ABSTRACT
A new type of coronavirus, causing an infectious disease called COVID-19, with a high rate of transmissibility has spread around the world. The population was told to stay in their homes, in social isolation, so as not to act as vectors of virus transmission to more vulnerable individuals. The pandemic of the new coronavirus has brought social, economic, and psychological effects all over the world. Although these are necessary measures, the impacts of social isolation on the mental health of the population must be taken into consideration. This study aims to reflect on the effects of quarantine and the increase of addictive behaviors in this period of pandemic, bringing the implications of these for the mental and physical health of the population. This is a narrative review of articles, reports and book chapters published since the beginning of the pandemic, the main databases being Medline, Scielo and Scopus Elsevier. The findings point out that quarantine, has negatively impacted both the mental and physical health of the population, triggering psychological symptoms, such as anxiety, depression and addictive behavior, in addition, can arouse feelings such as sadness and anger, and may be punctual or extend after the end of isolation. However, there are strategies that, when adopted together, can minimize the psychological effects of isolation and make this moment less unhealthy. In this sense, this study highlights the importance of offering interdisciplinary treatments and effective public health strategies in public health systems, so that they can meet the needs of the population by providing comprehensive care and treatment, and by considering short, medium, and long-term actions to prevent addictive behaviors.
ABSTRACT
Introduction: On May 1, 2020, the US Food and Drug Administration issued an emergency use authorization to permit the use of remdesivir for treatment of adults and children hospitalized with severe SARSCoV- 2. Severe SARS-CoV-2 infection leads to an acute kidney injury in up to 20-40% of critically ill patients. Patients with severe acute renal failure on hemodialysis were excluded from remdesivir trials;as a result, these patients may not be considered for treatment. Case: A 63-year-old African American male with past medical history of diabetes, hypertension, and vertigo presented with flu-like symptoms and shortness of breath. He was found to be SARS-CoV-2 positive. On arrival he developed acute respiratory distress syndrome and required intubation. Chest x-ray showed bilateral pulmonary opacities. The patient was diagnosed with acute renal failure with a BUN of 89 mg/dL, SCr of 7.8 mg/dL and CrCl of 12 ml/min on admission. The patient received hemodialysis daily until hospitalization day 9, and thereafter on Monday, Wednesday, Friday. The remdesivir loading dose was given on hospitalization day 7 and treatment was typically administered after dialysis, for a total of 5 days. The patient's liver function tests remained within normal limits, AST ranged from 24-28 IU/L and ALT ranged from 23-24 IU/L, throughout the full course of therapy. Discussion: Current literature dismisses the use of remdesivir in patients with a CrCl less than 30 ml/min. Concerns about the drug's potential toxicity in patients with kidney disease relates to the renal elimination and the potential accumulation of its sulfobutyletherbeta- cyclodextrin (SBECD) carrier, causing liver necrosis. The absence of liver function decline in this patient suggests remdesivir, a potentially beneficial agent, may be considered safe when scheduled after hemodialysis. Conclusion: Remdesivir appears to be safe in patients with acute or chronic renal disease on hemodialysis. Daily liver function tests should be performed in this patient population.