Acute necrotizing pancreatitis and disconnected pancreatic duct syndrome associated with COVID-19

Disconnected pancreatic duct syndrome (DPDS) is a rare but important complication of acute necrotizing pancreatitis (ANP). This syndrome presents as a circumferential discontinuity of the ductal anatomy between the pancreatic secreting tissue and the gastrointestinal tract. Most cases do not respond to conservative therapy and require surgical intervention. This condition is a challenge for the medical team, given the delay in diagnostic suspicion and the need for multimodal therapeutical approach. Acute pancreatitis has been reported in patients with COVID-19, although a direct cause and effect relationship has not yet been established. Whether infection with new Coronavirus can contribute as worsen-ing factor in acute pancreatitis due to viral tropism to pancreatic cells is not known. We present the case of a 44-year-old male patient with a diagnosis of acute necrotizing pancreatitis who evolved with disconnected duct syndrome due to necrosis of the central region of the pancreas. He performed multiple drainages of the collections and necrosectomy, with persistent pancreatic fistula, eventually requiring caudal pancreatec-tomy. This patient had a diagnosis of COVID-19 and thromboembolic events during hospitalization, constituting a challenge for treatment. He presented a good postoperative clinical evolution, being discharged 5 months after admission. Disconnect duct syndrome frequently presents as a treatment challenge. These patients are severe and an overlapping COVID infection acts as an important aggravating factor. Whether the infection is related to pancreatitis, either in its genesis or acting as a worsening factor has not yet been established.(Cite this article as: Capaverde LH, Hinrichsen LB, Fetzner B, Pieta MP, Cardoso AM, Costa LB, et al. Acute necrotizing pancreatitis and discon-nected pancreatic duct syndrome associated with COVID-19. Chirurgia 2022;35:241-5. DOI: 10.23736/S0394-9508.21.05347-X)

New coronavirus, old inequalities: distribution of cases, deaths and lethality by SARS arising from covid-19 in the City of Recife

The aim of the study was to reveal how the COVID-19 pandemic spread in the city of Recife, pinpointing the existence of inequalities in the rates of confirmed cases, mortality and lethality of the disease in the different socio-territorial configurations of the city. For the purpose of this study, data from the Severe Acute Respiratory Syndrome (SARS) were used, as they were the only ones available on the intra-urban scale. A grouping of the city's neighborhoods was carried out in five strata, considering the percentage of the neighborhood area in precarious settlements using the ArcGis 10.1 software. It was found that the record of cases of SARS in relation to the resident population is higher in the set of neighborhoods with a lower proportion of precarious settlements. Conversely, lethality rate is higher in strata with a higher proportion of precarious settlements. There was also a correspondence between strata, per capita income distribution and the black population. The data reveal an inequality in the impact of the disease on the population of Recife, suggesting that the diagnosis by SARS still seems to be a privilege of part of the population residing in the wealthier areas, while the healing capacity of the populations of precarious settlements is reduced. The results help to understand the uneven impact of the disease in the different territories of the city, where it was observed that, in areas of precarious living conditions, there was less response from the health system.