ABSTRACT
Background: Long term sequelae can be observed after SARS-CoV2. Aim: To describe the sexual, physical, mental and sleep sequelae four months after SARS-CoV2 diagnosis. Patients and Methods: Patients recovering from SARS-CoV2 with different degrees of disease severity were consecutively included and separated in two study groups, namely Group 1 including patients that had an acute respiratory distress syndrome (ARDS) and Group 2 including those with mild or moderate COVID-19. Handgrip strength, respiratory polygraphy (RP), Quality of life using the SF-12 questionnaire, and the international index of erectile (IIEF-5) function were assessed. Results: Twenty patients who had ARDS, and 10 without ARDS were included. Erectile dysfunction was observed in 77 and 10% of patients with and without ARDS, respectively (p < 0.01). The figures for sleep obstructive apnea were 82 and 40% respectively (p = 0.02) and for the physical domain SF-12 score were 39.2 and 47.9 points respectively (p = 0.01). No differences in muscle strength were observed. After a multivariable analysis, previous ARDS due to COVID-19 was independently associated with erectile dysfunction, with an odds ratio of 30.6 (95% confidence intervals, 3.08-300.3, p = 0.003). Conclusions: Among men with ARDS due to COVID-19, the prevalence of erectile dysfunction was high and independently associated with a severe disease four months after discharge. © 2022 Sociedad Medica de Santiago. All rights reserved.
ABSTRACT
Introduction: There are successful reports of the use of telemedicine in nephrology (TN), which would facilitate the access of patients with chronic kidney diseases (CKD) from the primary health centers (PHCs) to the nephrologist. Since 2019, TN has been implemented in Chile as a public health policy with national coverage. The process and outcome indicators associated with the Chilean National TN Program among PHCs and reference nephrologists are described. Methods: Descriptive study of asynchronous telemedicine care performed from urban and rural PHCs (574) (municipal health centers) to 17 nephrologists from Hospital Digital, between January 01, 2019 and June 30, 2021. The percentage of the rural population in Chile is 12.1%. Teleconsultations are sent by the PHCs doctor through a digital platform that contains clinical information, laboratory tests and treatments. The nephrologist in a deferred time, responds in the same way and decides between the options: 1) Counter-refer the patient to PHCs requesting more information or with treatment recommendations;2) Refer to a hospital for more complex studies or treatments. The following were analyzed: 1. Distribution by age, sex and comorbidities;2. Response times;3. Prevalence of CKD by stages;4. Destination post evaluation TN;5. Level of relevance of PHCs consultations. Results: In total, 12.705 asynchronous telemedicine visits were performed (2019: 50.8 %;2020: 31.9 %;2021:17.3%. During the Covid-19 pandemic, attention for TN was maintained although restricted by the health crisis in the public health network. The mean age was 65.9 (SD: 13.2) years;80% were older than 60 years;57%% women. CKD stages: S1 (8.5%%);S2 (16.2%);S3 (53.6%);S4 (17.9%) and S5 (3.7%). Comorbidities: diabetes 56%, hypertension 90.7%, dyslipidemia 65%, overweight 29.2% and obesity 38.7%. The average response time was 91 hrs. (range 1- 173). In total, 7.954 patients (62.6%) were referred to PHCs with recommendations, without requiring transfers to another center. In turn, 4.751 patients (37.4%) required face-to-face nephrological evaluation (58.1% high priority for CKD in stages 4-5). The relevance of the consultations according to the nephrologist's evaluation was considered high 23.1% and median 49.3%. Conclusions: The implementation of TN as a public policy has made it possible to facilitate expeditious access, evaluation and timely treatment of patients with CKD from urban and rural PHCs and prioritize face-to-face care by a nephrologist for those with greater risk or severity. Most of the patients evaluated (62.8%) were referred to PHCs, optimizing the limited space and high demand of face-to-face care per specialist. During the Covid-19 pandemic period, the use of TN was restricted but allowed continuity of control of patients with CKD and decongest PHCs and emergency care centers. Future studies should evaluate the impact of TN in the follow-up of patients screened with CKD, especially in stages 3-5, the decrease in travel-related CO2 emissions due to reduced displacement, the level of patient´s satisfaction/PHCs teams, and the evaluation effective cost of this care modality. No conflict of interest
ABSTRACT
Background: The new coronavirus-19 (COVID-19) disease has been associated with a persistent symptomatic state after the acute phase, called Long COVID-19. This study aimed to find liver effects and their association with pro-inflammatory cytokines and percentage (%) of neutrophil extracellular traps (NETosis) in this stage Methods: Prospective, observational study including symptomatic subjects four months after COVID-19 diagnosis. Clinical, demographic, anthropometry data, and blood samples were collected at enrollment time. Non-contrast computed tomography of chest and abdomen was performed, and fatty liver was defined as liver attenuation <40 Hounsfield units. Alanine aminotransferase [ALT], aspartate aminotransferase [AST], glycemic and insulin blood levels were obtained. Interleukine (IL)-1β, IL-6, IL-8, IL-12, and Tumor necrosis factor (TNF-a) levels were measured in blood samples using flow cytometry. % of vital NETosis was measured in freshly isolated neutrophils using SYTOX and LIVE/DEAD dye correlated, ex vivo, with circulating cytokine levels. Continuous variables were analyzed by U de Mann-Whitney and nominal variables by Fisheŕs test. A logistic regression model analyzed the clinical association between liver attenuation. We evaluated the correlation between ALT, AST, cytokines, and NETosis using a linear model Results: 60 subjects were enrolled. The age average was 46.4 years old (standard deviation[SD]±13.1), and 32/60 (53.3%) were male. 25/60 (41.6%) reported severe COVID-19 during the acute phase. The prevalence of fatty liver was 17/60 (28.3%). 6 out of these 17 subjects had fatty liver before their COVID-19 diagnosis. Fatty liver was associated with high body mass index (p=0.02), waist circumference (p=0,01), insulin resistant (p=0,003), severe COVID-19 during acute phase (p=0,04), higher ALT (p<0.01), AST (p<0.01), IL-6 (p=0.02) and IL-12 (p=0.03). 12/60 (20%) patients had ALT elevation, although most of them, 8/12 (66.6%), did not have fatty liver. Both ALT and AST were correlated to IL-8 levels (R2=0.158, p<0.01), and IL-8 levels were significant correlated with % vital NETosis (R2=0.068, p=0.04) Conclusion: Fatty liver is prevalent and associated with severe COVID-19 during the acute phase and associated with high ALT, AST, IL-6, and IL-12 levels during the long COVID-19 phase. However, the ALT, AST and IL-8 elevations in the long COVID-19 might not be necessarily related to fatty liver. Therefore, the association between IL-8 and vital NETosis could be a possible pathway.