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Medwave ; 20(11)dic. 2020.
Article in English | LILACS | ID: biblio-1146051


Objective This living, systematic review aims to provide a timely, rigorous, and continuously updated summary of the available evidence on the role of cell-based therapies in the treatment of patients with COVID-19. Data sources We conducted searches in PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), grey literature, and in a centralized repository in L·OVE (Living OVerview of Evidence). L·OVE is a platform that maps PICO questions to evidence from the Epistemonikos database. In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it covers and customized to group all COVID-19 evidence in one place. All the searches covered the period until 23 April 2020 (one day before submission). Eligibility criteria for selecting studies and methods We adapted an already published standard protocol for multiple parallel systematic reviews to the specificities of this question. We searched for randomized trials evaluating the effectiveness and safety of cell-based therapies versus placebo or no treatment in patients with COVID-19. Anticipating the lack of randomized trials directly addressing this question, we also searched for trials evaluating other coronavirus infections, such as MERS-CoV and SARS-CoV, and nonrandomized studies in COVID-19. Two reviewers independently screened each study for eligibility. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit this review to a peer-reviewed journal every time the conclusions change or whenever there are substantial updates. Results We screened 1 043 records, but no study was considered eligible. We identified 61 ongoing studies, including 39 randomized trials evaluating different types of cell-based therapies in COVID-19. Conclusions We did not find any studies that met our inclusion criteria, and hence there is no evidence to support or refute the use of cell-based therapies for treating patients with COVID-19. A substantial number of ongoing studies should provide valuable evidence to inform researchers and decision-makers in the near future. PROSPERO Registration number CRD42020179711

Humans , Pneumonia, Viral/therapy , Coronavirus Infections/therapy , Cell- and Tissue-Based Therapy
Medwave ; 20(10)18 nov. 2020.
Article in English, Spanish | LILACS | ID: biblio-1145803


Introducción Desde el comienzo de la pandemia de COVID-19, se han desarrollado diversas investigaciones sobre el pronóstico de pacientes con SARS-CoV-2 asociado a factores como edad, condiciones biodemográficas, comorbilidades, factores sociales, parámetros clínicos, hematológicos, marcadores inflamatorios, de coagulación, bioquímicos y gasométricos, entre otros. Hasta ahora, existen escasos estudios que hayan abordado el tema en América Latina, por lo que es de interés conocer el comportamiento de la enfermedad en la región. Objetivo Evaluar el curso del COVID-19 en pacientes ingresados en un centro terciario en Chile y analizar factores predictores, medidos en el período cercano a la admisión, que se asocien al pronóstico vital y al uso de ventilación mecánica invasiva. Métodos Estudio de cohorte retrospectivo realizado en Clínica Indisa de Santiago, Chile. Participaron todos los pacientes de 15 años o más hospitalizados entre el 11 de marzo y el 25 de julio de 2020. Se analizó la letalidad hospitalaria, la complejidad de los casos y se aplicaron modelos de regresión logística para identificar predictores de las variables de resultado definidas. Resultados La muestra estuvo constituida por 785 sujetos. La edad media fue 59 años, 59% fueron hombres y 61,3% tenía comorbilidades. El 45% requirió cuidados intensivos y 24% ventilación mecánica invasiva. La letalidad hospitalaria global fue de 18,7%. En pacientes de unidad de cuidados intensivos fue 32,1% y en quienes recibieron ventilación mecánica invasiva 59,4%. Los factores de riesgo independientes de morir incluyeron la edad (Odds ratio 1,09; intervalo de confianza 95%: 1,07 a 1,12), diabetes (1,68; 1,06 a 2,67), enfermedad pulmonar crónica (2,80; 1,48 a 5,28) y mayores niveles de proteína C reactiva, creatinina y ferritina. No se demostró asociación con el sexo, pertenencia al seguro público de salud, antecedente de cardiopatía, obesidad, ni dímero D. Similares factores fueron predictores de ventilación mecánica invasiva. Conclusiones El pronóstico y factores predictores en esta cohorte de pacientes hospitalizados en Chile por COVID-19 fueron comparables en su mayoría a los reportados en estudios similares de países de mayores ingresos. El sexo masculino no fue un factor de mal pronóstico en este grupo de pacientes.

Introduction Since the beginning of the COVID-19 pandemic, extensive research has been done on the prognosis of patients with SARS-CoV-2 associated with age, biodemographic conditions, comorbidities, social factors, clinical parameters, inflammatory blood markers, coagulation, biochemical and blood gas parameters, among others. Few studies have addressed this problem in Latin America, so it is of interest to know how the disease plays out in this region. Objective The purpose of our study is to evaluate the course of COVID-19 in patients admitted to a tertiary center in Chile and to assess factors measured close to hospital admission that may be associated with death and the need for invasive mechanical ventilation. Methods We did a retrospective cohort study at Indisa Clinic in Santiago, Chile. We included all patients aged 15 years and older hospitalized between March 11 and July 25, 2020. Hospital mortality and severity of the cases were analyzed, and logistic regression models were applied to identify predictors of outcome variables. Results The sample included 785 subjects. The mean age was 59 years, 59% were men, and 61.3% had comorbidities. Forty five per cent required intensive care, and 24% invasive mechanical ventilation. The overall hospital fatality rate was 18.7%. In intensive care patients, the case fatality was 32.1%, and in those who received invasive mechanical ventilation, it was 59.4%. Independent risk factors for death included age (odds ratio 1.09; 95% confidence interval: 1.07 to 1.12), diabetes (1.68; 1.06 to 2.67), chronic lung disease (2.80; 1.48 to 5.28), increased C-reactive protein, creatinine, and ferritin. No association with sex, public health insurance, history of heart disease, oxygen saturation upon admission, or D-dimer was found. Similar factors were predictors of invasive mechanical ventilation. Discussion The prognosis and predictive factors in this cohort of patients hospitalized in Chile for COVID-19 were comparable to those reported in similar studies from higher-income countries. Male sex was not associated with a poor prognosis in this group of patients.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Pneumonia, Viral/physiopathology , Respiration, Artificial/statistics & numerical data , Coronavirus Infections/physiopathology , Critical Care/statistics & numerical data , Hospitalization , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Prognosis , Chile , Sex Factors , Retrospective Studies , Risk Factors , Cohort Studies , Hospital Mortality , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Tertiary Care Centers
Säo Paulo med. j ; 138(5): 385-392, Sept.-Oct. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1139712


ABSTRACT BACKGROUND: The COVID-19 pandemic has led to an immense need to develop training on case recognition and management, with a focus on patients' and health professionals' safety at several levels of healthcare settings in Brazil. Different simulation strategies can be included in the diverse clinical care phases for these patients. OBJECTIVE: To suggest a complete simulation-based training program for Brazilian hospitals and/or academic institutions at this moment of the pandemic. DESIGN AND SETTING: Descriptive analysis on possible simulated clinical cases using different methodologies, thereby supporting suspected or confirmed COVID-19 patients. METHODS: This was a reflective theoretical descriptive study on an educational program based on clinical simulation, with four practical phases at different performance and complexity levels. Wearing, handling and adequately disposing of personal protective equipment, along with specific respiratory procedures in different healthcare settings up to intensive care for seriously infected patients were addressed. RESULTS: This program was designed for application at different Brazilian healthcare levels through different clinical simulation strategies. Summaries of expected performance were suggested in order to standardize technical capacity within these simulation settings, so as to serve these levels. CONCLUSIONS: Developing training programs for situations such as the current COVID-19 pandemic promotes safety not only for patients but also for healthcare workers. In the present context, clear definition of which patients need hospital outpatient or inpatient care will avoid collapse of the Brazilian healthcare system. Institutions that do not have simulated environments can, through the examples described, adopt procedures to promote didactic information in order to help healthcare professionals during this time.

Humans , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Health Knowledge, Attitudes, Practice , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Education, Continuing , Brazil , Pandemics , Simulation Training , Betacoronavirus , SARS-CoV-2 , COVID-19
Rev. bras. ginecol. obstet ; 42(9): 562-568, Sept. 2020.
Article in English | LILACS | ID: biblio-1137873


Abstract Objective The present comprehensive review aims to show the full extent of what is known to date and provide a more thorough view on the effects of SARS-CoV2 in pregnancy. Methods Between March 29 and May, 2020, the words COVID-19, SARS-CoV2, COVID- 19 and pregnancy, SARS-CoV2 and pregnancy, and SARS and pregnancy were searched in the PubMed and Google Scholar databases; the guidelines from well-known societies and institutions (Royal College of Obstetricians and Gynaecologists [RCOG], American College of Obstetricians and Gynecologists [ACOG], International Society of Ultrasound in Obstetrics & Gynecology [ISUOG], Centers for Disease Control and Prevention [CDC], International Federation of Gynecology and Obstetrics [FIGO]) were also included. Conclusion The COVID-19 outbreak resulted in a pandemic with > 3.3 million cases and 230 thousand deaths until May 2nd. It is caused by the SARS-CoV2 virus and may lead to severe pulmonary infection and multi-organ failure. Past experiences show that unique characteristics in pregnancy make pregnant women more susceptible to complications from viral infections. Yet, this has not been reported with this new virus. There are risk factors that seem to increase morbidity in pregnancy, such as obesity (body mass index [BMI] > 35), asthma and cardiovascular disease. Current reports describe an increased rate of pretermbirth and C-section. Vertical transmission

Resumo Objetivo A presente revisão detalhada busca fornecer dados objetivos para avaliar o que se sabe até o momento e possibilitar uma visãomais ampla dos efeitos do SARSCoV2 na gravidez. Métodos Entre 29 demarço e 2 de maio de 2020, foi realizada uma busca nos bancos de dados PubMed e Google Scholar com as palavras COVID-19, SARS-CoV2, COVID-19 e gravidez, SARS-CoV2 e gravidez, e SARS e gravidez. As recomendações dos principais órgãos sobre o tema também foram acessadas. Conclusão O surto de COVID-19 resultou em uma pandemia com> 3.3 milhões de casos e 230 mil mortes até 2 de maio. É uma condição causada pelo vírus SARS-CoV2 e pode levar ao acometimento pulmonar difuso e à falência de múltiplos órgãos. Características únicas da gestante tornam essa população mais propensas a complicações de infecções virais. Até o momento, essa tendência não foi observada para esse novo vírus. Os fatores que parecem estar associados à maior morbidade materno-fetal são obesidade (índice demassa corporal [IMC] > 35), asma e doença cardiovascular. Há descrição de aumento de parto prematuro e parto cesáreo. Não se pode descartar a possibilidade de transmissão vertical da doença, devido a relatos de positividade de reação em cadeia de polimerase (RT-PCR) de swab nasal, RT-PCR de líquido amniótico e imunoglobulina M (IgM) de recém-nascidos. Tratamentos devem ser analisados caso a caso, dada a falta de qualidade de estudos que comprovem a sua eficácia e segurança na gravidez. O corpo clínico deve utilizar equipamentos de proteção individual (EPI) ao manusear pacientes suspeitos ou confirmados e ficar atento aos sinais de descompensação respiratória.

Humans , Female , Pregnancy , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Pneumonia, Viral/transmission , Pneumonia, Viral/epidemiology , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/therapy , Pregnancy Complications, Infectious/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Coronavirus Infections/epidemiology , Pandemics , Betacoronavirus/isolation & purification , Cesarean Section/statistics & numerical data , Global Health , Risk Factors , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Perinatal Care/methods , Infectious Disease Transmission, Vertical/prevention & control , Premature Birth/epidemiology , Premature Birth/virology , SARS-CoV-2 , COVID-19
Rev. bras. ter. intensiva ; 32(3): 348-353, jul.-set. 2020. tab, graf
Article in English, Spanish | LILACS | ID: biblio-1138515


RESUMEN Objetivo: El coronavirus ha emergido este año como causa de neumonía viral. Una de las principales características es su rápida transmisión y su potencial severidad. El objetivo de este estudio de serie de casos es describir las características clínicas de los pacientes con confirmación de enfermedad por coronavirus (COVID-19) admitidos en diferentes unidades de cuidados intensivos de la Argentina con requerimiento de ventilación mecánica. Métodos: Estudio de serie de casos, descriptivo-prospectivo, multicéntrico realizado entre el 01 de abril y el 08 de mayo de 2020. Se incluyeron los datos de los pacientes mayores a 18 años, que ingresaron a la unidad de cuidados intensivos con requerimiento de ventilación mecánica por falla respiratoria aguda con diagnóstico positivo de COVID-19 Resultados: Se registraron las variables de 47 pacientes de 31 unidades cuidados intensivos, 78.7% hombres de una mediana de edad de 61 años, con un SAPS II de 43, un índice de Charlson de 3. El modo ventilatorio inicial fue volume control - continuous mandatory ventilation con volumen corriente menor a 8mL/kg en el 100% de los casos, con una mediana de presión positiva al final de la espiración de 10,5cmH2O. A la fecha de cierre del estudio, 29 pacientes fallecieron, 8 alcanzaron el alta, y 10 pacientes continúan internados al cierre del estudio. El SAPS II fue mayor entre los fallecidos (p = 0.046). El índice de Charlson se asoció con mayor mortalidad (OR = 2,27 IC95% 1,13 - 4,55; p = 0,02). Conclusión: Los pacientes con COVID-19 y ventilación mecánica de esta serie presentan variables clínicas similares a las descriptas a la fecha en otros reportes internacionales. Nuestros hallazgos proporcionan datos que permitirían de alguna manera predecir los resultados.

Abstract Objective: A novel coronavirus emerged this year as a cause of viral pneumonia. The main characteristics of the virus are rapid transmission, high contagion capacity and potential severity. The objective of this case series study is to describe the clinical characteristics of patients with confirmed coronavirus disease (COVID-19) admitted to different intensive care units in Argentina for mechanical ventilation. Methods: A descriptive, prospective, multicenter case series study was conducted between April 1 and May 8, 2020. Data from patients older than 18 years who were admitted to the intensive care unit for mechanical ventilation for acute respiratory failure with a positive diagnosis of COVID-19 were included. Results: The variables for 47 patients from 31 intensive care units were recorded: 78.7% were men (median age of 61 years), with a SAPS II score of 43 and a Charlson index score of 3. The initial ventilatory mode was volume control - continuous mandatory ventilation with a tidal volume less than 8mL/kg in 100% of cases, with a median positive end-expiratory pressure of 10.5cmH2O. At the end of the study, 29 patients died, 8 were discharged, and 10 remained hospitalized. The SAPS II score was higher among patients who died (p = 0.046). Charlson comorbidity index was associated with higher mortality (OR = 2.27, 95% CI 1.13 - 4.55, p = 0.02). Conclusion: Patients with COVID-19 and on mechanical ventilation in this series presented clinical variables similar to those described to date in other international reports. Our findings provide data that may predict outcomes.

Humans , Male , Female , Adult , Middle Aged , Aged , Pneumonia, Viral/therapy , Respiration, Artificial , Respiratory Insufficiency/therapy , Coronavirus Infections/therapy , Intensive Care Units , Argentina , Pneumonia, Viral/physiopathology , Respiratory Insufficiency/virology , Tidal Volume , Positive-Pressure Respiration , Coronavirus Infections/physiopathology , Pandemics , Betacoronavirus , SARS-CoV-2 , COVID-19
Rev. bras. ter. intensiva ; 32(3): 444-457, jul.-set. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1138512


RESUMO A pandemia por COVID-19 tem deixado os gestores, os profissionais de saúde e a população preocupados com a potencial escassez de ventiladores pulmonares para suporte de pacientes graves. No Brasil, há diversas iniciativas com o intuito de produzir ventiladores alternativos para ajudar a suprir essa demanda. Para auxiliar as equipes que atuam nessas iniciativas, são expostos alguns conceitos básicos sobre fisiologia e mecânica respiratória, os termos comumente utilizados no contexto da ventilação mecânica, as fases do ciclo ventilatório, as diferenças entre disparo e ciclagem, os modos ventilatórios básicos e outros aspectos relevantes, como mecanismos de lesão pulmonar induzida pela ventilação mecânica, pacientes com drive respiratório, necessidade de umidificação de vias aéreas, risco de contaminação cruzada e disseminação de aerossóis. Após a fase de desenvolvimento de protótipo, são necessários testes pré-clínicos de bancada e em modelos animais, a fim de determinar a segurança e o desempenho dos equipamentos, seguindo requisitos técnicos mínimos exigidos. Então, é imprescindível passar pelo processo regulatório exigido pela Agência Nacional de Vigilância Sanitária (ANVISA). A empresa responsável pela fabricação do equipamento deve estar regularizada junto à ANVISA, que também deve ser notificada da condução dos testes clínicos em humanos, seguindo protocolo de pesquisa aprovado pelo Comitê de Ética em Pesquisa. O registro do ventilador junto à ANVISA deve ser acompanhado de um dossiê, composto por documentos e informações detalhadas neste artigo, que não tem o propósito de esgotar o assunto, mas de nortear os procedimentos necessários.

ABSTRACT The COVID-19 pandemic has brought concerns to managers, healthcare professionals, and the general population related to the potential mechanical ventilators' shortage for severely ill patients. In Brazil, there are several initiatives aimed at producing alternative ventilators to cover this gap. To assist the teams that work in these initiatives, we provide a discussion of some basic concepts on physiology and respiratory mechanics, commonly used mechanical ventilation terms, the differences between triggering and cycling, the basic ventilation modes and other relevant aspects, such as mechanisms of ventilator-induced lung injury, respiratory drive, airway heating and humidification, cross-contamination risks, and aerosol dissemination. After the prototype development phase, preclinical bench-tests and animal model trials are needed to determine the safety and performance of the ventilator, following the minimum technical requirements. Next, it is mandatory going through the regulatory procedures as required by the Brazilian Health Regulatory Agency (Agência Nacional de Vigilância Sanitária - ANVISA). The manufacturing company should be appropriately registered by ANVISA, which also must be notified about the conduction of clinical trials, following the research protocol approval by the Research Ethics Committee. The registration requisition of the ventilator with ANVISA should include a dossier containing the information described in this paper, which is not intended to cover all related matters but to provide guidance on the required procedures.

Humans , Animals , Pneumonia, Viral/therapy , Respiration, Artificial/instrumentation , Ventilators, Mechanical , Coronavirus Infections/therapy , Pneumonia, Viral/epidemiology , Brazil/epidemiology , Respiratory Mechanics , Coronavirus Infections/epidemiology , Equipment Design , Ventilator-Induced Lung Injury/prevention & control , Pandemics , COVID-19
Rev. chil. obstet. ginecol. (En línea) ; 85(supl.1): S9-S15, set. 2020. tab
Article in Spanish | LILACS | ID: biblio-1138643


INTRODUCCIÓN: La infección por el coronavirus SARS-CoV2 (COVID 19), causal de la pandemia actual, ha significado a nivel mundial la hospitalización simultánea de múltiples pacientes poniendo a prueba la infraestructura hospitalaria y la capacidad de reacción del personal de salud. Una de las estrategias para el manejo es la reconversión de camas y servicios clínicos. OBJETIVOS: presentar experiencia de un equipo ginecológico en el manejo integral de pacientes no gineco-obstétricas con COVID 19, durante el mes de junio de 2020 en un hospital público de la Región Metropolitana. MÉTODOS: Estudio de corte transversal observacional, descriptivo. Se consideró el total de pacientes adultos hombres y mujeres sin patología gineco-obstétrica con COVID 19 ingresados al puerperio del Hospital Santiago Oriente, obteniéndose datos clínicos y demográficos a través del registro interno de la unidad y del sistema de información de red asistencial. RESULTADOS: Ingresaron 82 pacientes, 32 mujeres y 50 hombres, promedio de edad 64. El promedio de días de hospitalización fue 5, con diagnóstico de ingreso principal neumonía viral por COVID-19. Las comorbilidades frecuentes fueron hipertensión arterial sistémica y diabetes mellitus. La complicación más frecuente fue el tromboembolismo pulmonar agudo. Hubo una alta cobertura de entrega de información vía telefónica a familiares. De los 82 ingresos, 54 pacientes egresaron a su domicilio. El resto a otras unidades dentro de la institución, centros de menor complejidad o residencias sanitarias. Una paciente sexo femenino de 75 años fallece a causa de descompensación de patologias de base secundario a neumonia por Staphylococus aereus. En ella, se descarta la infección por COVID 19 dado tres exámenes por reacción de polimerasa en cadena negativos realizado antes y durante su hospitalización. CONCLUSIONES: Esta experiencia constituyó un desafío para todo el equipo de salud gineco-obstétrico, considerando que nos enfrentamos a otro tipo de pacientes y a una patología nueva. Los resultados médicos son promisorios, la experiencia humana y sentido de trabajo en equipo fue extraordinario.

INTRODUCTION: The infection by the SARS-CoV2 coronavirus (COVID 19), the cause of the current pandemic we are experiencing, has meant the simultaneous hospitalization of many patients worldwide, putting the hospital infrastructure and the reaction capacity of health personnel to the test. One of the management strategies is the reconversion of clinical services. OBJECTIVES: present the experience of a gynecological team in the comprehensive management of non-gyneco-obstetric patients with COVID 19, during the month of June 2020 in a public hospital in the Metropolitan Region. METHODS: descriptive, observational cross-sectional study. The total number of patients admitted to the ex-puerperium of the Santiago Oriente Hospital was considered, obtaining clinical and demographic data through the unit's internal registry and the healthcare network information system. RESULTS: 82 patients were admitted, 32 women and 50 men, average age 64. The average number of days of hospitalization was 5, with the main admission diagnosis being viral pneumonia due to COVID-19. Frequent comorbidities were systemic arterial hypertension and diabetes mellitus. The most frequent complication was acute pulmonary thromboembolism. There was a high coverage of the delivery of information via telephone to relatives. Of the 82 admissions, 54 patients were discharged home and the rest to other units within the institution, less complex centers or health residences. One 75 years old female patient dies from concomitant pathologies, and she wasn't positive for COVID-19. CONCLUSIONS: This experience was a challenge for the entire gynecological-obstetric health team, considering that we are facing other types of patients and a new pathology. The medical results are promising, the human experience and sense of teamwork was extraordinary.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Pneumonia, Viral/therapy , Obstetrics and Gynecology Department, Hospital/organization & administration , Coronavirus Infections/therapy , Patient Discharge/statistics & numerical data , Pneumonia, Viral/complications , Bed Conversion , Obstetrics and Gynecology Department, Hospital/statistics & numerical data , Comorbidity , Epidemiology, Descriptive , Cross-Sectional Studies , Coronavirus Infections/complications , Pandemics , Betacoronavirus , Length of Stay
Rev. chil. obstet. ginecol. (En línea) ; 85(supl.1): S35-S49, set. 2020. graf
Article in Spanish | LILACS | ID: biblio-1138647


INTRODUCCIÓN: Ante el escenario de pacientes obstétricas diagnosticadas por la nueva enfermedad por coronavirus (COVID-19), se hace imprescindible la necesidad de realizar un seguimiento adecuado tanto desde el punto de vista de obstétrico como del cuadro viral, durante el período de aislamiento domiciliario. Con este objetivo, se desarrolló un programa de seguimiento remoto por la Unidad de Medicina Materno Fetal (MMF) de nuestro centro, desde el diagnóstico de la infección hasta el alta médica según los criterios vigentes del Ministerio de Salud (MINSAL). OBJETIVO: Evaluar la satisfacción del paciente en el seguimiento remoto de embarazadas y puérperas con diagnóstico de infección por SARS-CoV-2. Material y Métodos: Estudio descriptivo mediante la aplicación de una encuesta anónima y voluntaria de satisfacción usuaria, a través de una plataforma online. El instrumento fue una adaptación de la versión en español del "Telehealth Usability Questionnaire" (TUQ) previamente validado. RESULTADOS: Se obtuvo un 94,5% de respuestas a la encuesta. El 86% de las pacientes evaluó como "Muy Bueno" o "Bueno" el control virtual. El 91% no experimentó problemas técnicos. El 14% de las pacientes prefiere un control virtual, el 26% presencial y el 60% un control mixto. El 80% cumplió todas sus necesidades con el control virtual. CONCLUSIONES: En el contexto de pandemia e infección por SARS-CoV-2, el seguimiento remoto ha sido evaluado globalmente en forma positiva con niveles aceptables de satisfacción de las pacientes.

INTRODUCTION: Given the scenario of obstetric patients diagnosed with the new coronavirus disease (COVID-19), the need for proper follow-up both obstetric and of the infection, during the period of home isolation, is essential. A remote monitoring program was developed by the Maternal Fetal Medicine Unit (MFM) of our center from the diagnosis of the infection until medical discharge according to the current criteria of the Ministry of Health (MINSAL). OBJECTIVE: To assess patient satisfaction of remote monitoring of pregnant and postpartum patients diagnosed with SARS-CoV-2 infection. METHODS: This is a descriptive-survey research. We performed a patient satisfaction survey through an online platform to pregnant and postpartum patients with remote monitoring for SARS-CoV-2 infection in our center. The survey was anonymous and voluntary. The instrument for this purpose was the Spanish adapted version of "Telehealth Usability Questionnaire" (TUQ) that has been previously validated. RESULTS: The survey was answered by 94,5% of the patients. The results show that 86% of the patients rated the virtual control as "Very Good" or "Good"; 91% did not experienced technical problems. 14% of the patients prefer virtual control, 26% prefer face-to-face control and 60% both virtual and face-to-face control. 80% fulfilled all their needs with virtual control. CONCLUSIONS: In the context of pandemic and SARS-CoV-2 infection, remote monitoring has been positively evaluated with acceptable levels of patient's satisfaction.

Humans , Female , Pregnancy , Pneumonia, Viral/psychology , Pneumonia, Viral/therapy , Pregnancy Complications, Infectious/psychology , Pregnancy Complications, Infectious/therapy , Coronavirus Infections/psychology , Coronavirus Infections/therapy , Postpartum Period , Epidemiology, Descriptive , Surveys and Questionnaires , Follow-Up Studies , Patient Satisfaction , Telemedicine/methods , Pandemics , Betacoronavirus , Virtual Reality
Rev. chil. obstet. ginecol. (En línea) ; 85(supl.1): S90-S96, set. 2020. tab
Article in Spanish | LILACS | ID: biblio-1138652


RESUMEN Introducción: La cetoacidosis en el embarazo es una emergencia médica que requiere tratamiento en Unidad de Cuidados Intensivos debido a su asociación con morbimortalidad maternofetal. Las gestantes pueden presentar una forma atípica del cuadro llamada cetoacidosis normoglicémica, siendo muy infrecuente en pacientes sin antecedente de diabetes. Caso Clínico: Se presenta una gestante cursando tercer trimestre de embarazo, sin antecedente de diabetes, ingresada en Unidad de Paciente Crítico debido a neumonía por COVID-19 y acidosis metabólica con anión gap aumentado. Se realizó diagnóstico de cetoacidosis normoglicémica posterior al ingreso, iniciándose tratamiento intensivo de trastorno ácido-base con buena evolución. Conclusión: La infección por SARS-CoV-2 puede causar cetoacidosis normoglicémicas en embarazadas no diabéticas; se requiere una alta sospecha clínica para realizar el diagnóstico y tratamiento oportuno.

ABSTRACT Introduction: Ketoacidosis in pregnancy is a medical emergency that requires treatment in an intensive care unit due to its association with maternal-fetal morbimortality. Pregnant women may present an atypical form of the condition called normoglycemic ketoacidosis, being very rare in patients with no history of diabetes. Clinical Case: We present a pregnant woman in the third trimester of pregnancy, without history of diabetes, admitted to a critical patient unit due to COVID-19 pneumonia and metabolic acidosis with an increased anion gap. A diagnosis of normoglycemic ketoacidosis was made after admission, and intensive treatment of acid-base disorder was initiated, with good evolution. Conclusion: SARS-CoV-2 infection can cause normoglycemic ketoacidosis in non-diabetic pregnant women; is required a high clinical suspicion to make the diagnosis and appropriate treatment.

Humans , Female , Pregnancy , Adult , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Coronavirus Infections/complications , Coronavirus Infections/therapy , Ketosis/etiology , Ketosis/therapy , Pandemics , Betacoronavirus , Ketosis/diagnosis
Rev. chil. obstet. ginecol. (En línea) ; 85(supl.1): S97-S100, set. 2020.
Article in Spanish | LILACS | ID: biblio-1138653


INTRODUCCIÓN: En diciembre de 2019 se reporta un brote de neumonía atípica causada por un nuevo coronavirus: SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2), cuya enfermedad se denomina COVID-19 (Coronavirus Disease 2019). Desde entonces su distribución se ha ampliado mundialmente causando una emergencia en los sistemas de salud. MÉTODO: Corresponde al reporte de caso clínico. Este estudio es descriptivo y se basa en el manejo realizado a paciente embarazada con COVID-19 confirmado. Esta publicación cuenta con la autorización del comité de ética local para la revisión de ficha clínica. CASO: Mujer de 40 años con un embarazo de 31 semanas, se le diagnostica COVID-19 tras contacto estrecho con caso confirmado. Evoluciona con disnea y por posibilidad de interrupción del embarazo se traslada a centro de mayor complejidad. Allí se pesquisa compromiso de función pulmonar, uso de musculatura accesoria y alteración sensorial, requiriendo oxigenoterapia. Se evalúa interdisciplinariamente decidiendo intubar y realizando manejo en unidad de cuidados intensivos (UCI). Se realiza cesárea de urgencia a las 31+4 semanas debiendo realizarse histerectomía total por inercia uterina. Tras el procedimiento evoluciona tórpidamente con deterioro de función pulmonar, describiéndose un pronóstico catastrófico con probabilidad de fallecer por insuficiencia respiratoria. Un mes después despierta con una mejoría en su función pulmonar, sin otra falla orgánica. Actualmente se encuentra en buenas condiciones y es tratada multidisciplinariamente para lograr una rehabilitación integral. DISCUSIÓN: En epidemias pasadas, las embarazadas mostraron altas tasas de letalidad y riesgo de ingreso a UCI. Basados en una revisión de reportes de casos, parece ser que COVID-19 durante el embarazo se asocia a morbilidad materna severa, riesgo que aumenta en mujeres con comorbilidades, lo cual hace cuestionarnos si la infección por COVID-19 intensifica el riesgo materno o estos casos ya eran embarazos de riesgo. Se necesitan futuras investigaciones al respecto.

INTRODUCTION: The coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, was first reported in december 2019 in China as an atypipical pneumonia. Since then its distribution has globally expanded causing a public health emergency. METHOD: Corresponds to a case report. A descriptive study about the management of a pregnant woman whith COVID-19. CASE: A 40 year old pregnant woman, 31 weeks gestational age, was admitted with a diagnosis of COVID-19. She developed dyspnea and preterm birth risk that needed a more complex hospital level. Thereafter, the patient developed respiratory distress, use of accessory breathing muscles and neurological alteration, requiring oxygen therapy. An interdisciplinary medical team evaluation decided to manage her condition at intensive care unit (ICU). Cesarean delivery was performed at 31+4 weeks. After the procedure, the pulmonary function declined to a life threatening condition. A month later, the patient woke up with improved pulmonary function, without any organ failure. Currently the patient is in a good general condition with a multidisciplinary rehabilitation treatment ongoing. DISCUSSION: In previous epidemic outbrakes, pregnant women presented high fatality rates and intensive care tratment risk. Based on a case report review, COVID-19 in pregnancy is associated with severe maternal morbidity, specially in women with associated comorbidities. This situation raises the question whether the COVID-19 infection intensifies the maternal risk or whether these cases were already a high risk pregnancies. Additional studies are needed to answer this issue.

Humans , Female , Pregnancy , Adult , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Pregnancy Complications, Infectious/therapy , Coronavirus Infections/complications , Coronavirus Infections/therapy , Patient Care Team , Pregnancy Trimester, Third , Uterine Inertia , Cesarean Section , Critical Care , Emergencies , Pandemics , Betacoronavirus , Hysterectomy
Goiânia; s.n; 08 set. 2020. 1-5 p.
Non-conventional in Portuguese | ColecionaSUS, LILACS, ColecionaSUS, CONASS, SES-GO | ID: biblio-1247459


Com referencial teórico do ano de 2020, foram condensadas as evidências sobre o uso de plasma convalescente no tratamento da Covid-19, abordando um estudo de uma série de casos de cinco pacientes com diagnóstico de COVID-19 e síndrome do desconforto respiratório; um estudo piloto, 10 pacientes com diagnostico de COVID-19 confirmado por RT-PCR; um estudo (preprint) envolvendo 5.000 pacientes; um ensaio clínico aberto, multicêntrico incluindo 103 pacientes com quadro grave de COVID-19; uma atualização de Revisão da Cochrane, que incluiu 20 estudos, 5443 participantes (5211 receberam tratamento com plasma). Resumem as Diretrizes de Food and Drug Administration (FDA), dos Estados Unidos para utilização da terapia. No Brasil, pontua as recomendações da ANVISA, as considerações do Ministério da Saúde e os esclarecimentos do Ofício Circular nº 40/2020. Os estudos analisados pontuam resultados positivos quanto à eficácia e segurança e apontam necessidade de maiores evidências

With the theoretical framework of the year 2020, the evidence on the use of convalescent plasma in the treatment of Covid-19 was condensed, addressing a study of a case series of five patients diagnosed with COVID-19 and respiratory distress syndrome; a pilot study, 10 patients with a diagnosis of COVID-19 confirmed by RT-PCR; a study (preprint) involving 5,000 patients; an open, multicenter clinical trial including 103 patients with severe COVID-19; a Cochrane Review update, which included 20 studies, 5443 participants (5211 received plasma treatment). They summarize the US Food and Drug Administration (FDA) Guidelines for using the therapy. In Brazil, the recommendations of ANVISA, the considerations of the Ministry of Health and the clarifications of Circular Letter nº 40/2020 are punctuated. The analyzed studies show positive results regarding efficacy and safety and point to the need for more evidence

Humans , Plasma , Pneumonia, Viral/therapy , Coronavirus Infections/therapy , Antibodies, Neutralizing/therapeutic use , Complementary Therapies/adverse effects
Medicina (B.Aires) ; 80(5): 417-424, ago. 2020. graf
Article in Spanish | LILACS | ID: biblio-1287192


Resumen Se trata de un estudio multicéntrico de cohorte retrospectivo, observacional, desde 15/5 a 1/7, 2020, en 272 pacientes COVID-19 internados en hospitales de la provincia de Buenos Aires, incluidos en un programa de acceso expandido de plasma de convalecientes de COVID-19. Nuestros objetivos fueron analizar letalidad y sus factores de riesgo independientes, y evaluar la evolución favorable, definida como alta hospitalaria, permanencia en sala (PISO), o alta de la UTI. Los pacientes fueron estratificados en 4 subgrupos: ingreso a PISO (n = 100) con neumonía y/o requerimiento de oxígeno; a UTI (n = 87); a UTI con requerimiento de ventilación mecánica (UTI-VM; n = 56), y a UTI-VM con shock séptico (UTI-VM-SS; n = 29). La letalidad total a los 28 días fue 26.1%, (71/272), para PISO 14.0%; UTI, 18.4%; UTI-VM, 44.6%; y UTI-VM-SS, 55.2%. El tiempo medio de supervivencia (días): 25.6 ± 0.6 (PISO); 25.3 ± 0.7 (UTI); 20.8 ± 1.2 (UTI-VM) y 18.2 ± 1.8 (UTIVMSS). Los predictores independientes de letalidad fueron VM, shock séptico y peso. Se registró una evolución favorable en 81.4% de los pacientes en PISO; 70.9% en UTI, 39.6% en UTI-VM, y en 27.6% de UTI-VM-SS. La gravedad al ingreso, edad, peso y frecuencia cardíaca fueron predictores independientes de evolución. No se registraron efectos adversos graves. Por falta de un grupo control, no fue posible evaluar la eficacia del plasma de convaleciente. La letalidad (26%) fue mayor que en otros ensayos clínicos con plasma convaleciente; esto podría deberse a mayor proporción de aquellos con VM y shock séptico en nuestra cohorte.

Abstract This is a preliminary, multicenter, retrospective cohort study, including 272 consecutive patients with COVID-19 admitted to hospitals in Buenos Aires Province, between May 15th and July 1st, 2020, included in an expanded access program to convalescent plasma. Our objectives were to analyze mortality and its independent risk factors, and to assess the occurrence of a favorable evolution, defined as hospital discharge, or stay at the ward, or transfer from ICU to ward. Patients were stratified into 4 subgroups: admission to the ward with pneumonia and/or oxygen requirement (WARD; n = 100); ICU admission (ICU; n = 87); ICU admission with requirement of mechanical ventilation (ICU-MV; n = 56), and ICU-MV plus septic shock (ICU-MV-SS; N = 29). Mortality at 28 days was 26.1% for the entire group, 14.0% for WARD group, 18.4% for ICU, 44.6% for ICU-MV, and 55.2% for ICU-MV-SS. Mean survival time (days) was 25.6±0.6 (WARD); 25.3±0.7 (ICU); 20.8±1.2 (ICU-MV) and 18.2 ± 1.8 (ICU-MV-SS). Independent predictors of mortality were MV, septic shock and weight. A favorable evolution occurred in 81.4% of WARD patients; in 70.9% of ICU; in 39.6% of ICU-MV and in 27.6% of ICU-MV-SS patients. Severity of illness on admission, age, weight and heart rate were independently associated with evolution. No major adverse effects were recorded. The lack of a control group precluded the estimation of efficacy. However, our 26% mortality rate was higher than that of the treatment arm of clinical trials comparing plasma with usual treatment, which might be ascribed to higher proportion of patients with MV and septic shock in our cohort.

Humans , Male , Female , Adult , Middle Aged , Aged , Pneumonia, Viral/therapy , Coronavirus Infections/therapy , Pandemics , Argentina/epidemiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Retrospective Studies , Immunization, Passive/methods , Treatment Outcome , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Betacoronavirus , SARS-CoV-2 , COVID-19 , Intensive Care Units