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INTRODUCTION: Different COVID-19 vaccines were developed in a short time after the beginning of pandemics, reducing mortality, especially in high risk population. This was demonstrated in several studies, mostly retrospective or based in mathematical models. The objective was to compare mortality in inpatients with COVID-19 related to vaccination.
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Introduction: Several factors have been proposed to explain the high mortality rate of the COVID-19, including hypertension and treatment with renin-angiotensin-aldosterone (RAAS) system inhibitors. Age and multimorbidity could be confounding factors. Method(s): Our Hypertension Center enlisted 462 Covid-19 patients, admitted from March 2020 to April 2021 at our Cardiovascular Medicine Unit (males 61.7%, 71 +/- 0.5 years), of which 338 patients (73.2%) had comorbidity. The 65.5% of patients had previous cardiovascular diseases, of which hypertension was the most represented (61.7%). At the onset the most frequent symptom is fever, followed by dyspnoea/tachypnoea and cough and frequently associated dyslipidaemia, diabetes mellitus and obesity. Among the main cardiovascular complications, 12 pulmonary embolism, 10 deep venous thrombosis, 7 acute coronary syndrome, 9 strokes and 1 peripheral acute ischemia. Result(s): One hundred and then people have died (24.9%). The main causes of deaths were ARDS (12.3%) and sepsis and MOF (9.2%). The population that did not survive had an average age of almost 80 years, significantly higher than the group of living, and different comorbidities, mainly cardiovascular, that configured a greater degree of fragility. Treatment with RAAS inhibitors in the group of deceased has been more frequently suspended. Conclusion(s): The stop of therapy was found to be attributable to either erroneous beliefs borrowed from early Chinese reports or sepsis hypotension, and arterial hypertension or therapy with RAAS blockers cannot be considered risk factors due to the onset or to the manhood of COVID-19. RAAS blockers certainly do not hurt, indeed it is hypothesized that their use is associated with protective effects on the prognosis of COVID-19, in line with what is stated in the Literature.
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Background: Systemic lupus erythematosus (SLE) prognosis is determined by a wide range of factors, such as the severity of the disease manifestations, the psychosocial aspects of patients, the proper management of comorbidities, adoption of a healthy lifestyle and adherence to treatment. Studies on chronic diseases highlight the value of patient education to foster treatment adherence and improve prognosis. Objectives: To promote health education to SLE patients and their families providing accessible and comprehensive Scientific information, in order to improve adherence to treatment and the patient's prognosis. Methods: The Waiting Room Project is linked to the Extension Health Care Program for SLE patients and their families of Universidade Federal de Minas Gerais, Brazil, since 2011. A total of 700 patients under SLE treatment at the Rheumatology Unit of the University Hospital are involved. Medical students and rheumatology fellows, altogether, developed high-quality informative texts, with clear content and layman language appropriate for the patient, under the supervision of the rheumatology professors. The texts are illustrated by the team of the Communication Department of the Medical School and medical students, and are printed in a leafet format. The material is handed out to the patients, while they wait for their medical appointment, by the students and the care team. The content of the leafets is discussed, making sure that all the concerns and doubts are properly addressed Results: The Waiting Room Project has produced 17 leafets, addressing different aspects of SLE, comorbidities, and treatment. The texts approach the traditional cardiovascular risk factors (Smoking, Arterial Hypertension, Diabetes, Obesity, Physical Activity), and some medical conditions related to general health and SLE treatment (Sun Protection, Healthy Food, Oral Care, Vaccination, Pregnancy, Osteoporosis). In 2020 and 2021, two leafets about Covid-19 were produced in order to clarify important aspects of this disease, its impact on lupus patients and to solve questions about SLE medications: one regarding the association between Lupus and Covid-19 and another about the treatment of lupus and Covid-19. Other four leafets were produced concerning SLE treatment, including Adherence to Treatment, the use of Antimalarials, Corticos-teroids, and Immunosuppressants. Information about the drugs, general importance on lupus treatment, recommendations and possible adverse events were described. Futhermore, additional content is currently in production with themes such as Intravenous Corticosteroid and Cyclophosphamide, Human Papilloma-virus Infection, Malignant Neoplasm, and specifc cancers frequently affecting women, such as Colorectal Cancer, Cervical Cancer, and Breast Cancer. The leafets are also available online on the Medical School website in Portuguese and in English (medicina.ufmg.br/alo/material-didatico/), on the Minas Gerais Rheumatology Society website (reumatologia.org.br/orientacoes-ao-paciente/), and on the Instagram page @lupusufmg Conclusion: The leafets have been an important source of information and health education for SLE patients and their families, improving student/physician-patient communication. Despite the adversities caused by the coronavirus pandemic, the Waiting Room Project has kept its purpose to make each patient with SLE an agent of their healthcare. Improving the patients' access to evidence-based information must be a goal of healthcare professionals that treat patients with SLE.
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The use of positive airway pressure is the treatment of choice for obstructive sleep apnea. Since the beginning of SARS-CoV-2 virus pandemic the recommenda-tions were to avoid the administration of this therapy in the sleep laboratory and to start treatment with auto-adjustable continuous positive airway pressure devices. The objective was to evaluate access to these devices in the current epidemiological context. Sixty-six patients were included, the mean age was 50.7 ± 12.8, 44% men with an AHI of 35.5 (22.7–64.2) and a BMI of 38.3 (32.8-46.1). Forty-five percent had health insurance. Of the 50 (74%) who processed the device, 19 (29%) had access. Health insurance was the only significant variable between those who had access to the device and those who did not: 54% vs. 21% (p=0.016). The delay between the beginning of the procedure to access the device and the start of treatment was 31 ± 21 in patients who had medical insurance and 65 ± 35.2 in those who did not (p = 0.008). Access to auto-adjustable therapies during the COVID-19 pandemic was below our former experience and that described in other studies with fixed therapies. It is worth considering whether this decrease is a product of the pandemic and indepen-dent of the type of therapy or is directly related to the higher costs of self-adjustable devices or to a lack of coverage from the healthcare providers.
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There are few data regarding the repercussion in the pulmonary function of patients who had severe or critical COVID-19 pneumonia. The objective was to describe these patients' pulmonary function and establish an association with the severity of the disease (patients with severe or critical pneumonia), the presence of comorbidities, the tomographic involvement and the persistence of dyspnoea. Fifty-five patients were included, 40 (73%) male, media of age 54.9 (11.6) years old and body mass index (BMI) 33.1 (6.09) kg/m(2). Fifty (90%) had 1 comorbidity, obesity 67%, arterial hypertension 36%, and diabetes mellitus 35%. Twenty-five (45%) had critical pneumonia. Fifteen (27%) had a spirometric alteration that suggested restriction and 32 (58%) had gas exchange defect. The latter had forced volume capacity (FVC), forced expiratory volume in the first second (FEV1) and carbon monoxide diffusion capacity (DLCO) values significantly lower. Ninety percent presented some degree of involvement in the chest CT scan, ground glass-opacities the most frequent finding. A moderate negative correlation was found between the severity of the tomographic involvement and the DLCO levels. Thirty patients (55%) referred some degree of dyspnoea. Patients with this symptom had DLCO and KCO values below those who did not have dyspnoea: 70.5 vs. 85.1 p = 0.02 and 88 vs. 104 p = 0.02. The presence of abnormal gas exchange is the main characteristic of patients with pulmonary sequelae due to COVID-19. Our study does not show either predictor of evolution towards pulmonary sequelae or an association with the severity of the disease.
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Background: SARS-COV2 is a threatful viral disease which can evolve into respiratory failure but identification of risk factors for progression towards severe forms is still ongoing During infection impairment of liver function tests has been frequently reported and evidence of the negative impact of metabolic alterations on the clinical course are emerging, mainly evaluated in Asiatic populations Aim: to define the prognostic role of metabolic disease and liver damage on SARS-COV2 severity in a cohort of Italian patients Methods: All patients with confirmed COVID-19 infection admitted to low-intensity care COVID Units between March and April 2020 were enrolled Severe SARS-COV2 infection was defined according to International consensus requiring intensive respiratory support (CPAP/orotracheal intubation) All data were collected at admission Results: 382 patients were enrolled, mean age was 65±17 ys and 60% were male Mean BMI was 27±5 kg/m2 (61% overweight and 25% obese), prevalence of T2DM 17%, hypertension 44%, dyslipidemia 29% At admission 39% and 40% of patients had increased ALT and GGT levels, respectively Median hospitalization stay was 14 days (IQR 8-24), with 30% of patients experiencing severe SARS-COV2 infection and mortality in 14% of overall cases Subjects with severe infection presented higher prevalence of male sex (68% vs 56%, p=0 03), T2DM (25% vs 14%, p=0 01), dyslipidemia (36% vs 26%, p=0 05) and increased ALT (53% vs 32%, p<0 001) and GGT (53% vs 34%, p=0 01) levels at admission In multivariate analysis (adjusted for age, sex, T2DM, dyslipidemia, increased ALT and GGT at admission and SARS-COV2 therapy), T2DM (OR 3 1, 95%CI 1 6-6 0;p=0 001), dyslipidemia (OR 1 9, 95%CI 1 1-3 3;p=0 03), and increased ALT (OR 4 7, 95%CI 2 5- 9 0;p<0 001) and GGT (OR 2 0, 95%CI 1 2-3-3;p=0 009), resulted associated with high risk of more severe SARSCOV2 disease Interestingly, in patients with both T2DM and dyslipidemia, this risk was further increased (OR 5 2, 95%CI 2 1-12 6;p<0 001) Conclusion: We confirm that liver involvement is common during SARS-COV2 infection and it is a negative prognostic factor although it is not clear whether it precedes or follows, the severity of clinical course In addition, the risk of severe form of respiratory distress is increased by metabolic alterations, and the more numerous the alterations, the higher the risk.