ABSTRACT
Introduction: The SARS-CoV 2 pandemic has brought a high burden of disease. Its long-term repercussions are still under investigation. The objective of this report was to evaluate the occupational, clinical, and functional respiratory recovery at 3 months of patients hospitalized for COVID-19, related to the ventilatory therapy received. Material(s) and Method(s): Prospective cohort of 116 patients from the Hospital Naval Almirante Nef de Vina del Mar, Chile, with clinical and functional respiratory follow-up at 3 months. Result(s): Median follow-up 100 days. 75 men, Median age 60 years, 50% obese, 34.5% smokers and 13.8% with respiratory comorbidity. 16% had undergo rehabilitation. Dyspnea in 73.7% and fatigue in 50%. Only 54.8% returned to work. 65% who used oxygen therapy (O2) returned to work compared to 44% who used HFNC and 33.3% IMV. Return to normal life achieved was greater in the O2 group compared with HFNC group and IMV group (71.4% versus 17.5% and 11.1%). Pulmonary function tests were normal in 39 patients (33.6%). Normal DLCO and normal distance walked in 6 minutes were higher in the group that return to work. The HNFC group had an OR of 5.9 of DLCO alterations, while VMI group had an OR of 3.6 in relation to the group that received O2. Discussion(s): This cohort repeats risk factors and persistence of symptoms described in literature. DLCO alteration was the most frequently founding and to a greater extent than other reports. Conclusion(s): At 3 months of follow-up, work absenteeism, persistence of symptoms and respiratory functional alteration were frequently evidenced, especially in those who received ventilatory support.
ABSTRACT
Introduction: Amoniquinolines such as hydroxycholorquine have shown to inhibit SARS-CoV2 replication in-vitro. However, their benefit in clinical terms are controversial. Objectives: To synthesize the available evidence regarding the use of aminoquinolines for treating patients with COVID-19. Methods: A systematic review was undertaken. Five databases were searched for randomized trials assessing chloroquine o hydroxychloroquine in the treatment of patients infected with SARS-CoV-2. All studies were assessed using the criteria endorsed by the Cochrane Collaboration. Metaanalyses were undertaken whenever possible. Results: The literature search yielded 852 references, and 5 randomized trials were included. All were at high risk of bias. All studies included several cointerventions, such as antibiotics, steroids and antivirals and only two of them included critically-ill patients. When meta-analyses were conducted, aminoquinolines showed no benefit in terms of viral clearance or clinical improvement. However, a significant increase in the incidence of adverse events was observed (RR 3.11, 95CI% 1.64-5.89, p < 0.001). Discussion: The inhibitory properties of aminoquinolines do not seem to translate in clinical benefits amongst patients with CO-VID-19. The perceived high risk of bias of included studies along the significant increase in terms of adverse events recommends against the routine use of these drugs for treating patients with COVID-19. © 2022 Sociedad de Anestesiologia de Chile. All rights reserved.
ABSTRACT
Introduction: Patients with COVID-19 can develop respiratory failure requiring treatment with invasive mechanical ventilation (IMV) and death. It is important to have clinical predictors of these outcomes. Objetives: To establish the diagnostic accuracy of neutrophil to lymphocyte ratios (NLr) in predicting the need of IMV and survival amongst patients with COVID-19 and to compare this accuracy with other laboratory tests. Methodology: Prospective cohort study of hospitalized patients with a SArS-CoV-2 infection confirmed by rT-PCr. Clinical, demographic and laboratory predictors were assessed, including LDH, C-reactive protein, absolute lymphocyte counts, serum ferritin and NLr. Statistical analyses were undertaken using receiver-operator characteristics (rOC) curves, which were in turn compared using the method described by Hanley and McNeal. Results: One hundred and twelve patients were studied, most were male (60.7%) with a mean age of 63.4 ± 18.3 years. Twenty-two patients required IMV during their stay and 28 died. The NLr showed a good diagnostic accuracy in detecting patients that would require IMV (AUC 0.70, 95% CI 0.57-0.86) or died during the hospitalization (AUC 0.83, 95%CI 0.75-0.91). A cutoff point of 5.5 or higher had an 80.8% sensitivity and 73.1% specificity in detecting patients that died during their stay. Conclusions. NLr showed favorable diagnostic properties in detecting patients with COVID-19 at risk of adverse outcomes. Its wide availability and low cost are desirable features that might facilitate its implementation in routine clinical practice. © 2022 Sociedad de Anestesiologia de Chile. All rights reserved.