) were associated with treatment with chloroquine or hydroxychloroquine, polypharmacy (p=0.0010) and number of comorbidities (p=0.0010). The rate of death in divorced people (OR: 2.4904; p=0.398; 95% CI 0.9125-0.4438) and widows (OR: 1.9823; p=0.0277; 95% CI 0 .6842-0.3108) was higher than in married people. The rate of death among people with a positive qSOFA score was 2.70 (OR: 2.7018; p=0.0009; 95% CI 0.9939-0.2981) times higher than those with a negative qSOFA score. In the analysis of the association between mechanical ventilation and other independent variables, among individuals who did not use mechanical ventilation, widowers and those with a positive qSOFA were more likely to die. High BMI was a protective factor, as the chance of death reduced by 10.97% for each increase of 1 unit in BMI among individuals on mechanical ventilation. Finally, in the complete main effects adjustment model based on the mechanical ventilation strata, to analyze the homogeneity of the groups, the results found regarding the risk in divorced, widowed and positive qSOFA remained in line with previous analyses. Conclusion: The results demonstrate that the use of chloroquine and hydroxychloroquine by patients with COVID-19 may be related to the occurrence of deaths and did not reduce the chance of mechanical ventilation. Survival rates were lower in indigenous, male, widowed patients who used mechanical ventilation and drug treatment with chloroquine or hydroxychloroquine. Furthermore, the results indicate that chloroquine/hydroxychloroquine are not beneficial in the treatment of COVID-19, however, further studies are necessary

Development of a Mobile Health Application Based on a Mixed Prenatal Care in the Context of COVID-19 Pandemic

Abstract Objective We describe the development and structure of a novel mobile application in a mixed model of prenatal care, in the context of the COVID-19 pandemic. Furthermore, we assess the acceptability of this mobile app in a cohort of patients. Methods First, we introduced a mixed model of prenatal care; second, we developed a comprehensive, computer-based clinical record to support our system. Lastly, we built a novel mobile app as a tool for prenatal care. We used Flutter Software version 2.2 to build the app for Android and iOS smartphones. A cross-sectional study was carried out to assess the acceptability of the app. Results A mobile app was also built with the main attribute of being connected in real-time with the computer-based clinical records. The app screens detail information about activities programmed and developed in the prenatal care according to gestational age. A downloadable maternity book is available and some screens show warning signs and symptoms of pregnancy. The acceptability assessment was mostly rated positively regarding the characteristics of the mobile app, by 50 patients. Conclusion This novel mobile app was developed as a tool among pregnant patients to increase the information available about their pregnancies in the provision of a mixed model of prenatal care in the context of the COVID-19 pandemic. It was fully customized to the needs of our users following the local protocols. The introduction of this novel mobile app was highly accepted by the patients.

Atenção psicossocial ao idoso em isolamento social/covid-19 / Cuidados psicosociales para los ancianos en aislamiento social/covid-19 / Psychosocial care for the elderly in social isolation/covid-19

RESUMO. A pandemia da Covid-19 levou ao isolamento social grande contingente populacional no Brasil e no mundo. Conforme as mais altas autoridades de saúde internacionais, entre elas a Organização Mundial da Saúde (OMS), os idosos fazem parte do denominado 'grupo de risco' para a doença. Portanto, foram exigidos mais rigor e cuidado entre as pessoas com idade mais avançada, incluindo o isolamento social. Apesar da indiscutível importância dessa medida, os idosos em situação de isolamento social ficaram mais vulneráveis a uma série de agravos, principalmente os de ordem psíquica. O objetivo do presente trabalho é apresentar propostas de atenção psicossocial ao idoso em situação de sofrimento ou vulnerabilidade decorrente do isolamento social. As propostas buscam estimular a memória, a cognição e a psicomotricidade por meio de narrativas, recursos artísticos, Tecnologias da Informação e Comunicação e objetos autobiográficos como, por exemplo, realizar videochamadas, ler, ouvir músicas, contar e relembrar histórias. Em geral, as atividades propostas podem ser coordenadas por profissionais e familiares e adaptadas conforme as características de cada idoso.

RESUMEN. La pandemia de COVID-19 llevó a un gran número de personas en Brasil y en todo el mundo al aislamiento social. Según las principales autoridades sanitarias internacionales, entre ellas la Organización Mundial de la Salud (OMS), las personas mayores forman parte del denominado 'grupo de riesgo' de la enfermedad. De esta forma, se requería más rigor y cuidado entre las personas mayores, incluyendo el aislamiento social. Como es sabido, a pesar de la indiscutible importancia de esta acción, las personas mayores aisladas socialmente fueron más expuestas a una serie de enfermedades, principalmente relacionadas con problemas psíquicos. El objetivo de este trabajo es presentar las propuestas de atención psicosocial para los ancianos en situación de sufrimiento o discapacidad debido al aislamiento social. Las propuestas buscan estimular la memoria, la cognición y la psicomotricidad a través de narraciones, recursos artísticos, tecnologías de la información y comunicación y objetos autobiográficos, como videoconferencias, lectura, escucha de música, narración y recordación de historias. En general, las actividades propuestas pueden ser coordinadas por profesionales y miembros de la familia y adaptadas según las características de cada persona mayor.

ABSTRACT. The COVID-19 pandemic drove a large population contingent in Brazil and worldwide into social isolation. As reported by the highest international health authorities, including the World Health Organization (WHO), the elderly people are part of the so-called 'risk group' for the disease. Thus, more rigor and care were required among elderly people, including social isolation. It is well known that, despite the undeniable importance of this action, elderly people in social isolation were more exposed to a series of illnesses, mainly related to psychic problems. The goal of this paper is to propose psychosocial care for the elderly in a situation of distress, or vulnerability due to social isolation. The ideas seek to induce memory, cognition and psychomotricity through narratives, artistic resources, Information, Communication Technologies and autobiographical objects, such as video calls, reading, listening to music, storytelling and recalling. In general, the proposed activities can be coordinated by professionals and family members and adapted according to the characteristics of each elderly person.

Promoting telemedicine in Latin America in light of COVID-19 / Fomentar la telemedicina en América Latina en vista de la COVID-19 / Promoção da telemedicina na América Latina frente à COVID-19

ABSTRACT The Faculty of Health Sciences at the Universitat Oberta de Catalunya (Barcelona, Spain) was officially designated a 'World Health Organization (WHO) Collaborating Centre in eHealth' on 5 April 2018. The Centre aims to provide support to countries willing to develop new telemedicine services; to promote the use of eHealth; and to study the adoption and use of mobile health in countries of both the Region of the Americas and Europe. On 11 March 2020, WHO declared COVID-19 a global pandemic given the significant increase in the number of cases worldwide. Since then, the Centre has played an important role in addressing COVID-19 by undertaking fruitful cooperative activities. Lockdowns and social distancing in response to the high contagion rate of COVID-19 were the main triggers for a challenging digital transformation in many sectors, especially in healthcare. In this extreme crisis scenario, the rapid adoption of digital health solutions and technological tools was key to responding to the enormous pressure on healthcare systems. Telemedicine has become a necessary component of clinical practice for the purpose of providing safer patient care, and it has been used to support the healthcare needs of COVID-19 patients and routine primary care patients alike. This article describes the Centre's contribution to the work of the Pan American Health Organization (PAHO) and WHO in supporting Latin American and European countries to develop new telemedicine services and guidance on how to address COVID-19 through digital health solutions. Future actions are also highlighted.

RESUMEN La Facultad de Ciencias de la Salud de la Universitat Oberta de Catalunya (Barcelona, España) fue oficialmente designada centro colaborador de la Organización Mundial de la Salud (OMS) en el ámbito de la salud digital (también denominada "cibersalud" o "eSalud") el 5 de abril del 2018. El centro está destinado a prestar apoyo a los países que deseen crear nuevos servicios de telemedicina, promover el uso de la salud digital, y estudiar la adopción y el uso de la salud móvil en países de la Región de las Américas y Europa. El 11 de marzo del 2020 la OMS declaró la COVID-19 una pandemia mundial dado el aumento significativo del número de casos en todo el mundo. Desde entonces, el centro ha desempeñado un papel importante en la respuesta a la COVID-19 mediante la realización de fructíferas actividades de cooperación. Los confinamientos y el distanciamiento social en respuesta a la alta tasa de contagio de la COVID-19 fueron los principales desencadenantes de una compleja transformación digital en muchos sectores, especialmente en la atención de salud. En esta situación de crisis extrema, la rápida adopción de soluciones digitales y herramientas tecnológicas fue clave para dar respuesta a la enorme presión sobre los sistemas de salud. La telemedicina se ha convertido en un componente necesario de la práctica clínica con el fin de proporcionar una atención más segura a los pacientes, y se ha empleado para apoyar las necesidades de atención de salud de los pacientes con COVID-19 así como los pacientes habituales de los servicios de atención primaria. En este artículo se describe la contribución del centro a la labor de la Organización Panamericana de la Salud (OPS) y la OMS al prestar apoyo a los países de América Latina y Europa en la creación de nuevos servicios de telemedicina y brindar orientación sobre cómo abordar la COVID-19 con soluciones digitales de salud. También se destacan las acciones futuras.

RESUMO A Faculdade de Ciências da Saúde da Universitat Oberta de Catalunya (Barcelona, Espanha) foi oficialmente designada, em 5 de abril de 2018, "Centro Colaborador da Organização Mundial da Saúde (OMS) em eSaúde". O centro tem como objetivo prestar apoio aos países dispostos a desenvolver novos serviços de telemedicina; promover o uso da eSaúde, ou saúde digital; e estudar a adoção e o uso da saúde móvel em países da Região das Américas e da Europa. Em 11 de março de 2020, a OMS declarou a COVID-19 como pandemia global, dado o aumento significativo do número de casos no mundo inteiro. Desde então, o centro tem desempenhado um papel importante no enfrentamento da COVID-19, empreendendo atividades frutíferas de cooperação. Os lockdowns e o distanciamento social em resposta à alta taxa de contágio da COVID-19 foram os principais desencadeadores de uma transformação digital desafiadora em muitos setores, especialmente na área da saúde. Neste cenário de crise extrema, a rápida adoção de soluções digitais de saúde e ferramentas tecnológicas foi fundamental para responder à enorme pressão sobre os sistemas de saúde. A telemedicina se tornou um componente necessário da prática clínica, com o objetivo de oferecer um atendimento mais seguro aos pacientes, e tem sido usada para apoiar as necessidades de saúde tanto dos pacientes com COVID-19 como dos pacientes da atenção primária de rotina. Este artigo descreve a contribuição do centro para o trabalho da Organização Pan-Americana da Saúde (OPAS) e da OMS no apoio aos países latino-americanos e europeus para desenvolver novos serviços de telemedicina e orientação sobre como enfrentar a COVID-19 por meio de soluções de saúde digitais. Ações futuras também são destacadas.

Síntesis de evidencia para intervenciones en COVID-19: informes de actualización de la Comisión Nacional de Evaluación de Tecnologías de Salud de Argentina / Evidence synthesis for COVID-19 interventions: update reports from Argentina's National Commission for Health Technology Assessment / Síntese de evidências para intervenções em COVID-19: relatórios de atualização da Comissão Nacional de Avaliação de Tecnologias em Saúde da Argentina

RESUMEN Este informe tiene por objetivo exponer el trabajo realizado sobre el diseño, la publicación y el impacto de las actualizaciones para intervenciones en COVID-19 basadas en la evidencia, para brindar síntesis de evidencia actualizadas a partir de revisiones sistemáticas vivas sobre intervenciones terapéuticas para dar soporte en la toma de decisiones. Para ello, se generó un grupo específico de trabajo en el ámbito de la Comisión Nacional de Evaluación de Tecnologías de Salud (CONETEC) en el Ministerio de Salud de Argentina en colaboración con la Organización Panamericana de la Salud (OPS). Se diseñó una metodología para elaborar y publicar documentos de evaluación orientados a dar apoyo en la toma de decisiones. Estos informes de actualización se respaldaron en la exploración de tres dominios: los efectos en la salud, la factibilidad de la implementación y las recomendaciones basadas en evidencia. Las conclusiones se adaptaron en un esquema semaforizado según el balance entre los beneficios y los aspectos negativos para los distintos escenarios clínicos, a fin de mejorar su interpretación y aplicación. Durante el año 2021 se publicaron 16 informes de síntesis de evidencia (13 originales y 3 actualizaciones completas) que recibieron un destacado número consultas desde la página web de CONETEC y la Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas (BRISA). Así se hizo visible la necesidad de disponer de resúmenes de evidencia robustos, actualizados y confiables con adaptación al contexto de aplicación en el sistema sanitario del país. El desafío se presenta, además, en la actualización constante de la información, la diseminación apropiada y el sostenimiento en la rigurosidad en el desarrollo de los informes.

ABSTRACT This report presents the work done on the design, publication, and impact of updates on evidence-based COVID-19 interventions, in order to support decision-making with updated evidence syntheses based on living systematic reviews of therapeutic interventions. To this end, a specific working group was created within the National Commission for Health Technology Assessment (CONETEC) of the Ministry of Health of Argentina, in collaboration with the Pan American Health Organization (PAHO). A methodology was designed to develop and publish assessment documents aimed at supporting decision-making. These update reports were based on the exploration of three areas: health effects, feasibility of implementation, and evidence-based recommendations. A color-coded system was used to present the conclusions according to the balance between their positive and negative effects in different clinical scenarios, in order to improve their interpretation and implementation. In 2021, 16 evidence synthesis reports were published (13 original reports and three full updates). These were downloaded many times from the CONETEC website and the Regional Database of Health Technology Assessment Reports of the Americas (BRISA), highlighting the need for robust, up-to-date, reliable evidence summaries adapted for implementation in the country's health system. Other challenges include constant updating of information, appropriate dissemination, and sustained rigorous preparation of the reports.

RESUMO Este relatório tem como objetivo apresentar o trabalho realizado sobre o delineamento, publicação e impacto das atualizações para intervenções em COVID-19 baseadas em evidências, que visam fornecer sínteses de evidências atualizadas provenientes de revisões sistemáticas vivas sobre intervenções terapêuticas para apoiar a tomada de decisões. Para isso, foi criado um grupo de trabalho específico no âmbito da Comissão Nacional de Avaliação de Tecnologias de Saúde (CONETEC, na sigla em espanhol), do Ministério da Saúde da Argentina, em parceria com a Organização Pan-Americana da Saúde (OPAS). Foi desenhada uma metodologia para a elaboração e publicação de documentos de avaliação destinados a apoiar a tomada de decisões. Esses relatórios de atualização se basearam na exploração de três domínios: efeitos na saúde, viabilidade da implementação e recomendações baseadas em evidências. As conclusões foram adaptadas a uma escala semafórica de acordo com o equilíbrio entre os benefícios e os aspectos negativos para os diferentes cenários clínicos, de forma a melhorar a sua interpretação e aplicação. Durante o ano de 2021, foram publicados 16 relatórios de síntese de evidências (13 originais e 3 atualizações completas), que receberam um número significativo de consultas no site da CONETEC e da Base Regional de Informes de Avaliação de Tecnologias em Saúde das Américas (BRISA). Assim, tornou-se visível a necessidade de contar com resumos de evidências robustos, atualizados e confiáveis adaptados ao contexto de aplicação no sistema de saúde do país. A atualização constante das informações, sua divulgação adequada e a manutenção do rigor na elaboração dos relatórios também apresentam desafios.

Characteristics and impact factors of SARS-CoV-2 infection in adult patients with relapsed/refractory B-cell non-Hodgkin lymphoma receiving chimeric antigen receptor T-cell therapy / 中华血液学杂志

Objective: To explore the clinical characteristics and treatment of COVID-19 infection in patients with relapsed/refractory B-cell non-Hodgkin lymphoma before and after receiving chimeric antigen receptor T-cell therapy, and study the influencing factors of severe COVID-19 infection in these patients. Methods: The data of 59 patients with relapsed/refractory B-cell non-Hodgkin lymphoma who received chimeric antigen receptor T-cell therapy at the Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology and Department of Hematology, the Second Affiliated Hospital, College of Medicine, Zhejiang University between December 2017 and February 2023, and who were infected with novel coronavirus between December 2022 and February 2023 were retrospectively studied. Patients were divided into light, medium, severe, and critical groups, and the differences between the groups were analyzed using the chi-square test. A univariate logistic regression model was used to evaluate the contribution of each variable and its relationship with severe infection. The chi-square and Fisher's exact tests were used to analyze the differences between the B-cell aplasia and B-cell recovery (BCR) groups. Results: Of the 59 pre- and post-infusion infections, 39 (66.1%) led to mild COVID-19, 9 (15.3%) resulted in moderate COVID-19, 10 (16.9%) resulted in severe COVID-19, and 1 (1.7%) led to critical COVID-19. Moroever, age greater than 55 years, having received autologous hematopoietic stem cell transplantation, progressive disease status, and B-cell aplasia at the time of diagnosis of COVID-19 infection are factors affecting severe infection. Patients with B-cell aplasia had a more severe infection with COVID-19 (P<0.001), a longer duration (P=0.015), a longer antiviral therapy course (P<0.001), and a higher hospitalization rate (P<0.001) than the BCR group. Conclusion: Active prevention and treatment of COVID-19 infection remains a crucial issue requiring urgent attention in managing patients with relapsed/refractory B-cell non-Hodgkin lymphoma treated with chimeric antigen receptor T-cell therapy.

Passive antibody therapy in emerging infectious diseases / 医学前沿

The epidemic of corona virus disease 2019 (COVID-19) caused by severe acute respiratory syndrome Coronavirus 2 and its variants of concern (VOCs) has been ongoing for over 3 years. Antibody therapies encompassing convalescent plasma, hyperimmunoglobulin, and neutralizing monoclonal antibodies (mAbs) applied in passive immunotherapy have yielded positive outcomes and played a crucial role in the early COVID-19 treatment. In this review, the development path, action mechanism, clinical research results, challenges, and safety profile associated with the use of COVID-19 convalescent plasma, hyperimmunoglobulin, and mAbs were summarized. In addition, the prospects of applying antibody therapy against VOCs was assessed, offering insights into the coping strategies for facing new infectious disease outbreaks.

Anti-inflammatory mechanism of electroacupuncture involves the modulation of multiple systems, levels and targets and is not limited to "driving the vagus-adrenal axis" / 中西医结合学报

In October 2021, an international collaborative study on the use of electroacupuncture (EA) to treat inflammation was published in the journal Nature by Dr. Qiufu Ma's team. Based on the results of EA on inflammation in the mouse model of lipopolysaccharide inflammatory storm, the study showed that the distal effect of acupuncture can be achieved by "driving the vagus-adrenal axis (through the adrenal medulla, by releasing catecholamines)." PROKR2Cre-marked sensory neurons, which innervate the deep hindlimb fascia but not the abdominal fascia, are crucial for driving this axis. The study suggests the existence of specificity distribution of acupoints, that different EA stimulation intensities or different needle penetration depths have different therapeutic effects, that photosensitive stimulation may be a substitute for needle acupuncture, and that massage, stretching and body movements may also activate PROKR2Cre-markable dorsal root ganglion sensory neurons and elicit anti-inflammatory effects. However, results of some other studies are contrary to the conclusions of Ma's team. For examples: low-intensity EA at GB30 point significantly reduced the inflammation in the rat model of persistent inflammation, which is more relevant to the real daily acupuncture practice, and this effect was partly related to the adrenal cortex and associated with the stimulation of corticosterone and adrenocorticotropic hormone; manual acupuncture (similar to the low-intensity EA) at KI3, Zhichuan point (an extra point), etc. was effective in a severe COVID-19 patient with sepsis; stimulating ST25 with low-intensity EA or manual acupuncture was effective against gastrointestinal inflammations; the above mentioned points are not in an area enriched with PROKR2Cre-marked sensory nerve endings. Evidence shows that the mechanism of EA against inflammation includes modulating multi-systems, multi-levels and multi-targets, which does not limit to "driving the vagus-adrenal axis." Please cite this article as: Fan AY. Anti-inflammatory mechanism of electroacupuncture involves the modulation of multiple systems, levels and targets and is not limited to "driving the vagus-adrenal axis." J Integr Med. 2023; 21(4):320-323.

Expert consensus on diagnosis and treatment of COVID-19 infection related cough in children / 中华预防医学杂志

An epidemic outbreak of the corona virus disease 2019(COVID-19) Omicron variant occurred in most regions of China. Children are susceptible to COVID-19 and the vast majority of them suffer from upper respiratory tract infection. Cough is one of the most common symptoms. COVID-19 infection related cough includes acute cough, persistent cough and chronic cough, and children with original chronic cough or chronic lung disease can also induce or aggravate symptom of cough after infection, which has a great impact on children's physical and mental health. The treatment for COVID-19 infection related cough vary with the etiology. Improper treatment would delay the patient's condition and increase adverse drug reaction. Currently, there is no guideline or consensus on the diagnosis and treatment of COVID-19 infection related cough in children in China, therefore this consensus is drafted. Referring to the latest international research and the diagnostic and therapeutic strategy for COVID-19 infection (Tenth Edition For Trial Implementation), and combining with clinical diagnosis and treatment experience,the consensus elaborates the pathogenesis and etiology of COVID-19 infection related cough, the use of cough relievers and expectorants, as well as the key points of diagnosis and treatment of different etiological factors. It is expected to provide specific and feasible guidance scheme for pediatricians, general practitioners and clinical pharmacists.

Clinical characteristics of neonates infected with the Omicron variant of SARS-CoV-2: a multicenter cross-sectional survey / 中国当代儿科杂志

OBJECTIVES@#To investigate the clinical characteristics of neonates infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).@*METHODS@#A cross-sectional survey was conducted on 542 hospitalized neonates with confirmed coronavirus disease 2019 (COVID-19) in 27 hospitals in Shenzhen from December 7, 2022, to January 12, 2023 (during the Omicron variant epidemic period). The neonates were divided into two groups: asymptomatic infection and symptomatic infection. The clinical characteristics, results of laboratory examination, chest X-ray findings, and outcome were compared between the two groups.@*RESULTS@#Among the 542 neonates, there were 285 males and 257 females. Among them, 515 (95.0%) were full-term infants, and 27 (5.0%) were preterm infants. The asymptomatic infection group had 60 cases, and the symptomatic infection group had 482 cases. Among them, 336 cases (69.7%) were mild, 125 cases (25.9%) were moderate, 15 cases (3.1%) were severe, and 6 cases (1.2%) were critical. Fever was the most common symptom (434 cases, 90.0%), followed by cough and/or spitting (183 cases, 38.0%), nasal congestion and/or runny nose (131 cases, 27.2%), shortness of breath (36 cases, 7.5%), and feeding intolerance (30 cases, 6.2%). Among the 325 cases who underwent chest X-ray examination, 136 cases (41.8%) had patchy or consolidative shadows in the lungs, 2 cases (0.6%) had pneumothorax, 2 cases (0.6%) had decreased lung transparency, and 185 cases (57.0%) showed no abnormality. Among the 396 cases (73.1%) who received treatment, 341 cases (86.1%) received symptomatic treatment, 137 cases (34.6%) received antibiotic treatment, 4 cases (1.0%) received immunoglobulin treatment, and 23 cases (5.8%) received respiratory support treatment. All 542 neonates were discharged from the hospital after their clinical symptoms were relieved, and the median hospital stay was 5 days. The white blood cell count, neutrophil count, hemoglobin, and procalcitonin were lower in the symptomatic infection group than those in the asymptomatic infection group (P<0.05), while the platelet count and blood glucose levels were higher in the symptomatic infection group than those in the asymptomatic infection group (P<0.05). The proportions of neonates with decreased neutrophil count, increased platelet count, and decreased hemoglobin concentration were higher in the symptomatic infection group than those in the asymptomatic group (P<0.05).@*CONCLUSIONS@#Most neonates with COVID-19 caused by the Omicron variant of SARS-CoV-2 are mild, with fever as the predominant symptom. Symptomatic neonates with COVID-19 are often accompanied by decreased neutrophil count, increased platelet count, and decreased hemoglobin level. Symptomatic treatment is the main treatment, and the prognosis is good.