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Introduction and objective: Functional Intestinal Constipation is a disease of high prevalence and origin not fully clarified. However, its primary treatment involves lifestyle changes, like improving eating habits, exercising and increase of water intake. Materials and Methods: According to this, the present study aimed to evaluate intestinal habits and associated factors of teachers from a municipal school in the city of Passo Fundo, Rio Grande do Sul. Thus, a cross-sectional study was made with teachers aged 20 years or over. Data collection was done through an electronic form involving the Bristol Scale Tool, Rome III Criteria and a form about dietary habits based on the Food Guide for the Brazilian Population, sent to the institutional e-mail of the teachers. Socioeconomic issues and water intake were also evaluated. After the collection, data were analyzed by statistical software. Results: The prevalence of functional constipation was 44,7% (The Rome III Criteria) and 24,3% (Bristol Scale Tool). Furthermore, its prevalence was 1,727 times (95%CI = 1,135;2,629) higher in the. With moderate / regular eating habits compared to habits with excellent practices. Discussion: Results similar to the study are observed in the literature. Conclusion: This way, the present study observed that the prevalence of constipation was related to the eating habits of the studied population.
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The research aimed to analyze the curricular practices of literacy in Portuguese language classes adapted for Emergency Remote Teaching (ERT) due to the Covid-19 pandemic scenario. It was guided by the questioning: what are the didactic strategies used by a literacy teacher in the Portuguese language teaching-learning processes during the ERT? It was a case study qualitative research. The research locus was a public school in the municipal network of Maceio-Alagoas whose classes were taking place remotely. For the collection of empirical data, the curricular practices developed in a class of the 2nd year of elementary school were observed. The results showed that the literacy teacher used the WhatsApp application as a "virtual classroom," resorted to the Portuguese language textbook and carried out other complementary parallel activities. Regarding the (re)invention of practices, the teacher produced video classes, explanatory audios, sent texts, digitalized activity proposals and photographs, with the pedagogical intention of mediating children's learning.
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The article describes a strategy to facilitate access to pneumococcal conjugate vaccine 13 (PCV-13) for people living with HIV/AIDS (PLHIV) during the COVID-19 pandemic. Method: report on the experience regarding the organization of a care service for PLHIV in the city of São Paulo to facilitate access to PCV-13 in the framework of the 2020 influenza vaccination campaign during the COVID-19 pandemic. Results: through the integration between a PLHIV care service and an Immunization Center (CRIE in Portuguese), it was possible to offer PCV-13 to PLHIV at the point of care, reducing physical barriers to access to immunization. Thus, of the 1,906 PLHIV who passed through the service during the period March 23-July 31, 2020, 84.4% (1,609) received the influenza vaccine, PCV-13 or both. Of the 1609 vaccinated, 50.6% (814) were eligible and received PCV-13. Conclusion: offering the vaccine at the point of care and orienting PLHIV on the importance of vaccination as a disease prevention strategy, identifying those eligible to receive it, was an important action carried out by the institution together with the nursing team, as a strategy to facilitate access to vaccination. © This is an open-access article distributed under the terms of the Creative Commons Attribution License.
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Purpose: Knee osteoarthritis (KOA) is a chronic and irreversible degenerative joint disease that commonly causes pain and functional disability, which results in decreased mobility and quality of life. To minimize pain and disability, regular physical activity (PA) is strongly recommended. Despite the recommendation, patients often do not adhere to regular PA. Thus, it is necessary to understand the challenges of implementing physical activity by patients. Currently, the COVID-19 pandemic and protective measures have become a barrier for people with OAJ to practice PA regularly and to avoid sedentary behavior, which contributes to increased load and pain in the knees. Understanding these challenges would help to develop interventions to minimize that behavior and increase patient adherence. To explore the challenges of physical therapists and patients with KOA implementing regular physical activity during the COVID-19 pandemic. Method(s): Cross-sectional study with qualitative analysis. Thirty KOA patients were recruited for a semi-structured online interview. Interviews were recorded, transcribed and thematic analyzed. Result(s): Three themes arose: 1) the impact of the pandemic on KOA care (social isolation, mental health, lack of care routine);2) Facilitators of physical activity (lower pain, socialization, confrontation, financial resource, health);3) challenges of physical activity (available infrastructure, fear, lack of time and motivation, digital literacy, age, pain). Conclusion(s): Patients with KOA were impacted by the pandemic, experiencing facilitators and challenges of physical activity. Care may be improved by increasing the focus on the facilitators of physical activity and also, to help patients facing their challenges of physical activity.Copyright © 2023
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This article aims to identify the perception of a group of incubated projects about the importance of entrepreneurship as alternative to face the economic crisis due to the new coronavirus pandemic. Entrepreneurship is a transversal subject to many areas of research and has been the object of study within themes such as economic, technological and innovation. The crisis in several sectors caused by the pandemic of the new coronavirus, raised other research possibilities. With a qualitative approach and through the case study method, using a structured questionnaire, it sought to investigate a group of companies/projects incubated ina technology-based business incubator, in the municipality of Mossoro in the state of Rio Grande do Norte. With the results, it was possible to verify that incubated have a positive perception about the importance of entrepreneurship in facing the crisis, thus pointing out that it is an alternative for the post-pandemic crisis period.
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Introduction: Following the inception of the COVID-19 pandemic, chloroquine compounds were proposed as potential therapeutic strategies, at the cost of a potential increase in cardiovascular risk. We aimed to evaluate clinical outcomes of patients with COVID-19, comparing those using chloroquine compounds to individuals without specific treatment. Method(s): Outpatients with suspected COVID-19 in Brazil who had at least 1 ECG transmitted to a Telehealth Network, were prospectively enrolled in 2 arms (G1: treatment with chloroquine compounds and G2: without specific treatment) and G3: registry of other specific treatments. Outcomes were assessed through follow-up phone calls on days 3 and 14, and also administratively collected from national mortality and hospitalization databases. The primary outcome was composed of: hospitalization and all-cause death. The association between treatment groups and the primary outcome was evaluated by logistic regression. Significant variables (p<0.10) were included in 4 multivariate models: 1: unadjusted;2: adjusted for age and sex;3: adjusted for model 2 plus cardiovascular risk factors and 4: adjusted for model 3 plus COVID-19 symptoms (when available from phone contact). Result(s): In 303 days, 712 (10.2%) patients were allocated in G1 (chloroquine), 3623 (52.1%) in G2 (control) and 2622 (37.7%) in G3 (other treatments). Median age was 49 (IQR 38 - 62) years, 57% women. Of these, 1969 had successful phone contacts (G1: 260;G2: 871;G3: 838). The primary outcome was more frequent in groups 1 and 3 compared to the control group, when assessed exclusively by phone (G1: 38,5% vs. G2: 18,0% vs. G3: 34,2%, p<0,001) or combined with administrative data (G1: 19,5% vs. G2: 11,0% vs. G3: 18,2%, p<0,001). In the adjusted models, chloroquine independently associated with a greater chance of the primary outcome: phone contact (model 4): OR=3.24 (95% CI 2.31 - 4.54), p<0.001;phone + administrative data (model 3): OR=1.99 (95% CI 1.61 - 2.44), p<0.001. Chloroquine also independently associated with higher mortality, as assessed by phone + administrative data (model 3): OR=1.67 (95% CI 1.20 - 2.28). Conclusion(s): Chloroquine compounds associated with a higher risk of poor outcomes in outpatients with COVID-19 compared to standard care.
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Introduction: Evidence of several studies suggest that patients who have achieved a sustained stable deep molecular response (DMR) as MR4 and MR4.5 can be safely discontinued with close monitoring without relapse, despite BCR/ABL1 DNA remaining detectable. In Brazil, CML patients have received almost exclusively Imatinib as first-line treatment. However, in both scenarios there is a limit coverage of PCR exams/ year which allows for adequate monitoring but it is not sufficient for the implementation of TFR safely in eligible patients. Aim(s): To report a Brazilian single institution Imatinib discontinuation trial and to evaluate factors impacting treatment -free response (TFR) and treatment free survival (TFS) provided by own founds. Method(s): From 2020 -2021, 26 eligible patients were invited to participate in a single arm trial of Imatinib discontinuation (DIP). Inclusion criteria: age > 18 years, chronic phase, minimum of 04 years of Imatinib therapy, deep molecular response sustained > or = 02 years (confirmed by 04 tests in the last two years, defined MR4.0 or MR 4.5 and a confirmatory exam at the moment of the screening). Atypical transcripts were excluded. After discontinuation, patients were monitored by RT- PCR monthly in the first year, every two months in the second year and every three months since the third year. Criteria for Imatinib re-initiation: loss of MMR confirmed by two exams, loss of cytogenetic response, loss of hematologic response, disease progression. TFR was calculated from the date of discontinuation until first event: loss of MMR, Imatinib reintroduction, death any cause or last follow up. TFS was calculated from the date of imatinib discontinuation until reintroduction or last follow- up (censoring deaths not related to CML). The costs of exams were provided by own founds of our institution. Result(s): From 26 patients, 20 patients agreed to consent inform to discontinuation of imatinib. 06 patients declined despite information because their insecurity about TFR. Twelve patients (60%) presented MR4. Median age was 52.3 years old and 13 (65%) were female. Median time diagnosis to discontinuation of imatinib 8.04(4.6-15.5) years. Twelve (60%) patients sustained TFR. Seven patients of twelve had presented MR 4 and five had MR 4.5 in the screening, respectively. (p = 0,85). It means 58,3% of the total of patients with MR 4 and 62,5% with MR 4.5. In this interim analysis the median time of follow up was 14.5 (2.7-18.8) months. One patient died due to COVID19 with major molecular response (MMR). Eight (40%) lost MMR and imatinib was restarted. In this group the median time until MMR loss was 7.24 (2.1-13.8) months. At this moment, 07 patients (87,5 %) recovered MMR. In addition, in this group 06 patients (75%) achieved the same level of MR with reintroduction of imatinib with median 5.2 (3.7-6.3) months. Regarding adherence, 4 (20%) had some absences in monthly medical consultations and 1(5%) missed follow-up. Fifteen tests (6.14%) were performed to confirm MR loss, however only in 8 tests (53.3%) were confirmed. In fact, 04 patients (33,33%) still in TFR because of the double confirmatory test. There was no transformation to advanced phases. Gender, age at de diagnosis, age at discontinuation, Sokal, BCR-ABL trasncripts type, duration of Imatinib therapy, duration of MR 4.0 or MR4.5 did not affect TFR. Withdrawal syndrome occurred in 05 patients (25%);04 patients with grade 1 and 01 patient with grade 2, had been used corticosteroid for few days. Conclusion(s): The preliminary results of this trial demonstrated the feasibility and safety of Imatinib discontinuation, even using Brazilian copies, and the results were similar of that presented in another trials. Copyright © 2022
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Objetivos: Descrever caso de paciente com leucemia linfoblastica aguda Ph+, nao elegivel a transplante alogenico de medula ossea, em uso de ponatinibe como terapia de resgate. Material e metodos: Avaliacao de prontuario e pesquisa em base de dados. Resultados: Paciente do sexo feminino, 65 anos de idade, com antecedente de obesidade, asma e nefrolitiase, em investigacao de plaquetopenia, tendo feito uso de prednisona sem incremento da contagem plaquetaria. Avaliacao medular evidenciou leucemia linfoblastica aguda B (LLA-B) com cariotipo normal. Iniciada quimioterapia de inducao com protocolo GRAAL e realizada coleta de BCR-ABL de sangue periferico, que resultou positivo (p190). Diante desse dado, e devido a pandemia de covid-19, com o objetivo de minimizar toxicidades e evitar internacao hospitalar, o tratamento foi modificado para o protocolo GIMEMA LAL, baseado em dasatinibe 140 mg/dia e prednisona. A paciente evoluiu com resposta citomorfologica completa, doenca residual mensuravel negativa e BCR-ABL indetectavel apos 3 meses de tratamento. Nesse periodo, apresentou multiplas intercorrencias - diverticulite aguda, colite pseudomembranosa e artrite (posteriormente diagnosticada com artrite reumatoide). Enviada para avaliacao com equipe de transplante de medula ossea, sendo considerada inelegivel naquele momento devido as comorbidades e decidido por manter inibidor de tirosino quinase. Evoluiu com recaida apos sete meses de uso de dasatinibe, sendo submetida a reinducao com inotuzumabe-mini-Hyper-CVAD. Apos o primeiro ciclo, alcancou resposta citomorfologica completa, porem evoluiu com cefaleia persistente e perda visual a direita. Evidenciada hemorragia intracraniana, sem indicacao de abordagem neurocirurgica. Devido a essa intercorrencia, foi considerada definitivamente inelegivel ao transplante alogenico. Nesse interim, foi pesquisada e detectada a mutacao t315i. Diante da nova informacao e do evento adverso grave, iniciou uso de ponatinibe 30 mg/dia em monoterapia. A paciente segue em uso do medicamento, mantendo resposta citomorfologica completa, com doenca residual mensuravel positiva (0,36% de blastos residuais) e BCR-ABL detectavel apos dois meses de tratamento. Apresenta boa tolerancia ao tratamento, sem toxicidade hematologica ou cardiovascular. Apresentou episodio de diverticulite aguda, sem necessidade de internacao hospitalar. Discussao: Historicamente, LLA-B Ph+ e considerada uma doenca de mau prognostico, com taxas de sobrevida em longo prazo inferiores a 20% na era anterior aos inibidores de tirosino quinase (ITK). Entretanto, com o advento dessa terapia-alvo, os desfechos de pacientes com LLA-B Ph+ tem se equiparado ou mesmo ultrapassado os daqueles sem essa alteracao molecular. No presente caso, a paciente atingiu resposta molecular completa com uso de terapia a base de corticoide e ITK de segunda geracao, tendo evoluido com recaida associada a mutacao T315i. Segue em resposta citomorfologica apos dois meses de ponatinibe, sendo necessario maior periodo de acompanhamento para avaliar a profundidade da melhor resposta, bem como sua duracao. Conclusao: Ponatinibe e opcao terapeutica eficaz e com boa tolerancia para paciente com LLA-B Ph+ (t315i) inelegivel a quimioterapia intensiva. Copyright © 2022
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Introduction: Since the decree by the World Health Organization (WHO) of a global pandemic by SARS-CoV-2, social isolation measures have impacted children and adolescents mainly due to factors such as the importance of peers and group living for this population. Therefore, the objective of this study was to investigate in the literature the impact of the pandemic caused by the new coronavirus on the mental health of children and adolescents.
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Background: Covid-19 is associated with an increased risk of pulmonary embolism (PE) therefore, should the cut off d-dimer value be adjusted for these patients? Material(s) and Method(s): Retrospective and observational study to understand if there is a d-dimer cut-off that could guide clinics to perform a thoracic computed tomography angiography (CTA) in patients with covid-19. The population was covid-19 patients admitted to covid-19 dedicated wards of a University Hospital Centre for one year. Result(s) and Conclusion(s): 725 (52%) patients with covid-19 had a d-dimer value dosed during the first 5 days of the disease. Those, 63 (9%) did a CTA with a diagnosis of 16 (25%) PE. Gender was equally represented, median age was 70 years (ID=3.49) and the majority (94%) survived. Thirteen (81%) patients with PE had a d-dimer value above 2500 ng/mL (OR=9.244, 95% CI 2.248-9.837), with 7 (54%) with values over 10000 ng/mL, but in 3 (9%) it was under 1500 ng/mL. Seventy-three (63%) of patients with a d-dimer over 1500 ng/mL did not had a thoracic CTA performed. In our population PE was not a frequent outcome. The results are influenced by the low number of thoracic CTA performed because, even tough the cut-off d-dimer value used at our hospital to perform a thoracic CTA to exclude PE is 1500 ng/mL, most patients with that d-dimer value did not take the exam and so PE could not be excluded. Although in most PE cases the d-dimer value was above 2500 ng/mL, the results of our study cannot verify if that is a better cut-off value.
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The thoughts and propositions presented in this article are related to studies and practices I carried out in the academia as well as in basic education institutions within the context of the COVID-19 pandemic, more specifically in the first semester of the year 2021. This investigation aims to bring readings, empirical and subjective practices based on local knowledge that were systematized by the Black Brazilian Movement, according to the educator Nilma Lino Gomes. The theoretical emphasis is based on decolonial thought and methodological technique is derived from the concept of "escrevivencias" (writing-livings), from the female author Conceicao Evaristo, who, as the anthropologist Arturo Escobar and the educator Paulo Freire, rejects the distinction between knowing and doing. Besides, my writing radically questions the binary and asymmetric relations between nature and culture, local and global, theory and practice. As a result, this article presents a critique of (developmentalist) globalizing thought, which makes invisible bodies and cosmoperceptions of groups that were oppressed by the (modern) capitalist world-system. The conclusion is that the dimension of a locus of enunciation through a "body-territory" can contribute to the production of "glocalities", as I suspect happens through the mediation of a network of Black geographers, which was initially in my doctorate investigation. Networks that, as the Black feminist geographers, are not exclusive to Brazil, but find echoes in actions that pursue the fight for political, social and economic emancipation. A task that regards itself as decolonial in theory and practice.
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The coronavirus Covid-19 pandemic has caused an unprecedented global crisis. From the economic scenario until the Indigenous people’s lifestyle, including the typically capitalist society, has been significantly reshaped. As invisible characters in History, the Indigenous people of Paraná have been socially isolated and may be under non-measurable inequalities, misleading statistics, and limited support by the health institutions. This study aimed to analyze the vulnerabilities and resilience responses of the Indigenous people of Paraná to the Covid-19 pandemic and discuss the underreporting and inconsistency of data on confirmed cases and deaths by Covid-19 based on state and national health institutions. This research consists of descriptive and qualiquantitative analysis conducted online that lasted ten months in which: (i) data from two governmental health institutions responsible for monitoring Covid-19 among the Indigenous people of Paraná and two Indigenous were collected and compared;and (ii) perceptions from the Indigenous people of Paraná through interviews and responses to the considered problem at indigenous organizations. As non-conclusive results, it is mentioned: (a) the confirmed cases and deaths by Covid-19 among Indigenous people of Paraná were discrepant according to the considered health institutions;(b) the Indigenous people of Paraná have probably got limited access to health services, including the lack of Covid-19 testing that may be influencing on the underreporting data, and (c) the transparency of methods of data collection and publishing has been inadequate among the studied health institutions. © 2022 Universidade Federal do Parana. All rights reserved.
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The new coronavirus pandemic has brought disruption to the world. One of the significant dilemmas to be solved by countries, especially in underdeveloped countries like Brazil, is the lack of mass testing for the population. An alternative to these tests is detecting the disease through the analysis of radiographic images. To process different types of images automatically, we employed deep learning algorithms to achieve success in recognizing different diagnostics. This work aims to train a deep learning model capable of automatically recognizing the Covid-19 diagnosis through radiographic images. Comparing images of coronavirus, healthy lung, and bacterial and viral pneumonia, we obtained a result with 94% accuracy.
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With the adoption of social distancing as a way to prevent Covid-19, classroom lessons were replaced by distance activities, with significant use of digital platforms. However, several limits have been observed in this form of school reorganization that, in addition to not guaranteeing access for all, has impacts on the teaching work. The present text discusses these impacts, based on the analysis of data from research being developed in a city in the Zona da Mata region of Minas Gerais, whose objective is to identify the perceptions of teachers who work in basic education about their work, during the pandemic context. The quantitative and qualitative study relies on the theoretical support of authors such as Ball, Mainardes, Oliveira, Tardif and Lessard and uses an online questionnaire and interviews. The data obtained so far indicate an overload of teaching activities, modifications in the learning process, and the influence of private groups in the conception of education.
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Objective: To compare absenteeism in Hospital Nursing before and during the COVID-19 pandemic. Method: A cross-sectional study. It involved compilation of the records of absence from Nursing work at a university hospital in southern Brazil in March, April and May 2019 (n=622) and during the same period in 2020 (n=475). The data were analyzed by means of descriptive and analytical statistics. Results: Both periods presented the same absence frequencies in women (98.4%;98.3%), aged between 40 and 49 years old (47.9%;44.8%) and working in wards for adults (30.7%;29.2%). Absenteeism-Disease was the most prevalent cause (48.4%;48%). The absolute number of absence cases was higher in the prepandemic period;however, the time in days and hours lost, as well as the absenteeism rate (13.9;18.6%), was significantly higher (p-value<0.001) in the current pandemic period. Conclusion: The COVID-19 pandemic exerted an impact on the increase in Hospital Nursing absenteeism. © 2022, Universidade Federal de Santa Catarina. All rights reserved.
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Objetivos: Desenvolvimento e implementação de reforço do processo de captação ativa de doadores de sangue, a fim de suprir as demandas do Hospital Cristo Redentor (HCR), especializado no atendimento às vítimas de trauma na cidade de Porto Alegre/RS, tendo início em setembro de 2020. Material e métodos: Elaboração e implementação de um fluxo de abordagem humanizada, educativa e transparente dos usuários e familiares para captação/ sensibilização quanto à importância da doação de sangue. O fluxo tem início na entrada do paciente no hospital, adotando estratégia mais abrangente com todos os familiares dos pacientes internados. A solicitação de doadores varia conforme o tipo de cirurgia a ser realizado. As abordagens ocorrem com os pacientes ambulatoriais que internam para realizar cirurgias eletivas, durante a consulta médica e de enfermagem e na marcação cirúrgica. Os pacientes internados vindos da emergência têm seus familiares abordados pela equipe do Serviço Social, de forma a esclarecer as dúvidas referentes à doação e entendimento da importância quanto à necessidade de manter os estoques de hemocomponentes para atender as demandas da hemoterapia. Resultados: A partir da implementação do fluxograma de captação/sensibilização de doadores ocorreu aumento do número de doações direcionadas ao HCR recebidas no Banco de Sangue do Hospital Nossa Senhora da Conceição, que abastece a demanda de estoques de hemocomponentes do serviço. A Agência Transfusional do HCR realiza em média 250 transfusões mensais (período da pandemia), dessas 174 são de Concentrado de Hemácias (CH). O cálculo do percentual de doadores reposição é realizado de acordo com a equação: número de doadores aptos/número total de transfusões de CH. O percentual de reposição foi de 54% (1° semestre 2020) para 111% (2° semestre 2020) e 140% (1° semestre 2021). Discussão: Considerando a drástica diminuição de doações de sangue durante o período da pandemia de COVID-19 e a necessidade de manter um estoque adequado para atendimento de vítimas de trauma, foi necessário o desenvolvimento de estratégias que possibilitassem um incremento do número de doações, a fim de suprir as demandas da Agência Transfusional do HCR. Após a implementação de uma abordagem mais ativa sobre a importância da doação de sangue, observamos uma maior mobilização de amigos e familiares de pacientes internados e consequentemente aumento no número de doações para o HCR, mesmo em nome de pacientes que não necessitaram efetivamente de transfusão. Conclusão: O trabalho de captação de doadores é uma tarefa contínua e integrada que requer participação de todos profissionais da saúde. Diante das adversidades enfrentadas na pandemia, diminuição da capacidade de atendimento de doadores no Banco de Sangue, doações com horário marcado e o isolamento social foi necessário criar métodos para continuar atendendo a demanda de transfusões. O esclarecimento quanto à segurança da doação e da importância da mesma para familiares dos pacientes foi fundamental para o engajamento no processo de captação de doadores. Esse esforço resultou em um salto na média de doadores de reposição de 54% no primeiro semestre de 2020 para 140% no primeiro semestre de 2021. Um aumento considerável no número de doadores de sangue mesmo em um período complicado por tantas restrições.
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Objetivo: Correlacionar as internações hospitalares por embolia e trombose arteriais com as infecções por SARS-Cov-2 no Brasil, através da lista de morbidade do CID-10 (CID 10 - I74) no período de maio de 2020 a maio de 2021. Materiais e métodos: Estudo epidemiológico, descritivo e retrospectivo, de análise quantitativa, cuja fonte de dados foi o Sistema de Morbidade Hospitalar (SIH-SUS) do Ministério da Saúde, tabulados em gráficos e tabelas no programa Microsoft Excel 2016. Resultados: Entre maio de 2020 e maio de 2021 foram observadas 24.971 internações por embolia e tromboses arteriais, sendo que 23.209 (93%) foi em caráter de urgência. Já entre maio de 2019 e abril de 2020 o número de internações foi de 20.706, valor que entre maio de 2018 e abril de 2019 foi de 20.400. Discussão: A infecção por SARS-Cov-2 em pacientes que desenvolvem a forma grave da Covid-19 é associado ao maior risco de formação de coágulos e, consequentemente, de embolias e tromboses. Uma das principais teorias para explicar a associação entre Covid-19 e coagulopatias é que o estado de hiperinflamação provoca uma desregulação nos eventos trombóticos. Desse modo, o aumento de 12% no número de internações por embolia e trombose arteriais observados entre maio de 2020 e maio de 2021 quando comparado ao período de maio de 2019 a abril de 2020 pode ter sido causado pela pandemia da Covid-19 iniciada em março de 2020. Além disso, uma análise retrospectiva mostra que esse aumento foi o maior em números absolutos nos últimos cinco anos. Conclusão: É possível notar o aumento do número de casos de embolias e tromboses arteriais no contexto pandêmico, corroborando com os estudos que associam a Covid-19 com os distúrbios da coagulação.
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Introduction: Obesity is a chronic disease that poses health risks and is associated with severe forms of COVID-19. During the COVID-19 pandemic, psychological difficulties may emerge more often in obese patients. Objective: to evaluate possible impacts when coping with the pandemic in patients in the preoperative period for bariatric surgery. Method: A cross-sectional descriptive study with a qualitative approach and data collected through semi-structured interviews. The sample was composed of patients in the preoperative period for bariatric surgery. Three main thematic axes were previously established, and after transcribing the interviews, the answers were analyzed and classified into categories. Results: Seventeen patients in the preoperative period for bariatric surgery were interviewed, 10 females and 7 males. The mean age of participants was 36.7 ± 13.6 years, and the mean body mass index was 43.9 ± 8.4 kg/m2. The patients had difficulties in following the nutritional protocol and performing physical activities, which are important in preparing for bariatric surgery. The moment experienced during the COVID-19 pandemic caused sequels, particularly emotional ones, in the interviewees. Conclusion: It is important to maintain frequent monitoring by multidisciplinary teams for these patients during the pandemic, even if remotely, to improve the management of their physical and mental health in the preoperative period of bariatric surgery.
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Introduction: Patients with COVID-19 admitted to the ICU are at high risk of developing infectious complications during their ICU stay. Data on acquired(AI) in Portuguese critical COVID-19 patients are scarce. The aim of this study was to investigate the characteristics and risk factors for AI in critical patients with COVID-19 pneumonia admitted to the ICU. Methods: Retrospective cohort of patients with COVID-19 pneumonia admitted to an ICU in a tertiary hospital, between September 2020 and June 2021. AI considered were ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT), bacteremia, CVC associated infections, urinary tract infections and soft skin tissue infections. Baseline characteristics, 3-months previous antibiotic (ATB) exposure, ATB treatment at ICU-admission and clinical management of COVID-19 pneumonia were analyzed. Results: Of the 159 patients included, with a median (IQR) age of 66 (57-72) and 63.5% males, 14 (8.8%) had no known comorbidities. A total of 63 patients(39.6%) developed AI: 45(71.4%) VAP, 20(33.3%) VAT, 28 (45.2%) UTI, 6 (9.5%) CVC associated infections and 3(4.8%) soft skin tissue infections. In univariate analysis, both SOFA score at admission (p < 0.001), acute cardiovascular (p = 0.003) and neurologic (p = 0.006) disfunction at ICU admission were associated with the development of AI. AI were also correlated to need of tracheostomy(p < 0.001), development of delirium (p < 0.001) or shock (p < 0.001);and with longer ICU and in-hospital stay (p < 0.001) and ICU and hospital mortality (p = 0.011 and p = 0.011, respectively). None of the COVID-19 pharmacologic treatments considered (remdesivir, steroids and tocilizumab), neither different regimens of ATB therapy at ICU admission were significantly associated with AI. Conclusions: In this cohort, almost 40% of the patients developed AI, that was associated with 4 times higher hazard of needing mechanical ventilation and higher rate of adverse events such as delirium, shock during in-ICU stay and longer length of ICU and in-hospital stay.