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Introduction: in the face of the health emergency, Cuban science undertook a series of protocols with the aim of achieving an effective treatment against COVID-19, thus giving rise to a homeopathic preparation called PrevengHo..-Vir. The trial has not yet finished and there remains a gap of doubts regarding the possible adverse reactions that the preparation could cause. Background: to characterize clinically and epidemiologically five towns' populations that consumed the homeopathic preparation and to identify the main adverse reactions reported by the patients under study. Method: an observational, descriptive, cross-sectional study was carried out in five towns in the municipality of Santa Clara, with the total of patients who used the preparation;with the sample being N=505. Results: a ratio of men and women of 1:1 is presented, with an average of 44.3 years of age, 63.7% have a high school degree (above 12th grade), only 4.8% used the preparation incorrectly, of which 3.2% had a low educational level. A total of 13 subjects presented reactions. Conclusions: Most of the adverse reactions are mild and do not require urgent medical attention. The homeopathic preparation PrevengHo..-Vir is safe and without risk to the lives of consumers.
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BACKGROUND AND AIM: To describe the cardiovascular and laboratory manifestations among children presenting with the multisystem inflammatory syndrome associated with SARS-CoV-2 infection (MIS-C). METHOD(S): Data obtained from the database of our PICU complemented by a review of the clinical records. Children from 1 month to 15 years of age, admitted to the hospital between August 1, 2020 and December 31, 2021 with a diagnosis of MIS-C were included. RESULT(S): A total of 8 children, represent 6% of our admissions during the study period, were included. Median age 5.7 years (IQR 1.5-10), 100% males, weight 10 to 59 kg, PICU LOS 1 to 11 days, median 2.6 days (IQR 1-7.5). PIM-3 median 1.75 (IQR 1.17- 2.54). Symptoms were persistent fever, gastrointestinal symptoms, polymorphic rash, conjunctivitis, and mucosal changes.The cardiovascular complications were shock, cardiac arrhythmias, pericardial effusion and coronary artery dilatation. Reduced left ventricular ejection fraction and elevated troponin were present in half of them. The biochemical markers of inflammation were raised in most patients: elevated C-reactive protein, serum ferritin, procalcitonin, N-terminal pro B-type natriuretic peptide, interleukin-6 level, and D-dimers. Polymerase chain reaction for SARS-CoV-2 virus was negative in all patients, whereas immunoglobulin (Ig) M antibodies were positive in 50% and IgG in 87.5% cases. CONCLUSION(S): The children have significantly raised levels of biochemical markers of inflammation.Cardiac involvement, including ventricular dysfunction, coronary artery dilation or aneurysm, and arrhythmias, is common in children with SARS-CoV-2-associated multisystem inflammatory syndrome and needs to be carefully identified and monitored over time due to uncertain prognosis and risk of progression of cardiac manifestation. (Figure Presented).
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Objetivos: O Venetoclax tem como alvo a proteina BCL-2. Aprovado para LLC, mostrou eficacia tambem LMA em combinacao com agentes hipometilantes como a Azacitidina. No ultimo ano, tivemos experiencias bem-sucedidas com a utilizacao desta associacao. Selecionamos 4 casos representativos de LMA e SMD para relatar nossa experiencia com este protocolo e desfechos obtidos. Material e Metodos: As informacoes foram obtidas por meio de revisao do prontuario. Resultados: Caso 1 - E.Q.O., 42 anos, sexo feminino, diagnosticada em janeiro de 2019 com LMA, evoluiu com 3 recidivas, quando foi optado pela associacao de Azacitidina e Venetoclax. Realizou ciclos com boa evolucao. Caso 2 - F.G.S., 72 anos, sexo feminino, historico de Linfoma Folicular EIIA em 2003. Em janeiro de 2021 recebeu diagnostico de LMA. Houve associacao de Azacitidina e Venetoclax como tratamento. Foram realizados 2 ciclos sem intercorrencias. Entretanto, antes do terceiro ciclo, a paciente relatou sindrome gripal, com diagnostico de COVID-19 e evoluiu a obito. Caso 3 - J.W.L.L., 37 anos, sexo masculino, em agosto de 2020 foi diagnosticado com SMD. Evolui com remissao e melhora significativa das citopenias de base. Foi submetido a TCTH nao aparentado com sucesso em julho de 2021, com enxertia no D+16 e internacao sem intercorrencias. Caso 4 - Paciente de 72 anos, sexo masculino, com diagnostico de SMD com excesso de blastos. Iniciou protocolo com Azacitidina associado a Venetoclax, persistia com elevada necessidade transfusional. Houve reducao das dosagens no segundo ciclo. O paciente evoluiu com melhor tolerabilidade, mantendo padrao transfusional. Manteve dose de Azacitidina e ajustada novamente dose de Venetoclax. Apos o quarto e quinto ciclos, paciente retornou com melhora significativa de indices hematimetricos O mielograma estava normal, bem como a imunofenotipagem e o cariotipo. Discussao: Apresentamos aqui 4 casos distintos de indicacao bem-sucedida da associacao entre Azacitidina e Venetoclax. A dose padrao utilizada foi de 75 mg/m2/dia de Azacitidina, do D1 ao D7 e 100 mg/dia de Venetoclax, com escalonamento progressivo ate atingir 400 mg/dia, do D1 ao D28. O caso 1 descreve paciente com doenca refrataria. Na literatura, esse perfil de pacientes tem beneficio importante com essa combinacao. Em nossa pratica clinica, o ajuste de dose ou duracao do Venetoclax e/ou espacamento entre os ciclos tem se mostrado uma alternativa viavel para minimizar os impactos da neutropenia. O caso 2 refere-se a paciente idosa, com mutacao do NPM1, sem status performance para quimioterapia intensiva, em primeira linha de tratamento. O impacto favoravel da mutacao NPM1 tende a reduzir em pacientes idosos (>65 anos). Nos casos 3 e 4 relatamos pacientes com SMD. Os bons resultados de Azacitidina e Venetoclax em LMA levaram os pesquisadores a avaliar a combinacao em pacientes com SMD de alto risco. Conclusao: A escolha do tratamento depende em grande parte da idade do paciente, status performance, remissao, caracteristicas geneticas e moleculares.A quimioterapia de baixa intensidade, em especial a associacao de Azacitidina com Venetoclax e uma opcao viavel, mesmo em pacientes com recidiva multipla/doenca refrataria ou naqueles com baixo status performance. Tambem aparenta ser promissora nos casos de SMD de alto risco. Os efeitos adversos mais frequentes dizem respeito as infeccoes decorrentes da neutropenia prolongada, mas nos 4 casos relatados, os pacientes evoluiram com estabilidade. Copyright © 2022
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SARS-CoV2-related infections have drawn the researchers’ attention to skin lesions. The motivation and purpose to present the cutaneous manifestations related to COVID-19 caused by SARS-CoV2 and the prolonged use of Personal Protective Equipment (PPE) by health professionals. The aim of the study is performed a systematic review of studies and official documents were carried out, in order to explore and synthesize the evidences and recommendations about the cutaneous manifestations related to SARS-CoV2 and the use of PPE. An integrative literature review was carried out with a search on the VHL library (LILACS, MEDLINE, SciELO). Articles from the period 2019 to june 2020 were included. In the results, 37 references were included, 10 original articles, 03 literature reviews and 24 other types of scientific publications. The conclusions demonstrated that the skin manifestations related to COVID-19 can be directly associated with the new SARS-CoV2, however it is necessary to have more conclusive studies. Skin lesions that have affected patients and frontline health professionals who need special care with the use of PPE. © 2022, Springer Nature Switzerland AG.
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PURPOSE/HYPOTHESIS: Altered breathing patterns have been reported after SARS-CoV-2 infection, but it is unclear if they result from changes in chest wall kinematics, inspiratory muscle weakness, or both. Lung volumes can be estimated through chest wall motion via optoelectronic plethysmography (OEP). We hypothesized that poor inspiratory muscle performance would relate to impaired quiet breathing pattern as assessed by OEP in adults post COVID-19 infection. NUMBER OF SUBJECTS: 20. MATERIALS AND METHODS: A convenience sample of 20 subjects recovered from RT-PCR-confirmed COVID-19 (mean ± SD age = 52.45 ± 11.93 years and BMI = 30.89 ± 6.48 kg/m2) with no overt pulmonary disease underwent measures of maximal inspiratory pressure (MIP) using a digital manometer followed by OEP analysis to evaluate chest wall motion and its compartments during quiet breathing. All OEP data were collected with subjects in a seated position and with arms supported laterally. Eighty-nine reflective markers were distributed on the anterior surface, side and back of the participants' trunks, who were instructed to breathe normally for three minutes while the system was operated. The displacement of markers during the requested spontaneous quiet breathing was picked up by six synchronized cameras that recorded their coordinates, from which lung volumes were later estimated using algorithms. Statistical analyses included normality tests, descriptive statistics, Pearson's correlation and independent samples t-tests. RESULTS: The mean ± SD MIP and tidal volume (VT) of the sample were 82.15 ± 34.32 cmH2O and 369 ± 216.31 ml, respectively. 65% of the participants were below their predicted values for VT, and 70% had lower than predicted MIP values. MIP was significantly and positively associated with VT (r = 0.40, P=0.04), while a negative relationship was found between MIP and the percentage contribution of abdominal rib cage motion to VT (r=- 0.45, P=0.02). No further correlation was observed between MIP and other OEP variables. Additionally, subjects classified as having normal inspiratory muscle function (i.e. MIP > 80 cmH2O) had significantly greater VT when compared to those presenting with inspiratory muscle weakness (450.64 ± 262.57 versus 269.22 ± 67.67 ml, respectively;P = 0.04). CONCLUSIONS: The variability of post COVID-19 ventilatory impairment requires a complex screening process. In our sample, most subjects presented with lower than predicted VT and MIP. Moreover, a significant association existed between inspiratory muscle dysfunction and reduced tidal volume. Changes in abdominal rib cage motion were also observed and likely occurred to compensate for a less efficient diaphragm even during normal, regular breathing. CLINICAL RELEVANCE: Subjects recovering from COVID-19 may present with diaphragm myopathy and impairment, highlighting the need to screen for inspiratory muscle weakness which may help identify altered breathing patterns and guide management such as inspiratory muscle training to mitigate persistent symptoms related to abnormal ventilation.
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This article reflects on the importance of teaching History in view of the proportions that the political-ideological polarization has been assuming in Brazil since 2013. Polarization is rapidly aggravating the scenario of the pandemic caused by the new Coronavirus (SARS-CoV-2). Negationist and revisionist speeches are propagated through cybernetic means anchored in a simplistic and simplified language that evokes false speeches of truth. A significant number of Basic Education students today are connected to social networks and receive the negationist, revisionist content on a daily basis. Given this scenario, the role of History teaching needs to be focused on the construction of spaces of sensitivity and alterity, contributing to a humanized society that values life, science and systematic reflection of the facts. © 2019 Inra Productions Animales. All rights reserved.
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BACKGROUND: How cigarette smoke (CS) and chronic obstructive pulmonary disease (COPD) affect severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection and severity is controversial. We investigated the effects of COPD and CS on the expression of SARS-CoV-2 entry receptor ACE2 in vivo in COPD patients and controls and in CS-exposed mice, and the effects of CS on SARS-CoV-2 infection in human bronchial epithelial cells in vitro. METHODS: We quantified: (1) pulmonary ACE2 protein levels by immunostaining and ELISA, and both ACE2 and/or TMPRSS2 mRNA levels by RT-qPCR in two independent human cohorts; and (2) pulmonary ACE2 protein levels by immunostaining and ELISA in C57BL/6 WT mice exposed to air or CS for up to 6 months. The effects of CS exposure on SARS-CoV-2 infection were evaluated after in vitro infection of Calu-3 cells and differentiated human bronchial epithelial cells (HBECs), respectively. RESULTS: ACE2 protein and mRNA levels were decreased in peripheral airways from COPD patients versus controls but similar in central airways. Mice exposed to CS had decreased ACE2 protein levels in their bronchial and alveolar epithelia versus air-exposed mice. CS treatment decreased viral replication in Calu-3 cells, as determined by immunofluorescence staining for replicative double-stranded RNA (dsRNA) and western blot for viral N protein. Acute CS exposure decreased in vitro SARS-CoV-2 replication in HBECs, as determined by plaque assay and RT-qPCR. CONCLUSIONS: ACE2 levels were decreased in both bronchial and alveolar epithelial cells from COPD patients versus controls, and from CS-exposed versus air-exposed mice. CS-pre-exposure potently inhibited SARS-CoV-2 replication in vitro. These findings urge to investigate further the controversial effects of CS and COPD on SARS-CoV-2 infection.