[Heterogeneous governmental responses in confronting the COVID-19 pandemic in Latin American countries]. / Respostas governamentais heterogêneas no enfrentamento da pandemia da COVID-19 por países da América Latina.

The study analyzes the development of responses to address the COVID-19 pandemic in Latin America. It is a descriptive study based on an analysis of documents, data, and policy measures adopted or announced between March and December 2020 in 14 Latin American countries. The analysis included assessment of the content, tenor, and scope of policy measures for containment and mitigation, health care, and reorganization of health services identified on government websites. In addition, quantitative demographic indicators were included, as well as those related to the epidemiological situation and the result of the Stringency index. In general, the responses of Latin American countries were heterogeneous, albeit multisectoral, characterizing the complexity and diversity of decision making when confronting a pandemic. The conclusion drawn is that there is still a great deal to reflect upon with respect to the consequences of regulatory weaknesses for the achievement of multidimensional demands during health crises.

O estudo analisa a elaboração de respostas para o enfrentamento da pandemia da COVID-19 na América Latina. Trata-se de um estudo descritivo com base em análise de documentos, dados e medidas políticas adotadas ou anunciadas entre março e dezembro de 2020 em 14 países latino-americanos. A análise compreendeu a apreciação de teor, conteúdo e abrangência das medidas políticas para contenção e mitigação sanitárias e para a reorganização dos serviços de saúde identificadas nos sites governamentais. Complementarmente, incluiu-se indicadores quantitativos demográficos e relativos à situação epidemiológica e resultado do Sringency index. No geral, as respostas dos países latino-americanos foram heterogêneas, apesar de multisetoriais, caracterizando a complexidade e diversidade decisória frente à pandemia. Conclui-se que ainda há muito a refletir sobre as consequências das fragilidades normativas para a consecução das necessidades multidimensionais durante crises sanitárias.

Acute kidney injury associated to sulfamethoxazole urine crystal: The importance of clinical suspicion.

Management of acute kidney injury (AKI) associated with drug-induced crystal nephropathy can be difficult, and timely diagnosis is critical to resolve this condition. We present the case of a 55-year-old woman with history of systemic lupus erythematosus (SLE), who, after treatment with trimethoprim/sulfamethoxazole (TMP/SMX) for suspected Pneumocystis jirovecii pneumonia, developed severe AKI. Automated urinary sediment initially reported hematuria, leukocyturia and "uric acid crystals". She did not have allergic symptoms, clinical manifestations of active SLE nor hyperuricemia. AKI persisted despite volume expansion with crystalloids. Due to SMX exposure, it was suspected that "uric acid crystals" could be in reality "SMX crystals", and were a possible cause of crystal nephropathy. TMP/SMX was withheld and urinary alkalization was performed, with subsequent resolution of AKI. SMX urine crystals were posteriorly confirmed by Fourier transform infrared spectroscopy.