ABSTRACT
Introduction: Kidney disease due to COVID-19 has been described with several presentations, both in acute phase and in posterior timing of the infection, and kidney biopsy is important for an ideal management. But the process of adequately perform a biopsy during the pandemic entails risks, as being the exposed and infected by the SARS-CoV-2. Besides of the usual potential complications, such as post-biopsy hemorrhage, that may require admission in an already crowded medical structure. For these reasons, attainment of kidney biopsies was limited to those who without an adequate histopathological diagnosis, were at higher risk of inappropriate management, as well as a pathology secondary to the SARS-CoV-2 could be ignored. The aim of this study is to perform a description of the cases biopsied during the SARS-CoV-2 pandemic, being emphasized those whose indication emerged because of the viral infection. Method(s): Descriptive study of the clinical presentation in addition to histopathological findings of cases requiring kidney biopsy during the period of March 2020 - July 2021. Result(s): A total of 37 cases were collected, with a median age of 40 years (range: 60), 51% males and 73% with known history of hypertension. A 35% of the cases presented nephrotic syndrome;with average proteinuria of 4189.5mg/24h. The most frequent histopathological diagnosis was focal segmental glomerulosclerosis (FSGS), accounting for 40% of the cases. 4 patients required biopsy after COVID-19. One of them presented with Acute Kidney Injury (AKI) during the acute phase of the SARS-COV-2 infection with prolonged hemodialysis requirement;presenting histopathological diagnosis of global and segmental glomerulosclerosis. Another case of AKI during the acute phase of infection and subsequent proteinuria presented global and segmental glomerulosclerosis with collapsing characteristics;while 2 cases due to nephrotic syndrome post-infection, presented histological data of minimal change disease and FSGS with acute tubular injury. Conclusion(s): Regardless of the appearance of a new pathology that affects the kidneys, the incidence of entities such as FSGS persists with greater frequency. However, that does not diminish the importance of performing renal biopsies, since this is an essential tool for management in cases where there is overlap of specific glomerual diseases with COVID-19. No conflict of interestCopyright © 2023
ABSTRACT
Introduction: The Coronavirus disease (COVID-19) is more severe in patients with pre-existing comorbidities;therefore, dialysis patients fall into this category. Not to mention the risk among patients receiving in-center dialysis, since they are known to be at higher risk of contracting this disease. Information about the clinical characteristics among hemodialysis patients with COVID-19 in Latin America and low-and middle-income countries are limited. Considering the importance of this topic, the aim of this study was to describe the clinical characteristics along with the outcome of 70 hemodialysis patients hospitalized for COVID-19. Method(s): This is a retrospective study in chronic hemodialysis patients hospitalized with COVID-19. All patients diagnosed with COVID-19 from March 2020 to January 2022 are included. Result(s): The mean age of the patients was 58 (range 19-87), where 65.7% were male. The most prevalent comorbidities were hypertension (98.6%) and type 2 diabetes (54.3%). The most common presenting symptoms were dyspnea (71.4%), fever (68.6%) and cough (58.6%). In addition of abnormal pulmonary auscultation in most patients (78.6%). Lymphocytopenia and elevated inflammatory markers as procalcitonin, erythrocyte sedimentation rate (ESR), D-dimer and C-reactive protein (CRP) were the main prevalent lab findings. At admission 90.1% had ground- glass abnormalities in the CT findings, being CO-RADS 3 the most frequent category between these patients. The average hospital stay was 8.51+/- 6.39 days;35.7% of these patients were admitted to the ICU and only 4 (5.7%) required mechanical ventilation. Therapeutic management included statins and antithrombotic therapy for all the patients at prophylactic doses. Treatment options were remdesivir, corticosteroids, hydroxychloroquine, antibiotics, and other immunosuppressant drugs. A total of 8 (11.4%) patients died during hospitalization and 62 (88.6%) were discharged. Conclusion(s): Even though dialysis patients are at higher risk of death, especially in developing countries, our findings suggest that the mortality rate were lower in comparison with other studies in Latin America and similar to some developed countries. The use of statins and antithrombotic prophylaxis in all hospitalized patients seems to be associated with a lower risk of death in conjunction with other therapeutic regimens according to the guidelines. No significant adverse effects were observed with remdesivir in these patients, so we believe that its use is beneficial in conjunction with the use of statins and antithrombotic prophylaxis, based on the patient's requirements. No conflict of interestCopyright © 2023
ABSTRACT
The airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via respiratory fluids and droplets suggests that mouthwashes containing substances with virucidal activity can help reduce viral spread. We conducted a multicenter, double-blind, placebo-controlled, randomized trial to assess the virucidal activity of cetylpyridinium chloride (CPC) mouthwashes. Outpatients who tested positive for SARS-CoV-2 infection with or without symptoms were randomized to perform washes and gargles for 1 min with 15 mL of either colored distilled water or 0.07% CPC (Vitis CPC Protect) mouthwash. The study outcomes were the SARS-CoV-2 log10 viral RNA load and the nucleocapsid protein levels, both in saliva at 1 and 3 h after the intervention. In total, 118 patients were enrolled and randomized (mean [SD], age 46 [14] y). Thirteen of 118 participants (11%) did not complete follow-up or had insufficient sample volume for testing and were excluded from the analysis. The assessment of the viral load showed no significant differences between groups at any of the investigated points. However, the levels of SARS-CoV-2 nucleocapsid protein of lysed viruses were significantly higher in the CPC group compared with the control group at 1 h (adjusted difference 269.3 pg/mL; 95% confidence interval [CI], 97.1-441.5) and at 3 h postintervention (561.1 pg/mL; 95% CI, 380.0-742.2). In nonhospitalized patients with asymptomatic or mild symptomatic SARS-CoV-2 infection, a 0.07% CPC mouthwash, compared to placebo, was associated with a significant increase of nucleocapsid protein levels in saliva, indicating enhanced disruption of viral particles.