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A foreign body can be intentionally or accidentally ingested. Timing of endoscopy relies on foreign body shape and size, location in gastrointestinal tract, patient's clinical conditions, occurrence of symptoms or onset of complications. In this short case, we present a middle age woman, who accidentally swallowed a portion of a nasopharyngeal swab half-broken during a diagnostic test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Upper gastrointestinal endoscopy was promptly performed to prevent the swab from crossing the pylorus leading to serious complications and, therefore, risk of surgical intervention. The broken nasopharyngeal swab was detected in the gastric body, and immediately removed with a foreign body forceps. Our hospital performs many nasopharyngeal swabs and to our knowledge, this is only the second reported swab ingestion during SARS-CoV-2 test.Copyright © 2021 The Gastroenterological Society of Taiwan, The Digestive Endoscopy Society of Taiwan and Taiwan Association for the Study of the Liver.
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Introduction: The post-COVID-19 syndrome is characterized by the appearance of symptoms and sequelae up to four weeks after the acute symptoms of COVID-19 and can affect various systems, such as respiratory, hematological and hepatic. Cases of chronic fatigue, thromboembolism events, myalgia and the increase in enzymes associated with liver damage have been reported. It is known that individuals with chronic liver disease, cirrhosis and/or hepatocellular carcinoma are more likely to develop post-COVID-19 syndrome. In addition, mutations in the ABCB1 gene (G2677T, C3435T and C1236T) that encode the drug-export pump (P-glycoprotein) are associated with drug resistance and hepatotoxicity. The T1331C mutation in the ABCB11 gene encodes the bile salt-exporting pump and is associated with cholestasis. Therefore, these mutations may be an aggravating factor for the post-COVID-19 syndrome, especially in hepatocompromised individuals. Objective(s): The aim of this study was to assess the frequencies of mutations in the ABCB1 and ABCB11 genes and to monitor the post-COVID-19 syndrome in patients with liver disease. Material(s) and Method(s): We analyzed 197 samples from patients with chronic hepatitis C from the Liver Disease Outpatient Clinic of the Gaffree and Guinle University Hospital. Extraction and mutation analysis by qPCR was performed using TaqMan Assays. Result(s): In the ABCB1 gene, the most frequent mutation was C3435T (rs1045642) in 13.7% (TT), in this group 40.1% were wild-type (CC) and 46.2% were heterozygous (CT). For the C1236T (rs1128503) the frequency of wild-type (CC) was 45.2%, of heterozygotes (CT) 43.6% and mutants (TT) 11.2%. The lowest frequency of mutations in the ABCB1 gene was G2677T (rs2032582) in 8.6% of patients, 52.8% are wild-type (GG) and 38.6% are heterozygous (GT). As for the T1331C (rs2287622) in the ABCB11 gene, most individuals were heterozygotes - TC (51.8%), followed by wild-type - TT (34.0%) and mutants - CC (14.2%). Discussion(s): This is the first study to evaluate the association of cases and severity of post-COVID-19 syndrome with mutations in the ABCB1 and ABCB11. So far, there are only reports in the literature of the association of this mutations with liver damage and resistance to drugs used in the treatment of COVID-19, such as lopinavir and dexamethasone. Therefore, the presence of these mutations could influence the presence of the post-COVID-19 syndrome. Conclusion(s): We observed a greater presence of heterozygous individuals than the other genotypes in the population studied. It is necessary to investigate its association with cases of post-COVID-19 syndrome in hepatocompromised patients, in order to establish the risks associated with the syndrome in these individuals and to understand the influence of these polymorphisms on the clinical picture and evolution of these individuals. Support: CAPES and FAPERJ. Copyright © 2022
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Objetivos: Em todo o mundo em 2020, havia 37,7 milhoes de pessoas vivendo com o virus da imunodeficiencia humana (HIV). O tratamento clinico utiliza uma combinacao de medicamentos antirretrovirais, sendo que, o paciente apos alguns meses pode alcancar a supressao viral, ficando com niveis indetectaveis de carga viral. Adicionalmente, pacientes com niveis indetectaveis de carga viral ha varios meses, nao transmitem o virus por via sexual. Dessa forma, torna-se importante o controle da carga viral para evitar novas transmissoes. Recentemente, a relacao neutrofilo/linfocito (RNL) e plaquetas/linfocitos (PLR) vem sendo estudadas quanto ao seu papel prognostico em diferentes infeccoes como preditor de gravidade e desfecho da doenca. Nesse contexto, nosso objetivo e avaliar se a RNL e PLR conseguem predizer carga viral detectavel em pessoas vivendo com HIV. Material e metodos: Estudo transversal com 651 pessoas vivendo com HIV atendidas pelo Servico de Atendimento Especializado (SAE) de Divinopolis/MG no ano de 2019. Foram coletados os dados sociodemograficos, resultados do hemograma e carga viral mais recentes nos prontuarios medicos. Os pacientes foram divididos em dois grupos: grupo 1 (n = 522) carga viral indetectavel e grupo 2 (n = 129) carga viral detectavel. A caracterizacao da carga viral indetectavel foi considerada abaixo de 50 copias/ml. A analise estatistica foi realizada usando o SPSS (ver.19.0). As comparacoes entre dois grupos foram realizadas pelo teste de Mann-Whitney. Para avaliar o desempenho da RNL e PLR como ferramenta para preditora de carga viral detectavel, a area sob a curva ROC foi calculada. O nivel de significancia foi de p < 0,05. Resultados: Dentre os pacientes com carga viral indetectavel, 310 (59%) eram do sexo masculino e 212 (41%) do sexo feminino, enquanto no grupo com carga viral detectavel 67 (52%) do sexo masculino e 62 (48%) do sexo feminino. Ao avaliar a RNL do grupo 2, a mediana foi significativamente maior, 1,69 (1,09 - 2,57), quando comparada com o grupo 1: 1,54 (1,07 - 2,04) (p = 0,020). A PLR tambem foi significativamente maior no grupo 2: 125 (88 - 175), enquanto no grupo 1: 111 (85 - 142) (p = 0,015). A curva ROC foi realizada para avaliar a performance da RNL e PLR em discriminar os dois grupos de estudo. A area sob a curva foi estatisticamente significativa (AUC= 0,566, p = 0,020) para a RNL e PLR (AUC= 0,569, p = 0,015). Discussao: A RNL e PLR vem sendo muito estudadas, de modo que muitos estudos foram realizados para avaliar o valor preditivo em diferentes infeccoes sendo uma delas a COVID-19. Ademais, a RNL e PLR sao de facil aquisicao e reproducao, alem de apresentar baixo custo, quando comparadas com o exame de analise de carga viral. Nesse estudo, a RNL e PLR mostraram-se elevadas em pacientes vivendo com HIV com carga viral detectavel, quando comparadas com aqueles com carga viral indetectavel, sugerindo uma provavel aplicabilidade clinica na avaliacao da carga viral. Conclusao: A RNL e PLR foram mais elevadas nos pacientes com carga viral detectavel, assim inferimos, que a determinacao de RNL e PLR pode ser util para auxiliar na avaliacao de carga viral em pacientes vivendo com HIV. Contudo, e importante ressaltar que se trata de um estudo piloto, dessa forma, sao necessarios estudos prospectivos para avaliar a RNL e PLR no controle de carga viral. Financiamento: CAPES, CNPq e FAPEMIG. Copyright © 2022
ABSTRACT
A foreign body can be intentionally or accidentally ingested. Timing of endoscopy relies on foreign body shape and size, location in gastrointestinal tract, patient's clinical conditions, occurrence of symptoms or onset of complications. In this short case, we present a middle age woman, who accidentally swallowed a portion of a nasopharyngeal swab half-broken during a diagnostic test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Upper gastrointestinal endoscopy was promptly performed to prevent the swab from crossing the pylorus leading to serious complications and, therefore, risk of surgical intervention. The broken nasopharyngeal swab was detected in the gastric body, and immediately removed with a foreign body forceps. Our hospital performs many nasopharyngeal swabs and to our knowledge, this is only the second reported swab ingestion during SARS-CoV-2 test.
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OBJECTIVE: To analyze the epidemic of COVID-19 in northeastern Brazil, one of the regions most affected by the virus. METHODS: The official data for COVID-19, from March 2020 to March 2021 in the states of the Northeast Region (NE), were used. The analysis of capital cities and states for accumulated weekly cases and confirmed deaths was made using the JoinPoint Trend Analysis application. RESULTS: In one year, the Northeast region reported 22.9% of the cases and 21.5% of the deaths in the country due to C OVID-19. At the beginning of the pandemic, all states showed a growing number of cases, first in the capitals and then in the interior. Following this wave, decreases are observed in all states and their capitals, but with many still reporting a large number of cases. In the middle of the 2nd semester of 2020 the number of cases begins to increase again simultaneously in states and their capitals-some at explosive speed-especially in late 2020 and early 2021. A similar pattern is observed in deaths, which exceed or approach the peak seen in the first wave. In the first wave, all capitals and northeastern states adopted intense isolation measures. Fortaleza, Recife and Teresina reached the highest isolation index of all capitals, close to 0.60. This index decreases, with a slight growth trend until the end of December. With the exception of Fortaleza and Salvador, the other capitals fell to less than 0.40. CONCLUSION: The Brazilian NE and the country are in increasingly complicated health, social and economic situations. It is necessary to speed up vaccinations and maintain nonpharmacological measures: face masks, social distancing measures and hygiene care, in addition to policies to protect workers who have lost their incomes and to subsidize small business owners.
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In order to support accelerating the diffusion of innovations in high value manufacturing related to enabling flexible mass customization, this paper presents a research-based maturity model for forecasting the speed of innovation diffusion from ideation to market saturation. The model provides an early stage applied research view of (groups of) "game changing" variables, which accelerate diffusion of innovations to significantly reduce financial uncertainty and minimize the time to derive value from the original idea. The model is applied to multiple case studies related to the repurposing and customization of existing mass manufacturing infrastructures and processes to meet novel requirements. Case studies include among others a reference model based on a literature review, the diffusion of 3-D printing technology in manufacturing, the diffusion of novel cement manufacturing technology and the manufacturing of intensive care ventilators during the Covid-19 pandemic. The diffusion of innovation model applied is based on diffusion of innovation principles founded in the research of Everett Rodgers, the Bass Diffusion Curve and aligned to recent advances in living (eco-) systems theory. Special emphasis is placed on determining not only the relevance of "known-known" success factors for rapid innovation diffusion, but also on identifying "unknown-unknown" game changers enabling the required changes at pace. Key findings are that "game changing" factors for the innovations are primarily the interdependent availability of budget and resources to achieve market saturation, urgency of need shared by all participants, observability of impact (value creation) and compatibility with existing ways of work. Critical as well is population of all diffusion web roles with unique individuals. Further research is suggested regarding the dependency of assessed variable (groups) and the integration of Technical Readiness Level phases into the forecasting model. © 2020 Elsevier B.V.. All rights reserved.
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Objectives: to evaluate the morbidity and mortality profile and factors associated with death due to severe acute respiratory syndrome (SARS) by COVID-19 in pregnant and postpartum women. Methods: this is a quantitative and retrospective research that analyzed the SIVEP-gripe Database (Influenza Epidemiological Surveillance Information System), from 01/01/2020 to 04/01/2021. All pregnant women and postpartum women diagnosed with SARS caused by COVID-19 in the State of Minas Gerais were included. After the descriptive analysis of the hospitalizations profile, the association between different exposure variables and the occurrence of death was evaluated. Results: of the 227 records obtained, 94.3% required hospitalization. Among hospitalizations in the Intensive Care Unit, 29.8% used invasive ventilatory support. Fifteen deaths were recorded. The most frequent clinical manifestations were: cough and fever;the predominant comorbidities were cardiovascular disease and diabetes mellitus. The variables “ICU stay”, “use of ventilatory support” and “heart disease” were associated with the occurrence of deaths. Conclusions: hospitalization was necessary for most pregnant women with SARS and the presence of previous heart disease increased the risk of death. Knowing the SARS morbidity and mortality profile is important in the definition of public health strategies aimed at reducing the impacts of COVID-19 during pregnancy and the puerperium. © 2021, Instituto Materno Infantil Professor Fernando Figueira. All rights reserved.
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INTRODUCTION: A marked proportion of patients with obesity has insulin resistance and hyperactivity of the renin-angiotensin-aldosterone system, which may be related to the worse results caused by SARS-CoV 2. In addition, the angiotensin 2-converting enzyme has greater expression in adipose tissue when compared to the lung, being susceptible to the entry of the virus in the adipocytes making it an important viral reservoir allowing the spread to too many organs. OBJECTIVE: To identify whether obesity can be a more serious predictor and worse prognosis for Coronavirus Disease 2019 (COVID-19). MATERIALS AND METHODS: Systematic review under the code CRD42020200617 with observational studies through the PubMed databases, the VHL Regional Portal, SciELO, Science Direct and Cochrane, and manual searches using the “Prognosis” OR “Patient Acuity” AND “ Coronavirus Infections " AND " Obesity ". Observational studies that assess the impact of COVID-19 in common with obesity of both sexes that assess a score ≥7 on the Newcastle-Ottawa scale were included. RESULTS: 9 studies were included, totaling a sample of 179,047 adult patients aged 18 to 80 years, with a minimum BMI <24 kg / m2 and a maximum> 35 kg / m2. It was found that with obesity, he wishes to present an increase in the admission rates for acute and mandatory care, invasive mechanical necessity IMV), pneumonia and develop severe COVID-19, thus increasing their hospital stay. CONCLUSION: Individuals with obesity develop greater severity and worse prognosis for COVID-19, since there is an increase in admission rates for acute and mandatory care, need for IMV, length of hospital stay, severity and lethality. © 2020, BAHIANA - School of Medicine and Public Health. All rights reserved.
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The COVID-19 pandemic has affected a large number of patients in all countries, overwhelming healthcare systems worldwide. In this scenario, surgical procedures became restricted, causing unacceptable delays in the treatment of certain pathologies, such as glioblastoma. Regarding this tumor with high morbidity and mortality, early surgical treatment is essential to increase the survival and quality of life of these patients. Association between COVID-19 and neurosurgical procedures is quite scarce in the literature, with a few reported cases. In the present study, we present a rare case of a patient undergoing surgical resection of glioblastoma with COVID-19.