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The current article has the main goal of debate the dynamics in the spread of Covid-19 based on the mobility of patients in the urban area of São Luís, Maranhão State. The time frame include the first 100 days of the pandemic, in the urban area of São Luís. The acknowledged data consists of ICU (intensive care units) spaces and the viral evolution during this time frame. The main data sources are the “Datasus” and the Maranhão State of health department. The characteristic suggests that the concentration of medical-hospital equipments in few cities, specially in Imperatriz, is considered a big bottle neck related to the fight against the pandemic Sars-CoV-2, since it requires more people mobility from centers with less health service offers to the ones with more health service offers, resulting into bigger contamination areas. Thereby the disease dissemination works in an hierarchical way in the urban area of the city, information that is not always clear in the data presented by the epidemiologic report. © 2021, Universidade Federal de Goias. All rights reserved.
ABSTRACT
This article has as main goal to discuss the Covid-19 spread due to the mobility of the patients over the urban network in the city of Imperatriz, in Maranhao State. The analyzed time frame refers to the first 100 days of the pandemic, emphasizing the urban network of the Imperatriz city space. The examined data of the ICU, hospital beds and respirators in the State, also the data about the viral evolution in this period. The main data source are the Datasus and the Maranhao State health offil ce. The studied characteristics suggest that the medical-hospital equipment concentration in few cities of the State, especially in Imperatiz, is an expressive bottleneck when fighting the Sars-CoV-2 pandemic, due to the necessity of mobilization of people from the smaller centers with less health services to the ones with more hospital beds, resulting in more spread areas. Therefore, the spread of the disease happens in a graduated way in the urban network of the city, and this data is not always evident in the epidemiologic reports.
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BACKGROUND AND AIMS: Patients on renal replacement therapy (RRT) pose multiple risk factors that may increase the risk of death from coronavirus disease 2019 (COVID-19). Currently, evidence of incidence, management, and prognosis of COVID-19 in this population are scarce. METHOD: Between May and December 2020, we followed two RRT populations that have the same tertiary hospital in Southern Brazil as its reference hospital for transplantation. Firstly, we monitored eight affiliated dialysis clinics keeping track of COVID-19 incidence and fatality rate in dialysis patients and those on the kidney transplant waiting list. In the same period, we also monitor COVID-19 incidence and mortality among our prevalent population of kidney transplant recipients. RESULTS: We evaluated 1049 patients in RRT in the dialysis centers. COVID-19 occurred in 89 of such patients (8.5%), and 31 died from such condition (35.8% death rate). Fifteen patients (5.45%), among 275 on the kidney transplant waiting list, contracted the virus, with one death (6.6%). Within our prevalent population of 1348 kidney transplant recipients, 113 were diagnosed with COVID19 (incidence: 8.4%), and 17 of them died (mortality rate: 15%). Finally, the number of kidney transplants decreased by 60.4% compared with the same period in the previous year. CONCLUSION: COVID-19 determined a substantial impact on RRT. A high frequency of chronic dialysis patients expired from the disease. The impact on the patients on the transplant waiting list seems to be less pronounced probably due to their better health conditions. The fatality rate in kidney transplant recipients is elevated and probably mostly related to comorbidities. Brazil is currently entering the second wave of the disease and it is crucial to find and provide means to protect such vulnerable populations.
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Objective: The overactivated immune system due to COVID-19 may be responsible for most of its physiological manifestations, including the neurological ones.
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Purpose: Comprehensive fetal care centers address congenital anomalies by first performing advanced fetal imaging (e.g. ultrasound, echocardiography, fetal magnetic resonance imaging (MRI)) and later discussing those findings, the prognosis, pregnancy management, need for fetal intervention, delivery plan and postnatal management in a multi-disciplinary format. This team approach to counseling can be logistically challenging due to the difficulty in assembling multiple providers from varied specialties on short notice. To reduce exposure during the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) broadened access to telehealth services. We assessed provider satisfaction with the rapid transition from in-person prenatal visits to multidisciplinary consultations via telehealth as an adaptive response to the pandemic. Methods: Patients who were referred to a busy fetal care center during the first six weeks of the pandemic were connected to the appropriate pediatric subspecialists by videoconference. Some patients underwent advanced fetal imaging and a telehealth consultation with radiology and other appropriate subspecialists took place immediately after imaging was complete. In other instances, imaging occurred and a telehealth visit with all applicable subspecialties took place in the patient's home at a later time. During multidisciplinary meetings, the images were reviewed with all participants via screen sharing. In some cases, providers met to review images prior to admitting the patient to the video call. Provider type is listed in Table 1. Provider satisfaction with the telehealth paradigm was assessed by convenience sampling using an electronic survey. Results: 22 surveys were administered and 18 providers responded for a response rate of 82%. Table 2 shows the overall satisfaction with connectivity and with the format compared to in-person visits. 89% of providers were highly satisfied with the telehealth format. 72% of providers would prefer the multidisciplinary telehealth format to an in-person visit for future visits after COVID-19 restrictions are lifted. 22% of providers would leave the choice to the patient's family. One provider preferred in-person visits. Other providers stated that they find inperson visits better for comforting the patient and for the ability to draw pictures or show educational materials. Conclusion: Providers were overwhelmingly in support of multidisciplinary telehealth conferences for prenatal consultations. This study shows that a multidisciplinary telehealth visit can be done with a high degree of satisfaction for providers. Specific benefits included the ability to review images together as a team, to review the delivery plan and to provide care coordination across specialties. Further studies are needed to better analyze the multidisciplinary approach to telehealth visits for prenatal care.
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OBJECTIVES: Although research in relation to new vaccines for the coronavirus, SARS-CoV-2 (COVID-19), is ongoing, it has been reported that medical teams are also considering the use of antiviral drugs in patients in order to verify their effectiveness when infection signs and symptoms present, mainly in stages one and two of the disease. METHODS: For the selection of studies, the combination based on the Medical Subject Heading Terms (MeSH) was used, and the databases Medline (Pubmed), LILACS, SciELO, SCOPUS, Web of Science, and BIREME were searched. The search period for articles consisted of manuscripts published between January 2010 and July 2020 without language and localization restrictions. RESULTS: Initially, 20 articles were selected and then reduced to 19 after exclusion based on repetititve articles. Titles and abstracts were analyzed, and 14 articles were excluded because they did not meet the inclusion criteria and did not answer the guiding question. Studies show that patients receiving certain medications in the initial stages (one and two) indicate a reversal of complications during hospitalization or often do not require hospitalization in addition to being discharged in a shorter period of time. CONCLUSION: Studies have reported that effective drugs for treating COVID-19 exist. In addition, this study emphasizes the importance of performing therapeutic interventions in the initial stages of infection aimed at reversing the disease and minimizing public health costs.