Avaliacao Das Principais Causas De Inaptidao Em Triagem Clinica No Periodo Apos Pandemia Por Covid-19 - Comparacao Com Periodo Anterior: Experiencia Da Unidade Gsh-Bsst

Introducao: O desafio continuo da Hemoterapia, e a busca por uma transfusao segura e, isto depende, diretamente de cada etapa do ciclo do sangue. As novas tecnicas laboratoriais permitiram uma triagem sorologica mais efetiva em seus resultados que nos traz maior confiabilidade, porem, nao exclui a etapa da triagem clinica que e fundamental na busca de um doador saudavel. As pandemias modificam as atitudes e posturas da humanidade, o que gera impacto direto na necessidade de adaptacao da abordagem clinica da triagem na doacao de sangue. A habilidade do profissional de triagem e essencial para a exclusao subjetiva, a orientacao adequada do doador sobre sua inaptidao e a captacao de doadores com o perfil adequado para as diferentes modalidades de doacao. Objetivo: Descrever as principais causas de inaptidao clinica na triagem no periodo pos-pandemia por COVID-19, comparando com periodo anterior ja analisado no BSST. Metodologia: Avaliamos retrospectivamente, o periodo de janeiro a junho dos anos de 2021 e 2022, assim como o mesmo perido em 2012 e 2013. O levantamento foi realizado atraves da analise do banco de dados eletronico do BSST. Observou-se o indice de inaptidao, as frequencias e as principais causa de inaptidao temporaria encontradas na triagem clinica. Resultados: A media de candidatos/mes do BSST nos periodos analisados: 2012 = 1032;2013= 1161,5;2021 = 1990 e 1707 em 2022. O indice de inaptidao total (definitiva e temporaria): 2012 = 13%;2013 = 12,5%;2021 = 7,98% e 2022 = 6,81% (872/6969). Os inaptos em definitivo representaram 3,3% do total em 2012;3,8% em 2013;2,9% em 2021 e 3,1% em 2022. A principal causa de inaptidao obervada foi a mesma nos anos de 2012, 2013 e 2021: Hematocrito baixo (23,5% / 14% / 21%),com predominio entre mulheres: 92,5%, assim como a segunda causa que e a utilizacao de medicamentos (10% / 10% / 17,7%). No ano de 2022 observa-se como principal causa o uso de medicacao: 27,2%;seguido de 12% por cirurgia recente e 8% de tatuagem e piercing, que tambem estavam entre as 5 principais causas nos anos anteriores. As relacoes sexuais desprotegidas ou promiscuas tiveram um aumento em 2013, representando 12,1%, sendo 85% em homens com < 40 anos. Em 2021 e 2022 o contato com pessoas vitimas do COVID 19 esteve em torno de 3, 1%. Discussao: Observa-se uma reducao no numero geral de inaptidao, porem nao atribuida a pandemia por COVID-19, mesmo com a incorporacao desta entre as causas de inaptidao. A diminuicao do numero geral de inaptidao clinica ao longo dos anos, e interpretada por varias acoes de melhorias na tentativa de encontrar o doador ideal e tambem na disseminacao da informacao para que gere vindas desnecessarias de doadores inaptos ao Banco de sangue. O desenvolvimento e curso de projeto elaborado no BSST para melhoria da experiencia do doador no BSST, descrito como Encantamento, levou entre suas acoes a entrega de um cartao com texto elaborado de agradecimento com uma bala, aonde e descrito a data de possivel retorno da inaptidao temporaria. Esta pode ser a principal razao de aumento do retorno desses doadores (30% nos anos anteriores para 57% apos essa implementacao). A utilizacao de banner na entrada do BSST com esclarecimentos sobre a realizacao de piercing e tatuagem tambem gerou um impacto nessas causa de inaptidao (em media de 8,5% em periodo anterior para 6,5% no periodo atual). Conclusao: Apesar de 10 anos de intervalo entre as analises, observa-se que a melhora dos indices estao atribuidas as acoes descritas na unidade, demonstrando a importancia da analise sistematica dessas causas para elaboracao de projetos que gerem impacto de melhoria. Copyright © 2022

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)

Perception of body image, food consumption, sedentary behavior and physical activity in a Brazilian academic population during the lockdown due to the COVID-19 pandemic

The study evaluates the perception of body image associated with food consumption, sedentary behavior, and practice of physical activity responses during the COVID-19 lockdown in the academic population of a Brazilian University. Four hundred fifteen students answered an online survey during 1-31 May/2020. Frequencies were used to describe the outcomes, and the Chi-square test (p< 0.05) to determine associations. A negative perception of change in body image was found in both females and males (e.g., 73% and 55%, respectively), significantly associated with a perception of an increase in food consumption, watching TV and social media (more than 2 hours), not practicing physical activity in females, and with an increase in food consumption in males. The results presented a general picture of behavioral responses during the COVID-19 pandemic of students in Brazil, suggesting that a negative perception of body image changing has been associated with health-related behaviors, especially in females © Copyright 2018: Servicio de Publicaciones de la Universidad de Murcia

RENAL RECOVERY AFTER ACUTE KIDNEY INJURY ASSOCIATED TO COVID REQUIRING CRRT DURING ICU HOSPITALIZATION

BACKGROUND AND AIMS: Renal recovery (RR) after AKI is a determinant outcome of future comorbidity and mortality in critical care patients. Related predictive factors remain uncertain. METHOD: We retrospectively analyzed patients admitted to ICU between January 2020 and February 2021 from our critical nephrology database. We analyzed adult patients with diagnosis of AKI (KDIGO criteria) treated with renal replacement therapy (RRT) during ICU hospitalization. We excluded patients with dialysis support previous to the admission. The main outcomes we evaluated were (1) RR (successful suspension of RRT without hyperkalemia, increase in serum creatinine (SCr), hypervolemia or acidemia after 1 week without RRT, with urine volume > 500 mL/d without diuretic treatment or > 2000 mL/d with diuretics). (2) Mortality during hospitalization. RESULTS: We found 1442 patients were admitted to ICU, 418 presented AKI (29.8%), of them, 178 patients (64% male) required RRT (AKI-RRTd) in ICU during follow-up, with mean age of 66 year old (52.8% >65 year). Main comorbidity and demographic data are in Table 1. Mean time in ICU was 19 days (RIC 11-35). The most frequent admission cause was non-surgical pathologies (93%), 53% of admitted patients had COVID-19 as main diagnosis (95 patients). There was need of vasoactive support in 73.6%, ventilatory support (82.6) and 67.2% of patients had fluid overload. The indication of dialysis was determined by a nephrologist: mainly oliguria, acidosis, hyperkalemia, fluid overload and increase SCr. Mean SCR at admission was 2.5 mg/dL. There were missing data in 48% of basal SCr (known SCr between 1 and 12 months prior to admission). Total mortality in AKI-RRTd was 70.8% (126 patients). In COVID patients, was 77.9% (74 patients). We found renal recovery in 63.4% of total survivors (33/52 patients). When analyzing COVID, there were 21 survivors, and we found renal recovery in 80.9% of patients. Patients who did not achieved renal recovery had longer ICU stay (median: 20 days, RIC: 4-26) and inhospitalization (median: 41 days, RIC: 29-58). Those patients were older, and had higher morbidity (diabetes), higher SCr at ICU admission and lower urine output. Their fluid balance was higher at 48 h after CRRT initiation (OR 3.05, 95% CI 1.39-6.65, P <.01). In COVID population without renal recovery, there were more urgent dialysis onset (OR 8.33, 95% confidence interval (95% CI) 1.04-66.2;P = .04), age > 65 year (OR 6.48, 95% CI 1.94-21.6;P < .01), positive fluid balance at 48 h after RRT (OR 3.25;95% CI 1.09-9.69;P = .03). The risk factors for mortality, were age > 65 year (OR 4.14, 95% CI 2.05- 8.35;P < .01), mechanical ventilation (OR 3.28, 95% CI 1.48-7.30;P < .01), haemodynamic support (OR 4.37, 95% CI 2.14-8.92;P < .01). Otherwise, lower SCr at admission (OR 0.82, 95% CI 0.71-0.93;P < .01) and at instauration of RRT (OR 0.75, 95% CI 0.065-0.88;P < .01) were associated to lower mortality. In COVID patients, fluid overload at RRT initiation (OR 10.83, 95% CI 1.37-85.36;P = .02), age > 65 year old (OR 8.85, 95% CI 2.68-29.1;P < .01) and FiO2 > 50% at RRT start (OR 2.77, 95% CI 1.02-7.50;P = .04) were associated to higher mortality. CONCLUSION: In ICU patients with AKI-RRT dependence, negative fluid balance at 48 h after RRT onset and in COVID patients, age < 65 year old, negative fluid balance at 48 h after RRT onset and non-urgent onset of RRT were related with renal recovery. (Table Presented).

AVALIAÇÃO RETROSPECTIVA DA INCIDÊNCIA DE IGG POSITIVO PARA CORONAVÍRUS – COVID-19 EM PLASMAS COLETADOS EM DOAÇÃO DE SANGUE DE DOADORES CURADOS APÓS INFECÇÃO RESPIRATÓRIA PELO COVID-19: EXPERIÊNCIA DA UNIDADE BANCO SANTA TERESA – GRUPO GSH

Introdução: A recente pandemia mundial pelo coronavírus – COVID-19 e sua alta incidência de morbi-mortalidade entre as pessoas infectadas, gerou a necessidade de busca pelas diversas modadlidades de terapias disponíveis pela medicina moderna. Entre essas, encontra-se o uso de plasma convalescente – forma de terapia já utilizada anteriormente para tratamento em outras doeças, porém com dados conflitantes em relação a dose efetiva e relação temporal de uso da mesma. Mediante a publicação da legislação brasileira com permissão para uso deste tipo de plasma fora de ambiente de estudo científico, gerou uma popularização desta prática em alguns centros e assim houve a necessidade de criação de critérios em Bancos de Sangue para coleta eletiva e armazenamento deste tipo de plasma. Objetivo: Analisar a incidência de positividade de IgG em plasmas produzidos a partir de doação de sangue em doadores aptos e recuperados após 30 dias da sua alta médica das formas não graves de infecção por COVID-19 (recuperação sem necessidade de uso de oxigênio complementar ou internação hospitalar). Metodologia: Foram avaliados, retrospectivamente, 538 doações que ocorreram no BSST a partir de junho de 2020. Sendo a identificação do anticorpo realizada através da técnica de Quimioluminescencência por laboratório tercerizado, com ponto de corte em superioridade a 1,4. A coleta era realizada no momento da produção do plasma fresco congelado e identificado por etiqueta elaborada para destaque de COVID-19. Resultados: Foram avaliados 538 doações no período, onde 455 apresentaram resultado positivo para IgG para COVID 19 na técnica e 83 negativos. Entre os negativos 46,9% eram homens e 53,1% de mulheres (44) e 46,9% de homens (39). Entre as mulheres 19 encontravam-se entre 20–30 anos (43,1%), seguidos por 10 entre 31–40 anos (22,7%), 9 entre 41–50 anos e 6 entre 51–60 anos. Entre os homens, 10 encontravam-se entre 20–30 anos (26,3%), seguidos por 9 entre 31–40 anos (23,6%), 8 entre 41–50 anos, 3 entre 51–60 anos e 1 com idade superior a 60 anos. Discussão: Encontramos 15% de negatividade na detecção na técnica empegada para IgG para COVID-19 em doadores com menos de 30 dias de cura de infecção não grave. Embora contarditórios, dados de pesquisas internacionais em taxas de prevalência, registraram uma resposta de anticorpos durável ao longo de quatro meses a partir do momento da infecção. Outros estudos referem que Idade, comorbidades e a gravidade da doença inicial são fatores que parecem desempenhar um papel na rapidez com que os anticorpos diminuem. A melhor técnica para detecção da presença e efetividade do anticorpo também segue sendo foco de atenção Conclusão: Os dados encontrados demonstram a necessidade de maior compreensão da evolução dessa doença e a titulação necessária para determinar a efetividade no uso do plasma convalescente como forma terapêutica para esta doença.

POST-INFECTIOUS DEMYELINATING POLYNEUROPATHY SECONDARY TO COVID-19 INFECTION

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Coronavirus disease 2019 (Covid-19) began late 2019 in Wuhan, China, declared health care emergency in January 2020 and by March 2020 was declared a pandemic by the WHO. Although respiratory symptoms are most commonly reported, it is important to notice that neurologic complications have been increasingly recognized. Symptoms include headache, dizziness, anosmia, ageusia, and encephalopathy. Demyelinating polyneuropathy presenting as post infectious sequela has not yet been well described. CASE PRESENTATION: Three weeks after being diagnosed with Covid-19, when fully recovered, a 66-year-old man presented with sudden onset walking difficulties owning to symmetric weakness in the lower extremities that rapidly progressed to the upper extremities. Once in respiratory distress with a negative inspiratory force of negative 12, he was intubated due to neuromuscular failure. The diagnosis of Guillain-Barre syndrome (GBS) was made through clinical evaluation in junction with Cerebrospinal Fluid (CSF) analysis (revealing albumin-cytological dissociation), electromyography, and magnetic resonance imaging. He had no significant improvement with intravenous immunoglobulin (400mg/kg/day for five days) and, thus, was started on plasmapheresis treatment (five sessions every other day). Although he only had a mild response, the patient was able to answer simple questions and was enrolled in a long-term physical and occupational therapy. DISCUSSION: Guillain-Barre is an immune-mediated disease that affects the peripheral neurons and nerve roots usually after a preceding respiratory or gastrointestinal illness. There are several proposed mechanisms through which Covid-19 can affect the nervous system. It is thought that the virus can enter the cells via an angiotensin-converting enzyme 2 receptor, invading the peripheral nerve terminals and spreading to the dorsal root ganglion. Then, it potentially shares epitopes similar to neurons, allowing the activation of a cell-mediated immunity leading to neuronal dysfunction. GBS as a sequela of Covid-19 has not been well reported in literature. The case hereby presented had a temporal relationship between the resolution of Covid-19 and the neurologic symptoms. Its rapid progression affecting the peripheral nerves and the albumin-cytological evidence dissociation on CSF analysis led us to consider Guillain-Barre as a strong differential. The poor clinical response despite aggressive treatments is usually associated with a worse prognosis and significant likelihood of reliance on mechanical ventilation. CONCLUSIONS: By reporting this case, we aim to reiterate the importance of fully understanding the spectrum of Covid-19 related complications, in order to prevent further mortality. REFERENCE #1: Huang C, Wang Y, Li X et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. REFERENCE #2: Zubair AS, McAlpine LS, Gardin T, et al. Neuropathogenesis and Neurologic Manifestations of the Coronaviruses in the Age of Coronavirus Disease 2019: A Review. JAMA Neurol. 2020;77(8):1018–1027. REFERENCE #3: Hughes RA, Cornblath DR. Guillain-Barré syndrome. Lancet. 2005 Nov 5;366(9497):1653-66. DISCLOSURES: No relevant relationships by Christiana Atuaka, source=Web Response No relevant relationships by Nishil Dalsania, source=Web Response No relevant relationships by Claudia De Araujo Duarte, source=Web Response No relevant relationships by Bruno De Brito Gomes, source=Web Response No relevant relationships by Varun tej Gonuguntla, source=Web Response No relevant relationships by Ravikaran Patti, source=Web Response No relevant relationships by Chanaka Seneviratne, source=Web Response No relevant relationships by Navjot Somal, source=Web Response

NOT EVERYTHING IS COVID: PERSISTENT FEVER AND MALAISE MIMICKING COVID-19 PNEUMONIA

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: The diagnosis of COVID-19 has depended on the use of a Reverse transcriptase polymerase chase reaction test (RT-PCR) on respiratory samples. While this has directed the response and care of patients with suspected COVID-19, there have been false-negative results depending on when the test was administered in relation to time of exposure and symptom onset. CASE PRESENTATION: A 19-year-old male with no significant past medical history presented to the emergency department in July 2020 with a persistent fever of 100 -103F for 10 days. He returned from Texas 9 days prior with onset of fever one day before depature. He had a mild, non-productive cough, body aches, and poor oral intake. He also had diffuse abdominal pain with diarrhea and bilious, non-bloody vomiting - up to three times a day. He had elevated WBC, ESR, CRP and LDH with Lymphopenia. Blood cultures and HIV, Syphilis, EBV and Mycoplasma screening were negative as was a COVID-19 test. CT scan of his chest and abdomen revealed peripheral ground glass opacities suspicious of COVID 19. A repeat COVID test on hospital day 2 was again negative. He was treated with Azithromycin and Doxycycline and discharged home on Azithromycin on hospital day 4. He was readmitted 6 days later because of persistent fever to 103F, joint pains, malaise and weight loss of about 10 pounds. ESR, CRP, Ferritin and LDH were again elevated. A repeat CT scan showed resolution of previously seen ground glass opacities in the anterior lung fields and new confluent areas of ground glass attenuation and interlobular septal thickening posteriorly. A 3rd, 4th and 5th COVID-19 tests performed were negative. He was treated with Acetaminophen alternating with Ketorolac. A TTE showed a hyperlucency concerning for a right atrial thrombus or vegetation. Left ventricular ejection fraction was 50%. An MRI of the heart showed an inflammatory picture consistent with myocarditis. Further testing was done to reveal the etiology of his myocarditis to be Coxsackie A7,9, and 16. Clinically, there was significant improvement with resolution of fever and malaise and return of WBC count to normal. DISCUSSION: This patient's diagnosis of Coxsackie A myocarditis was clouded by the medical team's strong suspicion of COVID-19 pneumonia because of his clinical presentation and history of travel during the month of June to a part of the US with rising rates of COVID-19 cases. The unknown precise false-negative rate of the COVID-19 test, which can be anywhere from 2-27% depending on the time of testing from initial exposure meant that the diagnosis was never deemed impossible even with consecutive negative test results. CONCLUSIONS: While the attention COVID-19 is receiving is well deserved, anecdotal accumulation of evidence along with the scientific community's first wave of research has produced heuristics that need to be overcome to optimize patient care and outcomes. REFERENCE #1: Kucirka LM, Lauer SA, Laeyendecker O, Boon D, Lessler J. Variation in False-Negative Rate of Reverse Transcriptase Polymerase Chain Reaction–Based SARS-CoV-2 Tests by Time Since Exposure. Ann Intern Med [Internet]. 2020 May 13 REFERENCE #2: Arevalo-Rodriguez I, Arevalo-Rodriguez I, Buitrago-Garcia D, Simancas-Racines D, et al. False-negative results of initial RT-PCR assays for COVID-19: a systematic review. April 21, 2020 (preprint). REFERENCE #3: Steven Woloshin, M.D., Neeraj Patel, B.A., and Aaron S. Kesselheim, M.D., J.D., M.P.H. False Negative Tests for SARS-CoV-2 Infection — Challenges and Implications. DOI:10.1056/NEJMp2015897, June 5, 2020 DISCLOSURES: No relevant relationships by Christiana Atuaka, source=Web Response No relevant relationships by Carmina Aybar Rodriguez, source=Web Response No relevant relationships by Claudia De Araujo Duarte, source=Web Response No relevant relationships by Khurriyat Foziljonova, source=Web Response No relevant relationships by Varun tej Gonuguntla, source=Web Response No relevant relationships by Margaret Ku n-Basti, source=Web Response

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.