Clinical characteristics of older patients with COVID-19: a systematic review of case reports / Características clínicas de pacientes idosos com covid-19: uma revisão sistemática de relatos de casos

ABSTRACT. In the context of the current COVID-19 pandemic, higher morbidity and mortality have been reported in older adults. This age group presents physiological changes and its own clinical conditions such as frailty, dementia, among others. Objective: To describe the characteristics of COVID-19 patients, both over and under 80 years old, by conducting a systematic review of the literature describing case reports, and to summarize and critically assess these characteristics. Methods: Systematic review. The study was registered on the Registry of Health Research Projects (PRISA) of the Peruvian National Institute of Health (code EI00000631). Five electronic databases (Scopus, PubMed, PubMed Central, LILACS, and SCIELO) were systematically searched during the period between December 31, 2019 and April 16, 2020. The search focused on case reports, case studies, and case series of older people with COVID-19 infection aged over or under 80 years. When selecting the cases, priority was given to clinical and epidemiological profile, laboratory and imaging patterns, and comprehensive geriatric evaluation. Results: 1,149 articles were identified; after applying the filters, a total of 15 publications of case reports and complete records of 27 older adults were obtained. The most frequent age group was between 60 to 69 years old. There is little literature regarding case reports of older adults aged over 80 years. The most frequent parameters were hypertension, fever, cough, respiratory distress, ground-glass opacification in chest radiography and tomography. Furthermore, decrease in PaO2/FiO2 ratio and lymphocytes, and increase in C-reactive protein and Interleukin 6 were observed. Conclusions: This systematic review found little available information of patients under 80 years old, and far less for those over 80 years old, and an absence of comprehensive geriatric assessment.

RESUMO. No contexto da atual pandemia de covid-19, maior morbidade e mortalidade têm sido relatadas em idosos. Sabe-se que essa faixa etária apresenta alterações fisiológicas e condições clínicas próprias, como fragilidade, demência, entre outras. Objetivo: Descrever as características de pacientes com covid-19, maiores e menores de 80 anos, por meio de uma revisão sistemática da literatura que descreve relatos de casos, e resumir e avaliar criticamente essas características. Método: Revisão sistemática. O estudo foi registrado no Registro de Projetos de Pesquisa em Saúde (PRISA) do Instituto Nacional de Saúde do Peru (código EI00000631). Local: cinco bases de dados eletrônicas (Scopus, PubMed, PubMed Central, LILACS e SCIELO) foram sistematicamente pesquisadas entre 31 de dezembro de 2019 e 16 de abril de 2020. A busca se concentrou em relatos de caso, estudos de caso e séries de casos mais antigos pessoas com infecção por SARS-CoV-2 com mais e menos de 80 anos. Na seleção dos casos, a prioridade foi dada ao perfil clínico e epidemiológico, padrões laboratoriais e de imagem, e avaliação geriátrica abrangente. Resultados: Foram identificados 1.149 artigos. Após a aplicação dos filtros, obteve-se um total de 15 publicações de relatos de caso e registros completos de 27 idosos. A faixa etária mais frequente foi de 60 a 69 anos. Há pouca literatura sobre relatos de casos de adultos com mais de 80 anos. Os parâmetros mais frequentes foram hipertensão, febre, tosse, dificuldade respiratória, vidro fosco na radiografia e tomografia de tórax. Também foram observados diminuição da PaO2 / FiO2 e linfócitos, e aumento da proteína C reativa e Interleucina 6. Conclusões: Esta revisão sistemática encontrou poucas informações disponíveis sobre pacientes com menos de 80 anos, em quantidade ainda menor para aqueles com mais de 80 anos, além de uma ausência de avaliação geriátrica abrangente.

Efecto antinociceptivo y antiinflamatorio de la metformina en modelos experimentales en ratón / Antinociceptive and anti-inflammatory effect of metformin in experimental models conducted in mice

Objetivo: Analizar la actividad antiinflamatoria y antinociceptiva de la metformina en un evento agudo de inflamaciónedema y dolor inducido en roedor. Materiales y métodos: Se utilizaron 198 ratones hembras. Se evaluó el efecto antiinflamatorio con la prueba de edema plantar inducido por carragenina en 64 ratones y, para evaluar el efecto sobre el dolor, se utilizó la prueba de placa caliente e inmersión de la cola, con 64 y 70 ratones, respectivamente. En ambos casos se tuvieron grupos controles, placebo y experimentales. Para el análisis se emplearon las pruebas de Shapiro-Wilk, de ANOVA de una cola, de Tukey y correlación de Pearson. Resultados: En el edema de la pata por carragenina, los grupos metformina 50 y 150 mg/kg presentaron efecto antiinflamatorio a la segunda y tercera hora. En la prueba de placa caliente, los grupos metformina 100, 200 y 250 mg/kg presentaron efecto analgésico en la segunda y cuarta hora. En la prueba de inmersión de cola, los grupos metformina 100, 150, 200 y 250 mg/kg presentaron efecto analgésico desde el minuto 15 hasta terminar el experimento; además, el grupo metformina 150 mg/kg tuvo efecto estadísticamente equivalente al grupo control de morfina 10 mg/kg. Conclusiones: Se demuestra la actividad antiinflamatoria y antinociceptiva aguda de metformina a diferentes dosis, en modelos experimentales con ratones.

Objective: To analyze the anti-inflammatory and antinociceptive activity of metformin in an acute event of inflammation-edema and pain induction in rodents. Materials and methods: One hundred ninety-eight (198) female mice were used. The anti-inflammatory effect was evaluated in 64 mice using the carrageenan-induced paw edema test, and the antinociceptive effect was assessed in 64 and 70 mice using the hot plate test and the tail immersion test, respectively. In both cases, there were control, placebo and experimental groups. For the analysis, the Shapiro-Wilk test, one-way ANOVA test, Tukey test and Pearsonian coefficient of correlation were used. Results: In the carrageenan-induced paw edema test, the metformin 50 and 150 mg/kg groups showed an antiinflammatory effect at the second and third hours. In the hot plate test, the metformin 100, 200 and 250 mg/kg groups showed an antinociceptive effect at the second and fourth hours. In the tail immersion test, the metformin 100, 150, 200 and 250 mg/kg groups showed an antinociceptive effect from minute 15 until the end of the experiment. In addition, the metformin 150 mg/kg group had a statistically equivalent effect to the morphine 10 mg/kg control group.

Análisis de la actividad sexual de gestantes sin riesgo obstétrico que acuden a hospitales públicos de Lima Metropolitana, Perú / Analysis of sexual activity in pregnant women without obstetric risk attending public hospitals in Lima, Peru

Conocer las características de la actividad sexual en gestantes sin riesgo obstétrico que acuden a hospitales públicos de Lima Metropolitana. Material y Métodos: Estudio exploratorio, multicéntrico, descriptivo y transversal, realizado durante el primer semestre del 2014 en 9 hospitales públicos de Lima Metropolitana. La muestra fue conformada por las gestantes sin riesgo obstétrico que asistieron a los Consultorios Externos de los Servicios de Obstetricia. Se usó un modelo no probabilístico por conveniencia. En quiénes aceptaron voluntariamente participar y firmaron el consentimiento informado, se realizó una encuesta validada por expertos. La información fue analizada usando el software STATA 21. Resultados: Se encuestaron 1991 gestantes, 924 (46,4%) tenían entre 15 y 25 años, la mayoría eran casadas, y católicas (81,8%) y 1380 (69,3%) habían nacido en Lima. La mayoría, era multigesta (46,3%), con embarazo a término y 86,3%, afirmó no haber tenido RN pre-término. 1347 (67,6%) tenían parto vaginal. La frecuencia de actos sexuales, el deseo sexual, el patrón de respuesta y el miedo a ejercer relaciones sexuales disminuyó de periodicidad a mayor edad gestacional. El miedo a tener actos sexuales aumentó de 12,6% a 76,2% en el tercer trimestre. La mayoría, refirió ausencia de orgasmo durante el coito (42,8%).La posición para el acto sexual pasó de ôÉl sobre ellaõ durante el primer trimestre a ôDe ladoõ, durante el tercer trimestre, con significancia estadística. Conclusión: A mayor edad gestacional, la actividad sexual en las gestantes de Lima Metropolitana tiende a disminuir en frecuencia, deseo, y ciclo de respuesta. Siendo la posición ôDe ladoõ la más utilizada en el tercer trimestre...

To know the characteristics of sexual activity in pregnant women without obstetric risk who attend public hospitals in Lima. Material and Methods: exploratory, multicenter, descriptive and cross-sectional study, conducted during the first half of 2014 in 9 public hospitals in Lima. The sample was made up of pregnant women without obstetric risk who attended the outpatient clinic of obstetric departments. A non-probabilistic model is used for convenience. An expert validated survey was conducted on patients who voluntarily agreed to participate and signed the informed consent. The information was analyzed using STATA21 software. Results: 1991 pregnant women answered the survey, 924 (46.4%) were between 15 and 25 years, most were married, and Catholic (81.8%) and 1380 (69.3%) were born in Lima. Most had several previous pregnancies (46.3%), with term pregnancy and 86.3% informed they had no pre-term infants. 1347 (67.6%) had vaginal delivery. The frequency of sexual acts, sexual desire, the response pattern and the fear of exercising sexual intercourse decreased at higher gestational age. Fear of sex acts increased from 12.6% to 76.2% in the third trimester. Most informed of a lack of orgasm during intercourse (42.8%). The position for intercourse went from "him on her" in the first trimester to "sideways" during the third trimester, with statistical significance. Conclusion: sexual activity in pregnant women of Metropolitan Lima tend to decrease in frequency, desire, and response cycle. The "sideways" position was the most often used in the third trimester...

Acción analgésica y neurofarmacológica de las fracciones soluble y no soluble del extracto etanólico de la semilla de Jatropha curcas L. / Analgesic and neuropharmacological activities of soluble and not soluble fractions of the ehtanolic extract from Jatropha curcas L. seeds

Introducción. Estudios preclínicos evidencian efectos dosis dependiente sobre la analgesia e inflamación y neurotoxicidad de las hojas, corteza y raíz de J. curcas L. El propósito del estudio fue evaluar la actividad analgésica y neurofarmacológica de las fracciones de la semilla de J. curcas L. Métodos. Estudio experimental, preclínico y prospectivo. Se distribuyeron 48 ratones en seis grupos control: ácido acético, diclofenaco, tramadol, agua destilada, diazepam y cafeína. Cuatro grupos experimentales: fracción soluble a 500 mg/kg y fracción no soluble a 250, 500 y 750 mg/kg; se evaluó los efectos sobre la algesia, por medio de la prueba de contorsiones abdominales por ácido acético a 1,5 %, y las manifestaciones neurológicas, mediante la prueba de Irwin. Se realizaron pruebas para el análisis de las variables cuantitativas y para las variables cualitativas. Resultados. La inhibición de las contorsiones fue 62,27 %, 56,86 %, 44,12 % y 42,06 % para los grupos 5, 2, 4 y 3, respectivamente. Las manifestaciones neurológicas de los grupos experimentales mostraron presencia y significancia de las variables excitación, sacudidas de cabeza, rascarse, incoordinación motora, cola de Straub, piloerección y estereotipias. Las variables estereotipias y rascado se presentaron en las dos fracciones. Conclusión. La fracción soluble y la no soluble del extracto etanólico de J. curcas L. presentaron efecto analgésico y efectos tóxicos a nivel del sistema nervioso central.

Introduction. Preclinical studies show the dose dependent effects on the analgesia, inflammation and neurotoxicity of the leaves, bark and root. The purpose of the study was to evaluate the analgesic and neuropharmacological activity of the fractions of the seed J. curcas L. Methods. Experimental study, preclinical and prospective. 48 rats were distributed in 6 control groups: acetic acid, diclofenac, tramadol, distilled water, diazepam, caffeine. Four experimental groups: 500 mg/kg of soluble fraction and 250, 500 y 750 mg/kg of insoluble fraction; the effects on the algesia were evaluated using an exam of abdominal contortions with acetic acid on 1,5%; the neurological manifestations were measured with the Irwin test. To analyze the quantitative and qualitative variables exams were used. Results. The inhibition of the contortions were 62,27 %, 56,86 %, 44,12 % y 42,06 % for the groups 5, 2, 4 y 3, respectively. The neurological manifestations of the experimental groups showed the presence and significance of the variables: excitation, head twitches, scratching, motor incoordination, Straub tail, piloerection and stereotypies. The variables stereotypes and scratching presented themselves in the two fractions. Conclusion. The soluble and insoluble fraction of the ethanoic extract of J. Curcas L. presented analgesic and toxic effects on the central nervous system.