Análisis del síndrome post-COVID-19 en personal de salud: comparación sobre condiciones de género y trabajo / Analysis of long COVID in health personnel: comparing gender and work factors

Resumen Introducción : El objetivo del estudio fue describir la prevalencia del reporte de síndrome post-COVID-19 y sus características según género, profesión y otros de terminantes sociales, en personal de salud. Métodos : Se realizó un estudio de corte transver sal en profesionales de salud con antecedentes de COVID-19 en América Latina, y para este análisis se seleccionaron las 2030 respuestas de Argentina. Se recolectaron datos sociodemográficos, información sobre el curso inicial de la enfermedad COVID-19, y persistencia de 21 síntomas más allá del primer mes, su gravedad, evolución clínica y requerimiento de ser vicios de salud. Resultados : Se identificó que la prevalencia re portada de síndrome post-COVID-19 fue mayor en mujeres para cada uno de los grupos de síntomas explorados. La gravedad del cuadro inicial, el género femenino, la profesión de enfermería, el multiempleo y trabajar en áreas de emergencia fueron variables independientes. Discusión : La mayor sobrecarga del personal de sa lud durante la pandemia -altamente feminizado- y las determinaciones de género asociadas podrían explicar parcialmente estos hallazgos.

Abstract Introduction : This study aimed to describe the re ported prevalence of post-COVID-19 syndrome and its characteristics by gender, profession, and other deter minants among health care workers. Methods : A cross-sectional study was conducted among health workers with a history of COVID-19 in Latin America, and the 2030 responses from Argentina were selected for this analysis. Sociodemographic infor mation, as well as data on initial course of COVID-19, and the persistence of 21 symptoms beyond the first month, their severity, clinical evolution, and health care demands were collected. Results : The reported prevalence of post-COVID-19 syndrome was higher in women for each of the symptom clusters studied. Severity of the initial symptoms, female gender, nursing profession, multi-employment, and work ing in emergency areas were all independent variables. Discussion : The greater strain of health care workers during the pandemic -highly feminized- and the as sociated gender conditions may partially explain these findings.

Histological and Ultrastructural Changes in Lungs One Year Post Asymptomatic or Mild SARS-CoV-2 Infection: Evaluating the Potential for Active Virus Presence / Cambios Histológicos y Ultraestructurales en los Pulmones un Año Después de una Infección Asintomática o Leve por SARS-CoV-2: Evaluación del Potencial de Presencia Activa del Virus

SUMMARY: Prior research on post-COVID-19 or long COVID primarily focused on the presence of SARS-CoV-2 mostly in symptomatic patients. This study aimed to investigate the persistence of SARS-CoV-2 after 1 year of asymptomatic or mild COVID-19. SARS-CoV-2 infected and control K18-hACE2 transgenic mice (n=25) were studied. Moderate and severe symptomatic subjects were sacrificed after eight days, while mild or asymptomatic mice were kept in BSL-III for twelve months. Analyses included general condition, histochemistry, immunohistochemistry, transmission electron microscopy, and qRT-PCR. Lungs from the twelve-month group showed thickening of alveolar walls, with some lungs exhibiting the recruitment of inflammatory cells, the presence of SARS- CoV-2 mRNA, immunopositivity for the SARS-CoV-2 spike protein, and TEM showed viruses (60-125 nm) within vesicles, indicating continued replication. Certain lung samples showed persistent SARS-CoV-2 presence in Club cells, endothelial cells, and macrophages. The eight-day group exhibited viral interstitial pneumonitis, SARS-CoV-2 immunopositivity, and mRNA. The eight-day hearts displayed viral mRNA, while the twelve-month hearts tested negative. Some asymptomatic twelve-month subjects presented reduced surfactant, basal membrane thickening, fibrosis, and mild autonomic nerve degeneration. In this study conducted on mice, findings indicate the potential for chronic persistence of SARS-CoV-2 in the lungs one year post initial mild or asymptomatic infection, which could suggest the possibility of recurrent episodes in similar human conditions. The observed thickening of alveolar walls and potential fibrotic areas in these mice may imply an increased risk of post-COVID fibrosis in humans. Furthermore, the presence of SARS-CoV-2-positive inflammatory cells in some asymptomatic murine cases could herald a progression toward ongoing inflammation and chronic lung disease in humans. Therefore, the necessity for further studies in human subjects and vigilant monitoring of high-risk human populations is underscored.

Investigaciones anteriores sobre COVID-19 o COVID prolongado se centraron principalmente en la presencia de SARS-CoV-2 principalmente en pacientes sintomáticos. Este estudio tuvo como objetivo investigar la persistencia del SARS-CoV-2 después de 1 año de COVID-19 asintomático o leve. Se estudiaron ratones transgénicos K18-hACE2 infectados con SARS-CoV-2 y de control (n=25). Los animales con síntomas moderados y graves se sacrificaron después de ocho días, mientras que los ratones con síntomas leves o asintomáticos se mantuvieron en BSL-III durante doce meses. Los análisis incluyeron estado general, histoquímica, inmunohistoquímica, microscopía electrónica de transmisión y qRT- PCR. Los pulmones del grupo de doce meses mostraron engrosamiento de las paredes alveolares, y algunos pulmones exhibieron reclutamiento de células inflamatorias, presencia de ARNm del SARS-CoV-2, inmunopositividad para la proteína de la espícula del SARS-CoV-2 y TEM mostró virus (60 -125 nm) dentro de las vesículas, lo que indica una replicación continua. Ciertas muestras de pulmón mostraron una presencia persistente de SARS- CoV-2 en exocrinocitos bronquiolares, células endoteliales y macrófagos. El grupo de ocho días presentó neumonitis intersticial viral, inmunopositividad al SARS-CoV-2 y ARNm. Los corazones de ocho días mostraron ARNm viral, mientras que los corazones de doce meses dieron negativo. Algunos animales asintomáticos de doce meses presentaron disminución del surfactante, engrosamiento de la membrana basal, fibrosis y degeneración leve del nervio autónomo. En este estudio realizado en ratones, los hallazgos indican la posibilidad de persistencia crónica del SARS-CoV-2 en los pulmones un año después de la infección inicial leve o asintomática, lo que podría sugerir la posibilidad de episodios recurrentes en condiciones humanas similares. El engrosamiento observado de las paredes alveolares y las posibles áreas fibróticas en estos ratones puede implicar un mayor riesgo de fibrosis post-COVID en humanos. Además, la presencia de células inflamatorias positivas para SARS- CoV-2 en algunos casos murinos asintomáticos podría presagiar una progresión hacia una inflamación continua y una enfermedad pulmonar crónica en humanos. Por lo tanto, se subraya la necesidad de realizar más estudios en seres humanos y realizar un seguimiento atento de las poblaciones humanas de alto riesgo.

Lower Urinary Tract Symptoms in a prospective cohort of COVID-19 survivors

ABSTRACT Purpose: To analyze the prevalence of lower urinary tract symptoms (LUTS) in patients who survived moderate and severe forms of COVID-19 and the risk factors for LUTS six months after hospitalization. Materials and Methods: In this prospective cohort study, patients were evaluated six months after hospitalization due to COVID-19. LUTS were assessed using the International Prostate Symptom Score. General health was assessed through the Hospital Anxiety and Depression Scale and the EQ5D-L5 scale, which evaluates mobility, ability to perform daily activities, pain and discomfort and completed a self-perception health evaluation. Results: Of 255 participants, 54.1% were men and the median age was 57.3 [44.3 - 66.6] years. Pre-existing comorbidities included diabetes (35.7%), hypertension (54.5%), obesity (30.2%) and physical inactivity (65.5%). One hundred and twenty-four patients (48.6%) had a hospital stay >15 days, 181 (71.0%) were admitted to an ICU and 124 (48.6%) needed mechanical ventilation. Median IPSS was 6 [3-11] and did not differ between genders. Moderate to severe LUTS affected 108 (42.4%) patients (40.6% men and 44.4% women; p=0.610). Nocturia (58.4%) and frequency (45.9%) were the most prevalent symptoms and urgency was the only symptom that affected men (29.0%) and women (44.4%) differently (p=0.013). LUTS impacted the quality of life of 60 (23.5%) patients with women more severely affected (p=0.004). Diabetes, hypertension, and self-perception of worse general health were associated with LUTS. Conclusions: LUTS are highly prevalent and bothersome six months after hospitalization due to COVID-19. Assessment of LUTS may help ensure appropriate diagnosis and treatment in these patients.

Salud mental en población pediátrica que presentó COVID-19 / Mental health in pediatric population presenting COVID 19

Resumen Introducción: Las investigaciones en salud mental de la población pediátrica en Colombia son escasas, aun cuando se han reportado impactos importantes relacionados con el COVID-19. El presente estudio tuvo como objetivo describir y comparar las alteraciones en la salud mental en la población pediátrica diagnosticada con COVID-19 y sin este diagnóstico, en Caldas, Colombia. Materiales y métodos: El estudio se desarrolló en niños y niñas que fueron diagnosticados con COVID-19 desde marzo del año 2020 hasta marzo del año 2021. Para esto se aplicó el Reporting Questionnaire for Children (RQC) por medio de entrevistas telefónicas, de las cuales 89 fueron incluidas en la investigación. Resultados: En la muestra total se encontró que el síntoma más frecuente fue asustarse o ponerse nervioso sin razón (35 %), seguido de los problemas del lenguaje (30 %) y los problemas de sueño (29 %). Discusión: Aunque la mayoría de estudios afirma que la salud mental pediátrica se vio afectada durante la pandemia, pocas veces se relaciona con las implicaciones directas de la infección. El presente estudio señala que los niños diagnosticados con COVID-19 tuvieron mayores dificultades en su salud mental. Conclusiones: Tanto las medidas para evitar la propagación del COVID-19 como la enfermedad sistémica que causa el virus, afectaron negativamente la salud mental de la población pediátrica estudiada.

Abstract Background: Research on the impact of mental health from the pediatric population in Colombia is scarce, even though significant mental health impacts have been reported in this population with COVID-19. The point of this study was to describe and compare changes in mental health in the pediatric population diagnosed with COVID-19 and without this diagnosis, in Caldas, Colombia. Methods: The study was done in children who were diagnosed with Covid-19 from March 2020 to March 2021. For this, the Reporting Questionnaire for Children (RQC) was applied through phone interviews, of which 89 were included in the investigation. Results: In total, it was found that the most frequent symptom was being scared or nervous for no reason 35% followed by language problems 30% and sleep problems 29% Discussion: Although most studies mention that pediatric mental health was affected during the pandemic, it is rarely related to the direct implications of the infection. The present study indicates that children diagnosed with COVID-19 presented greater difficulties in their mental health. Conclusions: The Covid-19 pandemic, as well as the measures to prevent its spread and the systemic disease caused by the virus, negatively affected the mental health of the pediatric population studied.

Tras las huellas de la convalecencia de la Covid-19

La propuesta de extender hasta dos o tres años la observación de las consecuencias negativas de la infección por el virus SARS-CoV-2 se considera razonable, al alargar el tiempo de seguimiento de un padecimiento anteriormente desconocido. El propósito de esta comunicación es aportar nuevas consideraciones sobre una realidad: existen personas que no se han recuperado totalmente, en un tiempo prudencial, después de haber padecido de COVID-19. Se enfatiza que todavía estamos lejos de conocer todos los efectos biológicos que tendrá en el tiempo, la "inmunoestimulación masiva" de la pandemia en algunas personas. Se plantean algunas recomendaciones prácticas como a) Incluir el dato de haber padecido de COVID-19 en los antecedentes patológicos personales de los pacientes; b) Insistir en el seguimiento periódico de los enfermos, sobre todo los que manifiesten quejas de una convalecencia prolongada. Otras consecuencias, además de las netamente biológicas, son también importantes, entre ellas: mentales, sociales, laborales, económicas, consumo de servicios de salud y de servicios sociales. En relación a la pos-COVID siempre el reto estará vinculado a la aplicación de estrategias eficaces para la prevención y el control de la COVID-19. Pero si se presentan enfermos, el desafío consistirá en evitar las posibles causas de la pos-COVID, así como prevenir o atenuar la aparición de sus diferentes formas clínicas con conductas coherentes, en dependencia de las características de cada caso, así como atenuar, por todos, las consecuencias que se han provocado en las personas afectadas y para la sociedad.

The proposal to extend the negative consequences of infection with the SARS-CoV-2 virus observation to two or three years is considered reasonable, by lengthening the follow-up time of a previously unknown condition. This communication' purpose is to provide new considerations about a fact: there are people who have not fully recovered, in a reasonable time, after having suffered from COVID-19. It is emphasized that we are still far from knowing all the biological effects that the "massive immunostimulation" of the pandemic will have over time on some people. Some practical recommendations are proposed, such as a) Include the information of having suffered from COVID-19 in the patients' personal pathological history; b) Insist on periodic monitoring of patients, especially those who express complaints of prolonged convalescence. Other consequences, in addition to the purely biological ones, are also important, including: mental, social, labor, economic, consumption of health services and social services. In relation to post-COVID, the challenge will always be linked to the application of effective strategies for the COVID-19 prevention and control. But if illness people appear, the challenge will be to avoid the possible causes of post-COVID, as well as prevent or mitigate the appearance of its different clinical forms with coherent behaviors, depending on the characteristics of each case, as well as mitigate, by all, the consequences that have been caused to the affected people and to society.

Impact on the nervous system of long COVID-19 infection in children / Impacto en el sistema nervioso de la infección COVID-19 larga en niños

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has had a profound global impact, raising concerns about its long-term effects, particularly neurological complications. While studies have highlighted such complications in adults, there is a paucity of research focusing on children. Objective To examine the medium- to long-term neurological and cognitive symptoms in 18 year old children and below with positive versus negative COVID-19 antigens and to identify the probable risk factors to promote specific health actions. Methods An observational study was carried out to determine neurological symptoms in the medium and long terms after COVID 19. A random sample of 124 children, both symptomatic or asymptomatic, tested positive or negative for COVID-19 through swab tests. Results Neurological symptoms were assessed between 6 to 12 months and 2 years after the infection. Acute symptoms, including headache, anosmia, ageusia, and myalgia, were observed in more than 20% of the children, but they generally resolved within 6 to 12 months. Persistent functional difficulties, such as in studying, paying attention, and socializing, were reported in 3% of the cases. Behavioral symptoms at baseline were noted in 7.8% of children, but they were remitted in most cases, except for those with prior involvement. Conclusion These findings underscore the need for continued monitoring of children following COVID-19 infection and the importance of tailored health interventions.

Resumen Antecedentes La pandemia por enfermedad por coronavirus 2019 (coronavirus disease 2019, COVID-19, en inglés) ha tenido un profundo impacto global y ha generado preocupación sobre sus efectos a largo plazo, especialmente sobre las complicaciones neurológicas. Si bien los estudios han destacado tales complicaciones en adultos, hay escasez de investigaciones centradas en niños. Objetivo Examinar los síntomas neurológicos y cognitivos a mediano y largo plazo en niños de 18 años o menos, con antígenos positivos versus negativos para COVID-19, e identificar los posibles factores de riesgo para promover acciones de salud específicas. Métodos Se llevó a cabo un estudio observacional para determinar los síntomas neurológicos en el medio y largo plazo tras COVID-19. Una muestra aleatoria de 124 niños se diagnosticó por tests de saliva. Los tests para COVID-19 podían ser negativos o positivos, en niños sintomáticos o asintomáticos. Resultados Los síntomas neurológicos se evaluaron entre 6 y 12 meses y 2 años posinfección. Se observaron síntomas agudos como cefalea, anosmia, ageusia y mialgias en más del 20% de los niños, que generalmente se resolvieron en un plazo de 6 a 12 meses. En el 3% de los casos, se informaron dificultades funcionales persistentes, como para estudiar, prestar atención y socializar. Los síntomas conductuales se produjeron en el 7.8% en el momento inicial, pero remitieron en la mayoría de los casos, excepto en aquellos con afectación previa. Conclusión Estos hallazgos enfatizan la necesidad del monitoreo continuo de niños tras la infección por COVID-19 y la importancia de intervenciones de salud personalizadas.

Panorama da COVID longa no Brasil: análise preliminar de um inquérito para pensar políticas de saúde / Overview of long COVID in Brazil: a preliminary analysis of a survey to think about health policies / Panorama de la COVID larga en Brasil: un análisis preliminar de una encuesta para pensar en políticas de salud

Caracterizada por sintomas que permanecem ou aparecem pela primeira vez em até três meses após a infecção pelo SARS-CoV-2, a COVID longa pode se manifestar de diferentes formas, inclusive entre casos não hospitalizados ou assintomáticos. Nesse sentido, este artigo apresenta um panorama da COVID longa no Brasil, com ênfase no diagnóstico, nos sintomas e nos desafios para a nova gestão da saúde. Foram utilizados dados de um estudo realizado com objetivo de investigar a COVID longa em pessoas acometidas pela COVID-19, com dados originais de um inquérito com indivíduos brasileiros adultos (18 anos ou mais) que tiveram COVID-19, coletados entre 14 de março e 14 de abril de 2022, por meio de questionário divulgado em redes sociais. O questionário abordou características sociodemográficas, histórico de infecções por COVID-19, vacinação contra a doença, investigação da situação de saúde e da qualidade de vida antes e após a COVID-19, além da busca e acesso a tratamento. Dos 1.728 respondentes, 720 foram considerados elegíveis para a análise. Desses, 496 (69%) tiveram COVID longa. Os indivíduos com COVID longa reportaram manifestações clínicas como ansiedade (80%), perda de memória (78%), dor generalizada (77%), falta de atenção (75%), fadiga (73%), queda de cabelo (71%), alterações de sono (70%), alterações de humor (62%), indisposição (60%) e dor nas articulações (59%). A maioria procurou os serviços de saúde durante e após a fase aguda de COVID-19 (94% e 80%, respectivamente), o que representa a necessidade de estruturar o sistema de saúde para atender esses pacientes.

Characterized by symptoms that remain or appear for the first time within three months of SARS-CoV-2 infection, long COVID can manifest itself in different ways, including in non-hospitalized or asymptomatic cases. Thus, this study offers an overview of long COVID in Brazil, especially of its diagnosis, symptoms, and challenges for new health management. Data from a study that investigated long COVID in people affected by COVID-19 were used. These original data stem from a survey with adult Brazilians (aged 18 years or older) who had COVID-19 that collected information from March 14 to April 14, 2022, by a questionnaire on social media. The questionnaire addressed sociodemographic characteristics, history of COVID-19 infections, vaccination against the disease, investigation of health status and quality of life before and after COVID-19, and search and access to treatment. Of the 1,728 respondents, 720 were considered eligible for analysis, of which 496 (69%) had long COVID. Individuals with long COVID reported clinical manifestations such as anxiety (80%), memory loss (78%), generalized pain (77%), lack of attention (75%), fatigue (73%), hair loss (71%), sleep changes (70%), mood swings (62%), malaise (60%), and joint pain (59%). Most sought health services during and after the acute phase of COVID-19 (94 and 80%, respectively), representing the need to structure the healthcare system for these patients.

Caracterizado por síntomas que permanecen o aparecen por primera vez dentro de los tres meses posteriores a la infección por SARS-CoV-2, la COVID larga puede manifestarse de diferentes formas, incluso entre casos no hospitalizados o asintomáticos. En este sentido, este artículo presenta un panorama la COVID larga en Brasil, con énfasis en el diagnóstico, los síntomas y los desafíos para la nueva gestión de la salud. Se utilizaron datos de una encuesta realizada para investigar la COVID larga en personas afectadas por COVID-19. Se trata de datos originales de una encuesta con individuos brasileños adultos (18 años o más), que tuvieron COVID-19, con datos recolectados entre el 14 de marzo y el 14 de abril de 2022, por medio de un cuestionario divulgado en las redes sociales. El cuestionario abordó características sociodemográficas, historial de infecciones por COVID-19, vacunación contra la enfermedad, investigación de la situación de salud y de la calidad de vida antes y después de COVID-19, además de la búsqueda y acceso a tratamiento. De los 1.728 encuestados, 720 fueron considerados elegibles para el análisis. De ellos, 496 (69%) tenían COVID larga. Las personas con COVID larga informaron manifestaciones clínicas como ansiedad (80%), pérdida de memoria (78%), dolor generalizado (77%), falta de atención (75%), fatiga (73%), pérdida de cabello (71%), cambios en el sueño (70%), cambios de humor (62%), malestar (60%) y dolor en las articulaciones (59%). La mayoría recurrió a los servicios de salud durante y después de la fase aguda de COVID-19 (94% y 80%, respectivamente), lo que representa la necesidad de estructurar el sistema de salud para atender a estos pacientes.

Rehabilitation interventions in long COVID: a case report / Intervenções em reabilitação na COVID longa: relato de caso

ABSTRACT. The repercussions of Long COVID demand specialised rehabilitation care. Interdisciplinary interventions in a 58-year-old patient were implemented to improve the clinical, motor and cognitive complaints associated with COVID-19. The rehabilitation team performed quantitative and qualitative evaluations in the initial phase and after 12 months of follow-up. The patient's neuropathic pain, ankle and foot muscle strength, gait pattern, general cognitive functioning, initiative, emotional expressiveness, processing speed, neuropsychiatric symptoms and quality of life improved. She demonstrated gains in metacognition and expanded the use of compensatory strategies, resuming her routine and professional activities, although still with signs of executive dysfunction. It is concluded that a rehabilitation program calibrated to the profile of the patient with Long COVID had positive effects on functionality and satisfaction with quality of life.

RESUMO. As repercussões da COVID Longa demandam atendimentos especializados de reabilitação. Intervenções interdisciplinares em paciente de 58 anos foram implementadas com o objetivo de melhorar as queixas clínicas, motoras e cognitivas associadas à COVID-19. A equipe de reabilitação realizou avaliações quantiqualitativas na fase inicial e após 12 meses de acompanhamento. A paciente evoluiu com melhora da dor neuropática, da força muscular de tornozelo e pé, do padrão de marcha, do funcionamento cognitivo geral, da iniciativa, da expressividade emocional, da velocidade de processamento, dos sintomas neuropsiquiátricos e da qualidade de vida (domínios físico e psicológico). Demonstrou ganhos na metacognição e ampliou o uso de estratégias compensatórias, retomando suas atividades rotineiras e profissionais, embora ainda com indícios de disfunção executiva. Conclui-se que um programa de reabilitação calibrado ao perfil do paciente com COVID longa trouxe efeitos positivos na funcionalidade e satisfação com a qualidade de vida.

Physical therapy performance in post-COVID-19 rehabilitation: knowledge and experience of physiotherapists / Actuación de la fisioterapia en la rehabilitación post-COVID-19: conocimientos y experiencia de los fisioterapeutas / Atuação fisioterapêutica na reabilitação pós-COVID-19: conhecimento e experiência de fisioterapeutas

ABSTRACT After the acute phase of COVID-19, many patients have persistent symptoms or develop sequelae, which leads them to seek physiotherapy rehabilitation services. Therefore, this study aimed to investigate the knowledge and experience of physiotherapists on the assessment and treatment of post-COVID-19 patients. The cross-sectional observational study was carried out with 73 physiotherapists using an online questionnaire about academic background, areas of expertise, knowledge about COVID-19, and knowledge and experience of assessment and treatment resources in post-COVID-19 rehabilitation, in addition to barriers to the care of these patients in the ambulatory care. Most physiotherapists had heard of post-COVID-19 syndrome, however, only 44% felt sufficiently informed about post-COVID-19 rehabilitation. There was a discrepancy between the degree of importance and experience with the frequency of use of assessment resources, especially the use of specific assessment instruments for skeletal muscle strength, mobility, and respiratory function, in addition to scales and questionnaires to assess disabilities, quality of life, and sleep quality. On the other hand, most reported the importance and had sufficient experience to treat post-COVID-19 patients using cheap and accessible resources. However, less than half use techniques related to respiratory muscle training and/or more sophisticated equipment. Thus, we conclude that most physiotherapists recognize the importance and report sufficient experience to assess and treat post-COVID-19 patients, however, there is a discrepancy between the assessment in the biopsychosocial context of the patient and the treatment process.

RESUMEN Terminada la fase aguda de la COVID-19, muchos pacientes presentan síntomas persistentes o desarrollan secuelas, lo que requiere servicios de rehabilitación fisioterapéutica. Ante esto, el objetivo de este estudio fue identificar los conocimientos y la experiencia de los fisioterapeutas respecto a la evaluación y el tratamiento de los pacientes post-COVID-19. Este estudio observacional transversal se llevó a cabo con 73 profesionales, mediante un cuestionario en línea sobre formación académica, áreas de actuación, conocimientos sobre la COVID-19 y experiencia con los recursos de evaluación y tratamiento en la rehabilitación post-COVID-19, además de las barreras para la atención de estos pacientes en el ámbito ambulatorio. Aunque la mayoría de los fisioterapeutas tenían algún conocimiento sobre el síndrome post-COVID-19, solamente el 44% de ellos se sentían suficientemente informados sobre la rehabilitación post-COVID-19. Se observa una discrepancia entre el grado de importancia y experiencia y la frecuencia de uso de los recursos de evaluación, especialmente el uso de herramientas de evaluación específicas para la fuerza muscular esquelética, la movilidad y la función respiratoria, además de escalas y cuestionarios para evaluar la discapacidad, la calidad de vida y la calidad del sueño. Por otro lado, la mayoría informó de la importancia de este tratamiento, afirmando tener experiencia suficiente para tratar a los pacientes post-COVID-19 utilizando recursos baratos y accesibles. Así, menos de la mitad de los profesionales utilizan técnicas vinculadas al entrenamiento de la musculatura respiratoria y/o equipos más sofisticados. Por lo tanto, se concluye que la mayoría de los fisioterapeutas reconocen la importancia de tratar a los pacientes post-COVID-19 y declaran tener experiencia suficiente para evaluarlos y tratarlos; sin embargo, hay una discrepancia entre el proceso de evaluación en el contexto biopsicosocial del paciente y el proceso de tratamiento.

RESUMO Após a fase aguda da COVID-19, muitos pacientes apresentam persistência de sintomas ou desenvolvem sequelas, o que os leva a procurar serviços de reabilitação fisioterapêutica. Sendo assim, o objetivo deste estudo foi investigar o conhecimento e a experiência de fisioterapeutas sobre a avaliação e tratamento de pacientes pós-COVID-19. O estudo observacional transversal foi realizado com 73 profissionais, por meio de um questionário online sobre formação acadêmica, áreas de atuação, conhecimento sobre a COVID-19 e experiência sobre recursos de avaliação e tratamento na reabilitação pós-COVID-19, além de barreiras para o atendimento desses pacientes no ambiente ambulatorial. A maioria dos fisioterapeutas já tinham ouvido falar da síndrome pós-COVID-19, no entanto, apenas 44% se sentiam suficientemente informados sobre a reabilitação pós-COVID-19. Houve uma discrepância entre o grau de importância e experiência e a frequência da utilização dos recursos de avaliação, principalmente o uso de instrumentos específicos de avaliação para força muscular esquelética, mobilidade e função respiratória, além de escalas e questionários para avaliar incapacidades, qualidade de vida e qualidade do sono. Em contrapartida, a maioria relatou a importância deste tratamento, alegando ter grau de experiência suficiente para tratar os pacientes pós-COVID-19 com a utilização de recursos baratos e acessíveis. Dessa forma, menos da metade dos profissionais realiza técnicas vinculadas ao treinamento muscular respiratório e/ou equipamentos mais sofisticados. Concluímos, então, que a maioria dos fisioterapeutas reconhece a importância do tratamento de pacientes pós-COVID-19 e relata uma experiência suficiente para avaliá-los e tratá-los, entretanto, há uma discrepância entre o processo de avaliação no contexto biopsicossocial do paciente e o processo de tratamento.

Chronotropic incompetence is associated with reduced aerobic conditioning and sedentary behavior in patients with post-acute COVID-19 syndrome

ABSTRACT Post-acute COVID-19 syndrome, or long COVID, presents with persistent symptoms, including cough, dyspnea, and fatigue, extending beyond one month after SARS-CoV-2 infection. Cardiac complications such as chest pain and arrhythmias have raised concerns, with chronotropic incompetence (CI), an inadequate heart rate increase during exercise, emerging as a significant condition contributing to diminished exercise tolerance and quality of life. This study estimated the prevalence of CI and explored its association with aerobic capacity and physical activity levels in long COVID patients. A cross-sectional study was conducted at a private hospital in Sergipe, Brazil, involving 93 patients over 18 years old with persistent post-COVID-19 symptoms after confirmed SARS-CoV-2 infections. Exclusion criteria included beta-blocker use, inadequate respiratory exchange ratio, and inability to complete cardiopulmonary exercise testing (CPET). Clinical histories, CPET results, and chronotropic index calculation were used to identify CI, with logistic regression analyzing associated factors. Of the participants (mean age 45 years; average duration since COVID-19 diagnosis 120 days), 20.4% were diagnosed with CI. Logistic regression identified a strong association between CI and sedentary behavior (OR 11.80; 95% CI 2.54 to 54.78; p=0.001). Patients with CI showed lower predicted peak heart rates and maximal oxygen uptake. The prevalence of CI among long COVID patients in this study was approximately 20%, associated with decreased aerobic capacity and increased sedentary behavior. These findings highlight the need for timely diagnosis and therapeutic interventions, including cardiopulmonary rehabilitation, to enhance the quality of life in post-COVID patients with CI. The study's cross-sectional design and its specific context have limited causality inference and generalizability, underscoring the importance of further research in diverse settings.

Neurological and neuropsychiatric manifestations of post-COVID-19 condition in South America: a systematic review of the literature / Manifestações neurológicas e neuropsiquiátricas da condição pós-COVID-19 na América do Sul: revisão sistemática da literatura

Abstract Background The post-COVID-19 condition is a major modern challenge in medicine and has a high global impact on the health of the population. Objective To determine the main neurological and neuropsychiatric manifestations after acute COVID-19 infection in South American countries. Methods This is a systematic review study, registered on the PROSPERO platform following the PRISMA model. 4131 articles were found with the search strategies used. Neurological and neuropsychiatric manifestations were investigated in individuals three months or more after acute COVID-19 infection, and older than 18 years, including studies conducted in South American countries published between 2020 and 2022. Results Six studies (four from Brazil and two from Ecuador) were analyzed. Regarding the type of study: three were cohorts, two were case reports, and one was cross-sectional. The main outcomes found were new pain (65.5%) and new chronic pain (19.6%), new headache (39.1%), daily chronic headache (13%), paresthesia (62%), in addition to neuropsychiatric diseases, such as generalized anxiety disorder (15.1%), post-traumatic stress syndrome (13.4%), depression and anxiety (13.5%), suicidal ideation (10.1%), and several cognitive disorders. Conclusion Neurological and neuropsychiatric manifestations related to depression and anxiety, and cognition disorders are reported during the post-COVID-19 condition in South America. Symptoms associated with chronic pain appear to be associated with the condition. More studies on post-COVID-19 conditions are needed in the South America region.

Resumo Antecedentes A condição pós-COVID-19 é um grande desafio moderno na medicina e tem alto impacto global na saúde da população. Objetivo Determinar as principais manifestações neurológicas e neuropsiquiátricas após a infecção aguda da COVID-19 nos países da América do Sul. Métodos Trata-se de um estudo de revisão sistemática, registrado na plataforma PROSPERO seguindo o modelo PRISMA. Foram encontrados 4131 artigos com as estratégias de buscas empregadas. Investigaram-se manifestações neurológicas e neuropsiquiátricas em indivíduos com três meses ou mais desde a infecção aguda por COVID-19, maiores de 18 anos, incluindo estudos realizados em países da América do Sul publicados entre 2020 e 2022. Resultados Foram analisados seis estudos (quatro do Brasil e dois do Equador). Em relação ao tipo de estudo: três eram coortes, dois relatos de casos e um transversal. Os principais desfechos encontrados foram em relação à dor nova (65,5%) e dor crônica nova (19,6%), cefaleia nova (39,1%), cefaleia crônica diária (13%), parestesia (62%), além de doenças neuropsiquiátricas como transtorno de ansiedade generalizada (15,1%), síndrome do estresse pós-traumático (13,4%), depressão e ansiedade (13,5%), ideação suicida (10,1%) e diversos distúrbios cognitivos. Conclusão Manifestações neurológicas e neuropsiquiátricas relacionadas à depressão e ansiedade e distúrbios de cognição são relatados durante a condição pós-COVID-19 na América do Sul. Os sintomas associados a quadros de dor crônica parecem estar associados à condição. Mais estudos sobre condições pós COVID-19 são necessários na região da América do Sul.

Alpha-lipoic acid does not improve olfactory training results in olfactory loss due to COVID-19: a double-blind randomized trial

Abstract Objectives Olfactory loss is a recognized long-term dysfunction after Coronavirus Disease 2019 (COVID-19) infection. This investigation aimed to assess the effect of alpha-lipoic acid as an adjuvant treatment of olfactory training on the improvement of smell loss in post-COVID-19 patients. Methods This randomized controlled trial included 128 adult outpatients who had persistent smell loss for more than 3-months after COVID-19 infection. The participants were randomly allocated into two groups: the intervention treatment group, which received alpha-lipoic acid associated to olfactory training, and comparison treatment group, which received placebo pills associated to olfactory training. The participants were followed-up for 12-weeks. Olfactory dysfunction was assessed in terms of Visual Analog Scale (VAS), and the Connecticut Chemosensory Clinical Research Center (CCCRC) test for the Brazilian population. Results A total of 100 participants completed the follow-up period and were analyzed in this study. Both groups have improved CCCRC score (p= 0.000), olfactory threshold (p= 0.000), identification score (p= 0.000) and VAS score (p= 0.000) after 12-weeks follow-up. No significant differences were determined between the intervention and comparison treatment groups in CCCRC score (p= 0.63), olfactory threshold (p= 0.50), identification score (p= 0.96) and VAS score (p= 0.97). In all these criteria, comparison treatment group went slightly worse. At the endpoint of the study, the frequency of anosmia reduced to 2% in the intervention treatment group and to 7.8% in the comparison treatment group. Also, 16.8% of the intervention group' subjects, and 15.7% of comparison treatment group's patients reached normosmia. Conclusions Overall, there was a strongly significant difference in olfactory function between baseline and endpoint for both groups. However, based on the lack of significant difference between the intervention treatment and the comparison treatment groups in terms of olfactory changes, our study appoints that the alpha-lipoic acid is not better than olfactory training alone to treat olfactory loss after COVID-19. Level of evidence Level 2.

Síndrome pós-COVID-19 entre hospitalizados por COVID-19: estudo de coorte após 6 e 12 meses da alta hospitalar / Síndrome post-COVID-19 entre hospitalizados por COVID-19: estudio de cohorte tras 6 y 12 meses del alta hospitalaria / Post-COVID-19 syndrome among hospitalized COVID-19 patients: a cohort study assessing patients 6 and 12 months after hospital discharge

A síndrome pós-COVID-19 é um termo usado para descrever um conjunto diversificado de sintomas que persistem por mais de 12 semanas da infecção diagnosticada. O objetivo deste estudo foi analisar a síndrome pós-COVID-19 entre hospitalizados por COVID-19 após 6 e 12 meses da alta hospitalar. Trata-se de estudo de coorte ambidirecional, realizado com indivíduos que receberam alta em três dos principais hospitais da capital de Mato Grosso, Brasil, entre outubro e dezembro de 2021 e janeiro e março de 2022. Após coleta de dados em prontuários, os indivíduos foram entrevistados por telefone após 6 e 12 meses da alta hospitalar, sendo questionados sobre a presença de sintomas persistentes ou novos, para a avaliação de sua frequência segundo características sociodemográficas, econômicas, relativas à internação e condições de saúde. Dos 277 prontuários avaliados, 259 pacientes foram elegíveis para o estudo, 190 aos seis meses e 160 após 12 meses da alta hospitalar. Aos seis meses, 59% eram mulheres, 40% com 60 anos ou mais de idade e 87,4% referiram a presença de pelo menos um sintoma. Aos 12 meses, 58,7% eram mulheres, 37,5% com 30 a 49 anos e 67,5% referiram a presença de pelo menos um sintoma. A fadiga foi o sintoma mais comum após 6 e 12 meses de alta hospitalar (55,3% e 40,6%, respectivamente), seguido de problemas de memória (36,8%; 20%) e perda de cabelo (26,8%; 11,2%). Foi maior a prevalência de síndrome pós-COVID-19 entre indivíduos de maior faixa etária, menor renda, hipertensos, diabéticos e com maior gravidade durante a internação. Os fatores de risco da síndrome pós-COVID-19 contribuem para a compreensão dos efeitos a longo prazo e da importância do acompanhamento após a fase aguda da doença.

El síndrome post-COVID-19 es un término utilizado para describir un conjunto diversificado de síntomas que persisten durante más de 12 semanas de la infección diagnosticada. El objetivo fue analizar el síndrome post-COVID-19 entre hospitalizados por COVID-19 tras 6 y 12 meses del alta hospitalaria. Se trata de un estudio de cohorte ambidireccional, realizado con individuos que fueron dados de alta en tres de los principales hospitales de la capital de Mato Grosso, Brasil, entre octubre y diciembre de 2021 y enero y marzo de 2022. Tras recolectar los datos en registros médicos, se entrevistaron los individuos por teléfono tras 6 y 12 meses del alta hospitalaria, cuestionándoles sobre la presencia de síntomas persistentes o nuevos y evaluando su frecuencia conforme las características sociodemográficas, económicas, relacionadas con la hospitalización y condiciones de salud. De los 277 registros médicos evaluados, se eligieron 259 pacientes para el estudio, 190 a los 6 meses y 160 tras 12 meses del alta hospitalaria. A los 6 meses, el 59% eran mujeres, el 40% tenían 60 años o más y el 87,4% refirieron la presencia de al menos un síntoma. A los 12 meses, el 58,7% eran mujeres, el 37,5% tenían entre 30 y 49 años y el 67,5% refirieron la presencia de al menos un síntoma. La fatiga fue el síntoma más común tras 6 y 12 meses del alta hospitalaria (el 55,3% y el 40,6%, respectivamente), seguido de los problemas de memoria (el 36,8% y el 20%) y caída del pelo (el 26,8% y el 11,2%). La prevalencia de síndrome post-COVID-19 fue más alta entre los individuos de mayor edad, menor renta, hipertensos, diabéticos y con mayor gravedad durante la hospitalización. Los factores de riesgo del síndrome post-COVID-19 contribuyen para la comprensión de los efectos a largo plazo y de la importancia del seguimiento tras la fase aguda de la enfermedad.

Post-COVID-19 syndrome involves a variety of symptoms that last more than 12 weeks after COVID diagnosis. This study aimed to analyze post-COVID-19 syndrome among hospitalized COVID-19 patients 6 and 12 months after hospital discharge. This is an ambidirectional cohort study conducted with individuals who were discharged from three main hospitals in the capital of Mato Grosso State, Brazil, between October and December 2021 and January and March 2022. After data collection from medical records, the individuals were interviewed by telephone 6 and 12 months after hospital discharge, when they were asked about the presence of ongoing or new symptoms and when symptom frequency was evaluated according to sociodemographic and economic characteristics hospitalization, and health conditions. Of all 277 medical records evaluated, 259 patients were eligible to participate in the study, 190 patients six months after discharge and 160 patients 12 months after hospital discharge. At six months, 59% were female patients, 40% were aged 60 years or older, and 87.4% reported at least one symptom. At 12 months, 58.7% were female patients, 37.5% were aged 30 to 49 years, and 67.5% reported at least one symptom. Fatigue was the most common symptom 6 and 12 months after hospital discharge (55.3% and 40.6%, respectively), followed by memory problems (36.8%; 20%), and hair loss (26.8%; 11.2%). The prevalence of post-COVID-19 syndrome was higher among patients of older age, lower income, with hypertension, diabetes, and more severe infection during hospitalization. The risk factors for post-COVID-19 syndrome help understand the long-term effects and the importance of monitoring after the acute phase of the disease.

Long COVID: neurological manifestations - an updated narrative review / COVID longa: manifestações neurológicas - uma revisão narrativa atualizada

ABSTRACT. Infection with the SARS-CoV-2 virus can lead to neurological symptoms in the acute phase and in the Long COVID phase. These symptoms usually involve cognition, sleep, smell disorders, psychiatric manifestations, headache and others. This condition is more commonly described in young adults and women. This symptomatology can follow severe or mild cases of the disease. The importance of this issue resides in the high prevalence of neurological symptoms in the Long COVID phase, which entails significant morbidity in this population. In addition, such a condition is associated with high health care costs, with some estimates hovering around 3.7 trillion US dollars. In this review, we will sequentially describe the current knowledge about the most prevalent neurological symptoms in Long COVID, as well as their pathophysiology and possible biomarkers.

RESUMO. A infecção pelo vírus SARS-CoV-2 pode levar a sintomas neurológicos na fase aguda e na fase de COVID longa. Esses sintomas geralmente envolvem cognição, sono, distúrbios do olfato, manifestações psiquiátricas, dor de cabeça e outros. Esta condição é mais comumente descrita em adultos jovens e mulheres. A sintomatologia pode acompanhar casos graves ou leves da doença. A importância desta questão reside na elevada prevalência de sintomas neurológicos na fase de COVID longa, o que acarreta morbilidade significativa nesta população. Além disso, tal condição está associada a elevados custos de cuidados de saúde, com algumas estimativas em torno de 3,7 trilhões de dólares americanos. Nesta revisão, descrevemos sequencialmente o conhecimento atual sobre os sintomas neurológicos mais prevalentes na COVID longa, bem como sua fisiopatologia e possíveis biomarcadores.

Persistence of symptoms and lung function in mild cases of COVID-19 six months after infection: a cross-sectional study / Persistência de sintomas e função pulmonar em casos leves de COVID-19 seis meses após a infecção: um estudo transversal

ABSTRACT Objectives: To describe persistent symptoms and lung function in mild cases of COVID-19 six months after infection. Methods: Data collection was performed through a semi-structured questionnaire containing information on the participants' demographic and anthropometric data, the disease in the acute phase, and persistent symptoms six months after COVID-19 using spirometry and manovacuometry. Results: A total of 136 participants were evaluated, of whom 64% were male, with a mean age of 38.17 ± 14.08 years and a body mass index (BMI) of 29.71 ± 17.48 kg/m2. The main persistent symptoms reported were dyspnea on exertion (39.7%), memory loss (38.2%), and anxiety (48.5%). Considering lung function, the participants reached 88.87 ± 17.20% of the predicted forced vital capacity (FVC), 86.03 ± 22.01% of the forced expiratory volume in one second (FEV1), and 62.71 ± 25.04% of peak expiratory flow (PEF). Upon manovacuometry, 97.41 ± 34.67% of the predicted inspiratory force (Pimax) and 66.86 ± 22.97% of the predicted expiratory force (Pemax) were observed. Conclusions: Six months after COVID-19 infection, a reduction in PEF and MEP was observed. Among the most commonly reported persistent symptoms were fatigue, tiredness with the slightest exertion, anxiety and depression, memory loss, and deficits in concentration.

RESUMO Objetivos: Descrever os sintomas persistentes e a função pulmonar em casos leves de COVID-19 seis meses após a infecção. Métodos: A coleta de dados foi realizada por meio de um questionário semiestruturado contendo informações sobre dados demográficos e antropométricos dos participantes, a doença na fase aguda e os sintomas persistentes seis meses após a COVID-19, utilizando espirometria e manovacuometria. Resultados: Um total de 136 participantes foram avaliados, dos quais 64% eram do sexo masculino, com uma idade média de 38,17 ± 14,08 anos e índice de massa corporal (IMC) de 29,71 ± 17,48 kg/m2. Os principais sintomas persistentes relatados foram dispneia ao esforço (39,7%), perda de memória (38,2%) e ansiedade (48,5%). Considerando a função pulmonar, os participantes atingiram 88,87 ± 17,20% da capacidade vital forçada (CVF) prevista, 86,03 ± 22,01% do volume expiratório forçado no primeiro segundo (VEF1) e 62,71 ± 25,04% do pico de fluxo expiratório (PFE). Na manovacuometria, observou-se 97,41 ± 34,67% da força inspiratória prevista (Pimáx) e 66,86 ± 22,97% da força expiratória prevista (Pemáx). Conclusões: Seis meses após a infecção por COVID-19, observou-se uma redução no PFE e na PEM. Dentre os sintomas persistentes mais comumente relatados estavam fadiga, cansaço com o mínimo esforço, ansiedade e depressão, perda de memória e déficits de concentração.

Cardiorespiratory optimal point in post-COVID-19 patients: a cross-sectional study

ABSTRACT The varied clinical presentations of SARS-CoV-2 infection have raised concerns about long-term consequences, especially "long-COVID" or "post-COVID-19 syndrome." In this context, the cardiorespiratory optimal point (COP) within the Cardiopulmonary Exercise Test (CPET) emerges as a crucial metric for evaluating functional capacities and detecting cardiovascular and pulmonary anomalies post-COVID-19. This study aimed to assess COP values among post-COVID-19 patients and categorized them based on the initial severity of their disease. In this cross-sectional study conducted in the Northeast Brazil, 80 patients (26 females and 54 males) previously infected with SARS-CoV-2 underwent CPET. We clinically stratified patients into mild, moderate, or severe COVID-19 categories and assessed COP values and other cardiorespiratory metrics. We found differences in the predicted COP between patients with mild and severe COVID-19 (p=0.042). Additionally, patients with moderate and severe COVID-19 record had an average COP value exceeding 22. Other parameters, including respiratory exchange ratio, heart rate, and oxygen uptake efficiency slope, did not differ across the groups. Patients with a history of severe COVID-19 showed altered COP values, suggesting potential discrepancies in cardiovascular and respiratory system integration. The outcomes emphasize the importance of continuous monitoring and assessment of the cardiorespiratory domain for post-COVID-19 patients. Further research is needed to understand the relationship between elevated COP in post-severe COVID-19 and its long-term prognostic implications.

Post-COVID-19 syndrome: An investigation of speech-language-hearing symptoms / Síndrome Pós-COVID-19: investigação de sintomas fonoaudiológicos

ABSTRACT Purpose: to investigate speech-language-hearing symptoms in adults after the acute phase of COVID-19 and the impact of these persistent symptoms on their physical and emotional aspects, functional capacity, and social relationships. Methods: 204 adults who tested positive for COVID-19 between January 2021 and July 2022 and who completed an online questionnaire, addressing different variables. Data were analyzed with descriptive statistics. Results: the most prevalent symptoms up to 30 days after infection were tiredness (46%), memory loss (40.2%), and ageusia (26.5%). The most found long-term symptoms were memory loss (34.3%), tiredness (21.1%), and difficulties in starting a sentence or conversation (10.1%). Anosmia and ageusia were also cited. These persistent symptoms had an impact on their emotional aspect (33.3%), followed by the physical (26%) and occupational (25%) ones. Conclusion: this study found persistent symptoms after the acute phase of COVID-19, which can lead to speech-language-hearing disorders, such as impaired oral language and eating. These persistent symptoms impacted the participants' emotional, physical, and occupational aspects.

RESUMO Objetivo: investigar a presença de sintomas fonoaudiológicos em adultos após o período da fase aguda da COVID-19, além do impacto da manutenção desses sintomas nos aspectos físicos, emocionais, capacidade funcional e relações sociais. Métodos: participaram 204 adultos que testaram positivo para COVID-19 no período de janeiro de 2021 a julho de 2022 e que preencheram um questionário on- line, abordando diferentes variáveis. Os dados foram analisados por meio de estatística descritiva. Resultados: os sintomas mais prevalentes até 30 dias após a infecção foram cansaço (46%), perda de memória (40,2%) e ageusia (26,5%). Os sintomas de longa duração mais observados foram perda de memória (34,3%), cansaço (21,1%) e dificuldades para iniciar um diálogo ou frase (10,1%). Anosmia e ageusia também foram citadas. Houve impacto da manutenção desses sintomas no aspecto emocional (33,3%), seguido dos aspectos físicos (26%) e ocupacionais (25%). Conclusão: neste estudo foram encontrados sintomas persistentes após o período da fase aguda da COVID-19 que podem levar a alterações fonoaudiológicas, como prejuízo na linguagem oral e nas questões alimentares. A manutenção desses sintomas impactou nos aspectos emocionais, físicos e ocupacionais dos participantes.

Assistência à saúde de pessoas com condições pós-covid / Health care for people with post-covid conditions

As condições pós-covid referem-se a sinais, sintomas e/ou condições que persistem ou surgem após quatro semanas da infecção pelo vírus SARS-CoV-2. No Brasil, o Ministério da Saúde denominou essas alterações como "condições pós-covid-19". Para atender às pessoas com essas condições, a Rede de Atenção à Saúde precisou se reorganizar, integrando a rede hospitalar, serviços especializados e a Atenção Primária à Saúde, com o objetivo de proporcionar uma assistência integral. O objetivo geral desta tese é analisar a assistência à saúde de pessoas com condições pós-covid-19. O estudo foi dividido em três etapas metodológicas. A primeira etapa consistiu em um procedimento teórico realizado por meio de uma scoping review, conforme as recomendações metodológicas do Joanna Briggs Institute, com o objetivo de identificar e mapear estudos que abordam ações e iniciativas governamentais mundiais para o cuidado às pessoas com condições pós-covid-19 na Atenção Primária à Saúde. Na segunda etapa, foi realizado um estudo quantitativo e descritivo do tipo transversal, que utilizou a pesquisa documental através de registros dos prontuários de pacientes, no período de janeiro de 2021 a dezembro de 2023, com a finalidade de caracterizar o perfil das pessoas com condições póscovid-19 e fatores associados ao desfecho do tratamento no Centro de Reabilitação Pós-covid SuperAR, no município de Campina Grande, Paraíba. Foram realizadas análises bivariadas para investigar a associação entre as características sociodemográficas e clínicas dos pacientes e a conclusão do tratamento. Os testes estatísticos utilizados foram o teste Qui-quadrado ou o teste exato de Fisher, com significância estatística considerada para valores de p≤0,05. A terceira etapa foi consistiu na elaboração de um produto técnico para orientar o atendimento das pessoas com condições pós-covid-19 na cidade de Campina Grande, Paraíba. A scoping review resultou em uma amostra final de oito artigos publicados entre 2021 (25%), 2022 (37,5%) e 2023 (37,5%), com predominância de estudos dos Estados Unidos (25%). Quanto ao nível de evidência, 50% dos estudos foram classificados como nível 3 (estudo qualitativo único). A pesquisa documental identificou 398 prontuários de pessoas com condições pós-covid-19 atendidas no Centro de Reabilitação SuperAR. A maioria desses pacientes era do sexo feminino (55,8%), casada (54,7%) e tinha nível de escolaridade entre ensino médio completo e incompleto (42,9%). As comorbidades mais frequentes registradas foram sinusite (44,1%), hipertensão arterial (40,9%), diabetes (23,3%) e asma (18,6%). Aproximadamente 53,8% dos indivíduos foram hospitalizados, predominantemente em instituições públicas, com uma duração média de internação de 11,3 dias. Os sintomas pós-covid mais prevalentes incluíam respiratórios (69,6%), musculoesqueléticos (47,4%) e neurológicos (15,2%), sendo a fisioterapia respiratória a intervenção mais frequentemente realizada (72,1%). A maioria dos pacientes concluiu o tratamento, apesar de 21,9% terem desistido. As variáveis que apresentaram associações estatisticamente significativas com a conclusão ou abandono do tratamento foram: sexo, hospitalização, necessidade de oxigenoterapia e a presença de bronquiectasia. Esta pesquisa destaca a importância da Atenção Primária à Saúde na gestão e coordenação do cuidado das condições pós-covid-19, além de reforçar a complexidade da reabilitação pós-covid-19, que exige a articulação de diferentes serviços da Rede de Atenção à Saúde. Evidencia-se a necessidade de abordagens multidisciplinares e adaptadas às realidades locais, além de recursos adequados e de estratégias de coordenação eficazes para melhorar a qualidade dos cuidados e otimizar os resultados para os pacientes (AU).

Post-COVID conditions refer to symptoms and conditions that persist or emerge after four weeks following infection with the SARS-CoV-2 virus. In Brazil, the Ministry of Health has termed these conditions "post-COVID-19 conditions." To address these conditions, the Health Care Network had to reorganize, integrating hospitals, specialized services, and Primary Health Care to provide comprehensive care. The main objective of this thesis is to analyze the health care provided to people with post-COVID-19 conditions. The study was divided into three methodological stages. The first stage involved a theoretical procedure through a scoping review following the methodological recommendations of the Joanna Briggs Institute, aiming to identify and map studies addressing global government actions and initiatives for the care of people with post-COVID-19 conditions in Primary Health Care. The second stage consisted of a quantitative, descriptive, cross-sectional study using documentary research from patient records between January 2021 and December 2023, to characterize the profile of people with post-COVID-19 conditions and factors associated with treatment outcomes at the SuperAR Post-COVID Rehabilitation Center in Campina Grande, Paraíba. Bivariate analyses were conducted to investigate the association between patients' sociodemographic and clinical characteristics and treatment completion. Statistical tests used included the Chi-square test or Fisher's exact test, with statistical significance considered for p-values ≤ 0.05. The third stage involved the development of a technical guide to assist in the care of people with post-COVID19 conditions in Campina Grande, Paraíba. The scoping review resulted in a final sample of eight articles published between 2021 (25%), 2022 (37.5%), and 2023 (37.5%), predominantly from the United States (25%). Regarding the level of evidence, 50% of the studies were classified as level 3 (single qualitative study). The documentary research identified 398 records of people with post-COVID-19 conditions treated at the SuperAR Rehabilitation Center. Most patients were female (55.8%), married (54.7%), and had an education level between incomplete and complete high school (42.9%). The most frequent comorbidities recorded were sinusitis (44.1%), hypertension (40.9%), diabetes (23.3%), and asthma (18.6%). Approximately 53.8% of individuals were hospitalized, predominantly in public institutions, with an average hospital stay of 11.3 days. The most prevalent post-COVID symptoms included respiratory (69.6%), musculoskeletal (47.4%), and neurological (15.2%), with respiratory physiotherapy being the most frequently performed intervention (72.1%). Most patients completed the treatment, although 21.9% discontinued it. Variables that showed statistically significant associations with treatment completion or abandonment were sex, hospitalization, need for oxygen therapy, and the presence of bronchiectasis. This research highlights the importance of Primary Health Care in managing and coordinating care for post-COVID-19 conditions and underscores the complexity of post-COVID-19 rehabilitation, which requires the integration of various services within the Health Care Network. It emphasizes the need for multidisciplinary approaches tailored to local realities, adequate resources, and effective coordination strategies to improve care quality and optimize patient outcomes (AU).

A influência de um programa de intervenção fisioterapêutica para pacientes com pós-COVID-19: um estudo quase experimental / The influence of a physiotherapeutic intervention program for patients with post-COVID-19 syndrome: a quasi-experimental study

A síndrome pós-COVID-19 afeta pacientes independentemente da gravidade da doença. Os sintomas mais comuns são fadiga, cefaleia, déficit de atenção, dispneia e depressão. Para ajudar na reabilitação dos pacientes, a intervenção fisioterapêutica tem sido utilizada como estratégia. Objetivo: Analisar os efeitos de um programa de reabilitação fisioterapêutica na qualidade de vida, capacidade funcional, percepção de esforço, percepção da dor e força muscular, em indivíduos com a síndrome pós-COVID-19. Métodos: Trata-se de um estudo quase experimental, com 33 indivíduos, divididos em dois grupos: intervenção (GI) que recebeu um programa de reabilitação fisioterapêutica e controle (GC) que não recebeu. Os participantes foram avaliados antes e após o período de intervenção para força, por meio de dinamometria de preensão palmar; nível de dor, pela escala visual analógica; capacidade funcional, pelo teste de caminhada de seis minutos; percepção de esforço, através da escala modificada de BORG e qualidade de vida pelo instrumento SF-36. Resultados: Observou-se no GI aumento significativo (p<0,05) da qualidade de vida nos domínios de capacidade funcional, aspectos físicos e redução da dor e aumento da força de preensão palmar. Houve diferença significativa (p<0,05) entre os grupos para percepção de esforço nos momentos antes e após as intervenções. Para as demais variáveis não foram evidenciadas diferenças significativas. Conclusão: O programa de intervenção fisioterapêutica promoveu melhora dos domínios de capacidade funcional, aspectos físicos e da dor da qualidade de vida, e aumento da força de preensão palmar de indivíduos com sintomas da síndrome pós-COVID-19.

Post-COVID-19 syndrome affects patients regardless of the severity of the disease. The most common symptoms are fatigue, migraine, attention deficit, dyspnea, and depression. Physiotherapeutic intervention has been used as a strategy to aid the rehabilitation of patients. Objective: To analyze the effects of a physiotherapeutic rehabilitation program on quality of life, functional capacity, perceived exertion, perception of pain, and muscle strength in patients with post-COVID-19 syndrome. Methods: This is a quasi-experimental study with 33 participants, divided into two groups: an intervention group (IG) who received the physiotherapeutic rehabilitation program and a control group (CG) who did not. Participants were assessed for strength before and after the intervention period, using handgrip dynamometry and being assessed with a visual analog scale (VAS) for pain, the six-minute walk test (6MWT) for functional capacity, the BORG scale for exertion perception, and the SF-36 scale for quality of life. Results: A significant increase (p<0.05) in quality of life was observed in the IG in the SF-36 domains of physical functioning, physical role limitations, bodily pain, and increased handgrip strength. There was a significant difference (p<0.05) between the groups for perceived exertion before and after the intervention. No significant differences were found among the other variables. Conclusion: The physiotherapeutic intervention program improved the quality of life assessed with the SF-36 domains of physical functioning, physical role limitations, and bodily pain, and increased handgrip strength of patients with symptoms of post-COVID-19 syndrome.

Cognitive impairment in post-acute COVID-19 syndrome: a scoping review / Comprometimento cognitivo na síndrome pós-COVID-19 aguda: uma revisão de escopo

Abstract Emerging studies indicate the persistence of symptoms beyond the acute phase of COVID-19. Cognitive impairment has been observed in certain individuals for months following infection. Currently, there is limited knowledge about the specific cognitive domains that undergo alterations during the post-acute COVID-19 syndrome and the potential impact of disease severity on cognition. The aim of this review is to examine studies that have reported cognitive impairment in post-acute COVID-19, categorizing them into subacute and chronic phases. The methodology proposed by JBI was followed in this study. The included studies were published between December 2019 and December 2022. The search was conducted in PubMed, PubMed PMC, BVS - BIREME, Embase, SCOPUS, Cochrane, Web of Science, Proquest, PsycInfo, and EBSCOHost. Data extraction included specific details about the population, concepts, context, and key findings or recommendations relevant to the review objectives. A total of 7,540 records were identified and examined, and 47 articles were included. The cognitive domains most frequently reported as altered 4 to 12 weeks after acute COVID-19 were language, episodic memory, and executive function, and after 12 weeks, the domains most affected were attention, episodic memory, and executive function. The results of this scoping review highlight that adults with post-acute COVID-19 syndrome may have impairment in specific cognitive domains.

Resumo Estudos emergentes indicam a persistência dos sintomas além da fase aguda da COVID-19. O comprometimento cognitivo foi observado em alguns indivíduos durante meses após a infecção. Atualmente, há pouco conhecimento sobre os domínios cognitivos específicos que sofrem alterações durante a síndrome pós-aguda da COVID-19 e o possível impacto da gravidade da doença na cognição. O objetivo desta revisão é examinar estudos que relataram comprometimento cognitivo na COVID-19 pós-aguda, categorizando-os em fases subaguda e crônica. A metodologia proposta pela Joanna Briggs Institute foi seguida neste estudo. Os estudos incluídos foram publicados entre dezembro de 2019 e dezembro de 2022. A busca foi realizada no PubMed, PubMed PMC, BVS - BIREME, Embase, SCOPUS, Cochrane, Web of Science, Proquest, PsycInfo e EBSCOHost. A extração de dados incluiu detalhes específicos sobre a população, os conceitos, o contexto e as principais descobertas ou recomendações relevantes para os objetivos da revisão. Um total de 7.540 registros foi identificado e examinado, e 47 artigos foram incluídos. Os domínios cognitivos mais frequentemente relatados como alterados de 4 a 12 semanas após a COVID-19 aguda foram linguagem, memória episódica e função executiva e, após 12 semanas, os domínios mais afetados foram atenção, memória episódica e função executiva. Os resultados dessa revisão de escopo destacam que adultos com síndrome pós-aguda da COVID-19 podem apresentar comprometimento em domínios cognitivos específicos.