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Clinical case: Female patient, 78 years-old, that complained of epigastric pain and intense fatigue for a week. While waiting in the urgency department, she became hypotensive, with refractory shock. Electrocardiogram showed sinus rhythm, 90 bpm, De novo right bundle block and infraST in the right precordial leads. The echocardiogram showed a dilated right ventricle (ratio RV/LV>1), with depressed function and major tricuspid regurgitation, RV/RA gradient of at least 55 mmHg. Left ventricle presented "D-shape", preserved function and no segmental kinetic changes. The pulmonary artery was dilated and a serpentiform mass was visible, protruding through the pulmonary valve;similar masses were also visible in its branches. The diagnosis of pulmonary embolism (PE) was assumed and fibrinolysis was started, given there were no contra-indications. One year before, she had an intermediate-risk PE in the context of COVID-19, with a similar echocardiographic presentation. She recovered RV function in the following months and stopped anticoagulation 3 months after that episode. Discussion(s): PE can present with varying degrees of severity. Bedside echocardiography can be of major help in its diagnosis, especially in critical patients. The visualization of a thrombus in the pulmonary artery is rare, particularly in transthoracic echocardiogram. Echocardiogram is also useful for risk stratification and prognostic evaluation. This patient developed obstructive shock due to massive PE and the fibrinolytic treatment was paramount for her survival. A good echocardiogram helped in the differential diagnosis and enabled the Cardiologist to assist the patient in the best way.
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Purpose: Emerging evidence suggests that 3 doses of SARS-CoV-2 mRNA vaccine enhance immunity in kidney transplant (KT) patients. However, few studies have focused on humoral response after inactivated virus-based vaccines. Here we report the results of humoral response in KT recipients in comparison with healthy control group after homologous and heterologous regimens with inactivated virus (Coronavac) and mRNA vaccine BNT162b2. Method(s): A multicenter prospective study was conducted. KT recipients received heterologous vaccine schedule (2 doses of Coronavac and a booster of mRNA BNT162b2, n= 136) or homologous (3 doses of BNT162b2 n=19). Healthy control group received 2 doses or Coronavac (n=67) or BNT162b2 (n=15). Serum IgG antibodies against Receptor Binding Domain of SARS-CoV-2 Spike protein were determined 30 and 40 days after last dose. Result(s): Seroconversion was 52.2% and 57,9% with heterologous and homologous vaccination schedules in KT, p=0.789, figure 1. Among KT patients with seroconversion, antibody levels against RBD of SARS-CoV-2 were [1012 (183-3111) and 603 (41-1255) BAU/mL, with heterologous and homologous schedule, respectively. Levels were higher in KT compared to heathy control with 2 doses of inactivated virus 308 (209-335), p=0.03 and lower than heathy control with 2 doses of BNT162b2: 2638 (2608-3808) BAU/mL, p=0.001]. Conclusion(s): Seroconversion improves after a third dose with homologous or heterologous vaccine schedules. Among patients with seroconversion antibody levels were higher than in heathy control with two doses of inactivated virus. Measurement of antibody levels could help to improve vaccination policies.
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The objective of this mini review was to discuss the relationship between nutritional deficiencies and mental health, and to present a structure that helps to visualize these associations based on a literature review and the scenarios of the COVID-19 pandemic. The study was conducted to demonstrate the effect of the nutritional deficiencies on the occurrence and/or worsening of mental health problems, mainly related to the most drastic measures of social distance during the COVID-19 pandemic. Studies have already shown that a nutritionally unbalanced diet may be associated with greater chances of mental health problems. Insufficient levels of micronutrients can, by regulating the stress response, immune and oxidative systems, negatively affect brain functions and, consequently, cognitive functions and mental health of individuals. The current pandemic of COVID-19 reveals an increase in food and nutritional insecurity, and a worsening of this situation among already vulnerable populations. Micronutrient deficiencies may be exacerbated in a context of increased food insecurity and the COVID-19 pandemic, which may contribute to increased mental health problems.
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New 2019-Coronavirus (SARS-CoV-2) pandemic is presenting daily diagnostic challenges to emergency departments (ED) doctors, especially as an increasing number of atypical clinical presentations have been reported, including acute sialadenitis (most of parotid). We present a case of a 46-year-old obese caucasian woman, with no relevant medical history, that presented in ED with complaints suggesting parotitis, with normal laboratory tests, at first with no virus isolation, confirmed by computed tomography. One week later, anosmia and dysgeusia were notice, and SARS-CoV-2 was tested and confirmed. Authors want to alert that SARS-CoV-2 should be excluded as parotitis etiology, highly important, especially in this pandemic phase, as a way of transmission control.
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Objective: To analyse how testing the population influences the health indicators used to monitor the COVID-19 pandemic in the 50 countries with the highest number of diagnosed cases.
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OBJECTIVE: To analyse how testing the population influences the health indicators used to monitor the COVID-19 pandemic in the 50 countries with the highest number of diagnosed cases. METHODS: This was an ecological study using secondary data retrieved on 8/19/2020. Cumulative incidence, mortality rate, case-fatality rate, and proportion of positive tests were calculated. The data were described and presented graphically, with their respective Spearman Correlation Coefficients. RESULTS: The testing rate varied enormously between countries. Cumulative incidence and the proportion of positive tests were correlated with the number of tests, while the mortality rate and case-fatality rate showed low correlation with this indicator. CONCLUSION: Most countries do not test enough to ensure adequate monitoring of the pandemic, and this is reflected in the quality of the indicators. Expanding the number of tests is essential, but it needs to be accompanied by other measures, such as isolation of diagnosed cases and contact tracing.
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Aim: This cross-sectional study aimed to investigate where Brazilian dental students seek information about COVID-19 by a self-administered web-based questionnaire. Methods: A social network campaign on Instagram was raised to approach the target population. The dental students responded to a multiple-response question asking where or with whom they get information about COVID-19. The possible answers were government official websites or health and education institutions websites, TV Programs, professors, social media, scientific articles, health professionals, and family members. The data were analyzed by descriptive statistics, and the frequency distributions of responses were evaluated by gender, age, type of institution, and year of enrollment. Results: A total of 833 valid responses were received. The main source of information used by the dental students were government official websites or health and education institutions websites, which were reported by 739 (88.7%) participants. In the sequence, 477 (57.3%) participants chose health professionals while 468 (56.2%) chose scientific articles as information sources. The use of social media was reported by 451 (54.1%) students, while TV programs were information sources used by 332 (39.9%) students. The least used information sources were professors, reported by 317 (38.1%) students, and family members, chosen only by 65 (7.8%) participants. Conclusion: Brazilian dental students rely on multiple information sources to stay informed about COVID-19, mainly focusing their information-seeking behavior on governmental and health professional’s websites. © 2021. All Rights Reserved.