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Introducao: A Sindrome de embolia gordurosa e uma complicacao rara da doenca falciforme, descrita principalmente na doenca nao homozigotica. Resulta de extensa necrose da medula ossea (MO), durante crise vasoclusiva (CVO), com liberacao de embolos de gordura na circulacao e disfuncao organica multipla. Os criterios diagnosticos sao envolvimento de multiplos/unico orgao histologicamente comprovado por embolia gordurosa e/ou medular necrotica ou desenvolvimento de insuficiencia respiratoria aguda (IRpA) e manifestacoes neurologicas ou falencia de multiplos orgaos com evidencia de necrose medular (laboratorial ou histologica). Objetivos: Descrever caracteristicas clinicas, laboratoriais e de tratamento de 5 pacientes com sindrome de embolia gordurosa atendidos no HCFMUSP entre 10/2021 e 07/2022. Resultados: Os 5 casos eram HbSS (4 mulheres),1 em uso de hidroxiureia (HU), 2 sem HU por hepatotoxicidade e em programa transfusional, 1 interrompeu o tratamento e 1 nunca havia usado. Mediana de idade no evento: 34 (22-52) anos. Fatores desencadeantes provaveis em 3 pacientes: infeccoes por Influenza, Covid19 e S.aureus Oxacilina resistente. A admissao, todos apresentavam dor generalizada e dessaturacao;4 apresentavam confusao mental e rebaixamento do nivel de consciencia com TC de cranio normal;3 com consolidacao pulmonar sendo iniciado antibiotico. Medianas e ranges de exames a admissao: Hb 5,7 (3,6-7,2)g/dL;leucometria 30900 (8620-51600)/mm3, 2 com desvio ate mielocitos, 2 ate metamielocitos e 1 ate bastoes;eritroblastos 38,5 (2,5-53,8) EOC/100 leucocitos;plaquetas 208 (46-507) mil/mm3;DHL 1296 (502->6000)mg/dL;Cr 1,59 (0,94-3,72)mg/dL;BI/BD 2,32 (2,09-4,84)/3,4 (2,57-12,8)mg/dL;TGO 101 (44-289)mg/dL;TGP 19 (18-29)mg/dL;GGT 185 (118-423)mg/dL;FA 369 (142-1060)mg/dL. Durante a internacao, todos evoluiram com reacao leucoeritroblastica (desvio ate mielocitos/promielocitos), aumento de DHL, TGO, TGP, GGT, FA, BI, BD (predominio de BD) e lesao renal aguda, 3 evoluiram com plaquetopenia e 2 com reticulocitopenia. Todos receberam concentrado de hemacias nas primeiras 24h e durante a internacao (mediana 13;range 2-19), 2 iniciaram hemodialise e 2 foram intubados e receberam drogas vasoativas (DVA). Nenhum desenvolveu CIVD. A biopsia de MO de 1 paciente mostrou tecido hematopoietico difusamente necrotico de padrao isquemico. A mediana de internacao foi 11 dias (range 2-22). 1 paciente faleceu em 48h, 1 foi extubado e teve DVA suspensa apos 17 dias, 4 pacientes receberam alta com Hb proxima ao basal e leucometria, plaquetas e funcao renal normais. Discussao: A sindrome de embolia gordurosa e caracterizada por IRpA e manifestacoes neurologicas, podendo haver comprometimento das funcoes renal e hepatica alem de reacao leucoeritroblastica ou pancitopenia, quadro apresentado por nossos pacientes embora nossos casos destoem da literatura quanto ao genotipo, onde apenas 15% sao HbSS. Suspeitar do diagnostico e fundamental para o desfecho dos casos. Na suspeita, a instituicao rapida de terapia transfusional, para reduzir HbS, e determinante para a sobrevida. Uma revisao sistematica descreveu mortalidade de 29, 61 e 91% para quem recebeu troca, reposicao ou nenhuma transfusao, respectivamente. Conclusao: A falta de suspeita diagnostica dificulta o reconhecimento da sindrome, determinando taxas altas de mortalidade. Familiaridade com o quadro clinico e inicio imediato de terapia transfusional tem se mostrado os unicos indicadores de sobrevida. Copyright © 2022
ABSTRACT
Introduction: COVID-19 disease has been declared as a pandemic since February 2020. Resulting from this, home peritoneal dialysis training programme was implemented. However, infectious complications was one of our major concerns. Material(s) and Method(s): This is a single centre, observational, retrospective study. We recruited patients who were newly enrolled into the peritoneal dialysis programme from January 2020 until March 2021 and follow up them for 6 months duration. Patients' demographic data, baseline characteristic, clinical outcome were collected through electronic health record (eHIS) and data were analysed using SPSS version 23. Result(s): A total of 133 patients were enrolled into the peritoneal dialysis programme. The median age of the patients was 55(42-65) years old. Most of the patients were on CAPD, 87(65.4%), and 76(57.1%) of them were on self-care peritoneal dialysis (PD). During this observational period, 29(21.8%) patients underwent hospital based training, while a total of 104(78.2%) patients underwent home based training. The PD peritonitis rate for hospital based training was 1 episode per 55.8 patient months while home based training group was 1 episode per 25.4 patient month. The survival free to 1st PD peritonitis for home based training was 83.7% over 6 months. The exit site infection rate was 1 episode per 73.1 patient month. Conclusion(s): Home based PD training should be encouraged especially during Covid-19 pandemic period, but standardised training protocol should be implemented to improve the clinical outcome of our patients.
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Coronavirus disease-2019 (COVID-19) is an ongoing global pandemic exerting considerable strain on the health-care system. Sudden-onset sensorineural hearing loss (SSNHL) among patients with COVID-19 had been reported sparingly in the literature. Hearing loss can be easily overlooked in intensive care settings and establishing diagnosis can also be challenging. Proposed causes include injury to inner ear structures, cochlear nerve, or auditory brainstem. Prompt diagnosis and treatment is recommended to avoid long-term morbidity. All patients presenting with sudden-onset hearing loss should be screened for COVID-19. Here, we report a case of COVID-19 patient with SSNHL and how the hearing level is determined. Copyright © 2022 Indian Journal of Otology Published by Wolters Kluwer-Medknow.
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COVID-19 limitation strategies have led to widespread school closures around the world. The present study reports children's mental health and associated factors during the COVID-19 school closure in France in the spring of 2020. We conducted a cross-sectional analysis using data from the SAPRIS project set up during the COVID-19 pandemic in France. Using multinomial logistic regression models, we estimated associations between children's mental health, children's health behaviors, schooling, and socioeconomic characteristics of the children's families. The sample consisted of 5702 children aged 8-9 years, including 50.2% girls. In multivariate logistic regression models, children's sleeping difficulties were associated with children's abnormal symptoms of both hyperactivity-inattention (adjusted Odds Ratio (aOR) 2.05;95% Confidence Interval 1.70-2.47) and emotional symptoms (aOR 5.34;95% CI 4.16-6.86). Factors specifically associated with abnormal hyperactivity/inattention were: male sex (aOR 2.29;95% CI 1.90-2.76), access to specialized care prior to the pandemic and its suspension during school closure (aOR 1.51;95% CI 1.21-1.88), abnormal emotional symptoms (aOR 4.06;95% CI 3.11-5.29), being unschooled or schooled with assistance before lockdown (aOR 2.13;95% CI 1.43-3.17), and tutoring with difficulties or absence of a tutor (aOR 3.25;95% CI 2.64-3.99;aOR 2.47;95% CI 1.48-4.11, respectively). Factors associated with children's emotional symptoms were the following: being born pre-term (aOR 1.34;95% CI 1.03-1.73), COVID-19 cases among household members (aOR 1.72;95% CI 1.08-2.73), abnormal symptoms of hyperactivity/inattention (aOR 4.18;95% CI 3.27-5.34) and modest income (aOR 1.45;95% CI 1.07-1.96;aOR 1.36;95% CI 1.01-1.84). Multiple characteristics were associated with elevated levels of symptoms of hyperactivity-inattention and emotional symptoms in children during the period of school closure due to COVID-19. Further studies are needed to help policymakers to balance the pros and cons of closing schools, taking into consideration the educational and psychological consequences for children.
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Introduction: Arteriovenous fistula (AVF) delivers the best treatment dose prescribed for hemodialysis. KDOQI guideline 2006 advocate the adoption of ultrasound mapping for pre access creation. However, this is not translated to routine practice due to scarce resources. In this study, we wish to study the efficiency of clinical assessment in determining the suitable vessels for AVF creation and the access survival. Methods: This is a single tertiary nephrology center, prospective study of a series of patients who were referred to our AVF outsource program that was funded by Ministry of Health. This program diverting non Covid-19 CKD 5 or new ESKD patients that have opted for hemodialysis to private facilities for AVF creation due to the limitation of available operating theatre slot in government hospital attributed by Covid-19 pandemic. Those assessed by our nephrologists and trainees in a specially created outsourcing clinic that deemed suitable for assess creation will be outsource to the private institutions. Clinician assessment of suitability of the vessels and the outcome of AVF creations at 6 months were captured and analyzed. Results: A total of 147 patients were identified, reviewed, and outsourced, with the mean age of 54-year-old, male predominant (n: 94). 65% of the cohort has diabetes mellitus as their primary disease followed by hypertension at 17%. 37.4% of the cohort are CKD 5 patients who are not on dialysis, while 10.8% on peritoneal dialysis and 51.7% were on hemodialysis. 87% of the patients were AVF naïve whereas 13% had prior history of failed AVF. Out these, 15.6% of patients did not have access created (1 passed away, 7 needed complex grafts, 13 have small vessels, 2 needed two stages surgeries). Of the remaining 124 patients (84.4%), 2 received AVGs and 122 received AVFs. From the first subsequent vascular review by the surgeons, the concordance for the vascular access creation suitability with our assessment was 91.1%. Subsequently, the concordance for vascular access that was successfully created was 84.3% with site of creation agreement at 61%. At 6 months post AV access creation, 13 patients (10.5%) have primary failures whereas 11 patients (9%) had secondary failure. 21 patients (17%) unfortunately passed away during the study period and were excluded. At 6 months, 60% of the patients have functional AV access. In addition, for the 26 patients that have deemed no suitable vessels for AV access creation from prior vascular review before referred to our program, 84.6% has AV access created subsequently. Their outcome in 6 months includes: 36.3% have functional AV access, 18% have primary failure, 22.7% have secondary failure and another 22.7% passed away. Conclusions: We have demonstrated a careful clinical assessment of a patient’s vascular access by a nephrologist led team provides a high and consistent level of accuracy as to successfulness of the vascular creation. The omittance of routine vascular mapping in our protocol provide considerable cost and time saving which echoes the latest guideline by KDOQI 2019. Patients who failed assessment prior still warrant a repeat clinical assessment if they are considering hemodialysis as the life plan of kidney replacement therapy. No conflict of interest
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Objective: to map existing evidence in the literature on the impacts of the Covid-19 pandemic on child violence. Method: scope review carried out according to the recommendations of the Joanna Briggs Institute and the international guide PRISMA-ScR in the Databases PubMed, CINAHL, Web of Science and LILACS in October 2020. Inclusion criteria were: studies available in full text, online, in the Portuguese, English or Spanish language, published in 2020 and addressing violence against children in the context of the pandemic. The data were submitted to descriptive analysis. Results: 216 articles were found, of which 26 were kept for review. The results were presented in the form of a table and, for their discussion, were summarized in the following axes: Closing schools, increasing risks and reducing reports of violence;Economic changes, parental stress and increased violence against children;Health professionals, protection services and negligence violence against children. Conclusion: the Covid-19 pandemic has had numerous impacts on violence against children. The summary of the findings of this review may contribute to the dissemination of the theme and stimulate actions that favor the identification, notification and monitoring of cases of violence against children as an important part of the responses against the Covid-19 pandemic. © 2021, Universidade Federal de Santa Catarina. All rights reserved.