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The onset of the COVID-19 pandemic saw a period of rapid experimentation with insolvency law settings, designed to prevent a wave of insolvencies. Although governments acted quickly to keep debtors out of insolvency processes, they did not alter high levels of underlying indebtedness. In this worsening economic climate characterized by low growth, high inflation, fiscal tightening and high indebtedness, it appears, in certain countries, that these measures may have deferred, rather than prevented, high insolvency levels. A key economic legacy of the COVID-19 pandemic is the extensive fiscal stimulus and the resulting budgetary constraints this has placed on governments. In this context, there is increasing evidence of the importance of frameworks for out-of-court debt workouts as a complement to formal corporate restructuring frameworks. © 2023, The Author(s).
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Objetivo: O presente trabalho tem como objetivo relatar um caso de evolucao de sindrome mielodisplasica para leucemia mieloide aguda, diagnosticada atraves de biopsia de lesao intraoral de sarcoma mieloide. Material e Metodos: Trata-se de um estudo descritivo, retrospectivo, do tipo relato de caso. Os dados foram coletados atraves dos registros em prontuarios eletronico e fisico da instituicao. Resultados: O caso apresentado envolveu um paciente do sexo masculino, de 51 anos, melanoderma, matriculado na instituicao devido ao diagnostico de sindrome mielodisplasica, tratado com 19 ciclos de decitabina. Devido a um quadro de odontalgia e abscessos de repeticao o paciente foi encaminhado ao setor de Odontologia onde, durante o exame clinico, foi constatada presenca de lesao eritematosa, amolecida, friavel, de superficie lisa, base sessil, de aproximadamente 3 x 1cm na regiao distopalatina do dente 26. No exame radiografico, foi observada imagem radiopaca associada a raiz mesial do dente 26, com margens definidas. Foi realizada biopsia excisional da lesao em regiao de palato com carater de urgencia e as hipoteses diagnosticas iniciais foram de granuloma piogenico e cisto radicular. O laudo histopatologico foi compativel com quadro de sarcoma mieloide comprometendo mucosa, com imuno-histoquimica positiva para CD34 e CD117 e negativa para CD163 e TdT. Diante do diagnostico previo de sindrome mielodisplasica, associado ao diagnostico de sarcoma mieloide oral, a equipe medica constatou a transformacao da doenca inicial em leucemia mieloide aguda. Foi definido novo protocolo terapeutico e realizado um ciclo de citorreducao com Citarabina (ara-C) subcutaneo e resgate com hidroxiureia + ara-c (HYDAC) + idarrubicina. Durante este ciclo, o paciente foi diagnosticado com Covid-19, evoluindo para obito, nao concluindo portanto, o protocolo terapeutico proposto. Discussao: O diagnostico de sarcoma mieloide oral permitiu que a equipe multiprofissional detectasse a transformacao da doenca primaria em leucemia mieloide aguda, resultando na reformulacao do tratamento e conduta do caso. O prognostico da leucemia mieloide aguda secundaria a sindrome mielodisplasica e pior quando comparado as primarias, bem como, apresenta baixas taxas de remissao apos quimioterapia intensiva e a sobrevida global mediana de 9-12 meses. O diagnostico dessas lesoes por parte do cirurgiao-dentista e considerado um desafio, visto que sao raras em cavidade oral e as apresentacoes clinicas costumam ser variadas e inespecificas. Conclusao: O presente relato de caso evidencia a importancia de uma avaliacao clinica minuciosa e do diagnostico preciso e completo de lesoes orais, que podem implicar diretamente na definicao da doenca de base, tratamento e prognostico do paciente. Alem disso, ratifica a importancia do cirurgiao-dentista na pratica clinica e na atuacao profissional de forma interdisciplinar e integrada com a equipe de saude. Copyright © 2022
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Background: As a care tool for the elderly population, caregivers must have knowledge about the prevention of COVID-19 to minimize the transmission of SARS-CoV-2. Objective: Describe the process of construction and validation of educational leaflet content for caregivers of the elderly on covid-19 prevention measures. Methods: Methodological study developed in three stages. The first stage corresponds to the literature review;the second involved the construction of the brochure and the last stage was content validation by a committee of twenty-three experts who judged the objectives, structure/presentation and relevance of the brochure from a validated 3-point Likert scale. Items with positive opinions by more than 80.0% were considered adequate. Results: The leaflet was prepared containing six pages, with information on the new coronavirus, forms of transmission, signs and symptoms, protection of the disease, alteration of the routine of daily care, the importance of hand hygiene, surfaces and food;correct use of mask;care for the caregiver or family member;emotional health and how to proceed in case of suspicion of COVID-19. Only one evaluation round was required;the content validity index was 1.0 and the agreement between judges was statistically significant in all domains of the scale (p<0.006). Conclusion: This study provides an educational leaflet with validated content, configuring a capable component to improve the knowledge of caregivers about prevention measures against COVID-19 in the elderly. © 2021 Faculdade de Medicina de Ribeirao Preto - U.S.P.. All rights reserved.
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Covid-19 is an infectious disease caused by the new Coronavirus (SARS-CoV-2) that had its first records in China's Wuhan province and in March 2020, WHO declared Covid as a Pandemic. Since then, several studies have been carried out to analyze the transmission of SARS-Cov-2 through analyzes of Geographic Information Systems and Statistics with the purpose of evaluating the socioenvironmental elements. For the present work, the methodology is characterized by the creation of socioenvironmental vulnerability indices, analyzing the unavailability of drinking water, the absence of sanitary sewage collection, high demographic densities, contamination rates and lethality rates. The selected neighborhoods were Brasília Teimosa and Pina, using information from IJCPM, Compesa, IBGE, Health Secretariat of the City of Recife and Secretariat of Planning and Management of the State of Pernambuco. After processing the data, the Socio-Environmental Vulnerability Index was introduced using social indicators. For the Pina neighborhood, sectors were selected whose IVSA was greater than or equal to 0.6. It is perceived that, for these sectors, the vulnerability regarding home care for sewage and income is moderate. While the Brasília Teimosa neighborhood has an asymmetry in stilt areas with high vulnerabilities. This same behavior is observed in relation to the IVCD. The Pina neighborhood stands out for the number of outliers, which occur in exactly the same sectors. This may imply a direct relationship between the number of cases and the number of deaths, but it can also be related to shared socioeconomic vulnerability. © 2021, Universidade Federal de Pernambuco. All rights reserved.
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Relato: OAMJ, 75 anos, masculino, diagnostico de leucemia mieloide cronica (LMC), em tratamento com imatinibe, em remissao molecular maior. Antecedentes de diabetes, hipertensao, dislipidemia e doenca arterial coronariana com angioplastia previa. Paciente apresentou febre em 19/06/2020, realizado RT-PCR positivo para SARS-CoV-2 em 20/06. Foi admitido no hospital em 22/06 e iniciado tratamento com corticoide, enoxaparina e sintomaticos porem evoluiu com hemoptise, dessaturacao e piora na febre sendo transferido para a UTI. Evoluiu insuficiencia respiratoria e necessitou de ventilacao mecanica a partir de 23/06, associado a antibioticoterapia de amplo espectro e interrupcao do tratamento de base com imatinibe. Na evolucao apresentava-se com bons parametros ventilatorios porem fez duas paradas cardiorrespiratorias em 29/06, uma de 8 minutos e outra de 5 minutos, seguidas de crises convulsivas. A etiologia nao foi estabelecida, porem a principal hipotese foi tromboembolismo pulmonar, nao confirmada pois paciente nao tinha condicoes clinicas de angiotomografia. Evoluiu com encefalopatia, comprovada por eletroencefalograma e exames de imagem, mostrando severa lesao hipoxica e metabolica cerebral. Necessitou de hemodialise devido a disfuncao renal severa e desenvolveu infeccao fungica pulmonar, precisando antibioticoterapia antifungica. Paciente segue com quadro clinico inalterado em 12/08, com glasgow 6 e sem sinais de recidiva da LMC. Discussao: A terapia com inibidores de tirosinoquinase (TKI) em pacientes com LMC em fase cronica, em geral, nao implica em estado de imunossupressao significativa, e, ate o momento, nao ha evidencias que estes pacientes tenham maior risco de contrair infeccao por SARS-CoV-2 ou de apresentar a forma mais grave da doenca quando comparados com a populacao em geral. As recomendacoes atuais sao de manutencao do tratamento com TKI em formas leves da infeccao, e para casos graves, a interrupcao da terapia deve ser discutida individualmente. O efeitos adversos associados aos TKI, como hipertensao portal e derrame pleural, mais comumente vistos durante o uso de TKI de segunda geracao, como dasatinibe, podem agravar o quadro clinico da infeccao viral. Para estes pacientes (que apresentam evento adverso ao inibidor e desenvolver COVID-19) deve-se considerar interromper o TKI a fim de causar menor morbidade pulmonar. Em 2014, os TKI foram testados contra outros tipos de coronavirus. Imatinibe e dasatinibe mostraram-se ativos contra MERS-CoV e SARS-CoV, enquanto que nilotinibe foi ativo contra SARS-CoV. Os autores sugerem que a inibicao das vias de sinalizacao celular dependentes da tirosinoquinase ABL seja crucial para inibicao da replicacao viral. Ha um estudo em andamento, randomizado, controlado com placebo, para avaliacao da utilizacao de imatinibe em pacientes com COVID-19. Conclusao: Mediante o exposto, entendemos que apesar de todos os dados de literatura ate o momento demonstraram um perfil favoravel de evolucao em pacientes com LMC e infectados por SARS-Cov-2, outras variaveis devem ser consideradas na avaliacao individual do paciente. Juntos, todos os fatores podem contribuir para desfechos graves, como no relato apresentado.Copyright © 2020
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Relato: FSF, diagnóstico mieloma múltiplo IgG, indice prognóstico internacional (ISS) II, Durie-Salmon III, em julho de 2020, antecendentes de diabetes, hipertensão arterial sistêmica, coronariopatia, marca-passo e dislipidemia. Iniciou quimioterapia com bortezomibe e dexametasona em pulsos em 16 de julho. Após 12 dias do início do tratamento apresentou quadro febril, tosse e dessaturação, tomografia demonstrou lesões em vidro fosco e exame de swab nasal por PCR foi positivo para Sars-CoV-2. Foi tratado conforme protocolo da instituição recebendo antibioticoterapia, dexametasona e enoxaparina. No décimo dia da infecção pelo Sars-CoV-2 apresentou dor torácica atípica de forte intensidade, com aumento progressivo das enzimas cardíacas e instabilidade hemodinâmica, transferido para UTI, realizado cateterismo cardíaco que não demonstrou lesões coronárias, apenas prejuízo função cardíaca. Submetido a ressonância magnética cardíaca que demonstrou área inativa em parede inferior. Apresentou taquicardia ventricular e após estabilização clínica foi submetido a novo cateterismo cardiaco, porém evoluiu com choque cardiogênico refratário e óbito em 15/08/2020. Discussão: Evidências apontam que a infecção por coronavírus 19 (COVID-19) em pacientes com doenças hematológicas malignas está associada a quadros mais severos, com mais chance de desenvolverem a forma fatal. Associa-se esse quadro ao tratamento imunossupressor, além da disfunção imune que a neoplasia em si causa, sendo que o aumento da letalidade desses pacientes pode estar relacionado a co-infecção com bactérias. Entretanto, vários fatores confundidores se associam, como o fato de que muitos pacientes onco hematológicos apresentam comorbidades associadas, como hipertensão, idade avançada, obesidade e doenças cardiovasculares, que são fatores de risco conhecidos por agravar o quadro de infecção por Sars-CoV-2. Em cardiopatas e hipertensos, é frequente a elevação de enzimas cardíacas relacionadas à casos severos de COVID-19, que pode estar associado à miocardites, isquemia e arritmias. Além disso, pacientes com mieloma múltiplo são de 7 a 10 vezes mais susceptíveis a infecções bacterianas e virais, sendo que o seu tratamento leva a deficiência imune humoral, hipogamaglobulinemia e prejuízo na resposta de células-B. Em caso de infecção sintomática por COVID-19, o tratamento anti-mieloma deve ser suspenso até recuperação. Conclusão: As altas taxas de hospitalizações de pacientes onco hematológicos devido a periodicidade de seu tratamento podem aumentar a chance de infecções nosocomiais por COVID-19. Portanto, o ideal seria adiar o tratamento específico para a doença de base quando possível e tomar medidas de precaução especiais para o isolamento desses pacientes no ambiente hospitalar além de orientar medidas de isolamento domiciliar. É importante fazer o diagnóstico diferencial de outras infecções microbiológicas nesses pacientes, que podem apresentar quadros clínicos semelhantes. Além disso, é necessário uma monitorização próxima para complicações relacionadas ao COVID-19, já que a intervenção precoce é uma das principais ferramentas para controle da morbimortalidade, haja vista a falta de estratégias terapêuticas disponíveis contra a doença.
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OBJECTIVE: To estimate the prevalence of SARS-CoV-2 antibodies and the adherence to measures of social distancing in children and adolescents studied in three national surveys conducted in Brazil between May-June 2020. METHODS: Three national serological surveys were conducted in 133 sentinel cities located in all 27 Federative Units. Multistage probability sampling was used to select 250 individuals per city. The total sample size in age ranges 0-9 and 10-19 years old are of 4,263 and 8,024 individuals, respectively. Information on children or adolescents was gathered with a data collection app, and a rapid point-of-case test for SARS-CoV-2 was conducted on a finger prick blood sample. RESULTS: The adjusted prevalence of antibodies was 2.9% (2.2-3.6) among children 0-9 years, 2.2% (1.8-2.6) among adolescents 10-19 years, and 3.0% (2.7-3.3) among adults 20+years. Prevalence of antibodies was higher among poor children and adolescents compared to those of rich families. Adherence to social distancing measures was seen in 72.4% (71.9-73.8) of families with children, 60.8% (59.6-61.9) for adolescents, and 57.4% (56.9-57.8) for adults. For not leaving the house except for essential matters the proportions were 81.7% (80.5-82.9), 70.6% (69.6-61.9), and 65.1% (64.7-65.5), respectively. Among children and adolescents, social distancing was strongly associated with socioeconomic status, being much higher in the better-off families. CONCLUSIONS: The prevalence of antibodies against SARS-CoV-2 showed comparable levels among children, adolescents, and adults. Adherence to social distancing measures was more prevalent in children, followed by adolescents. There were important socioeconomic differences in the adherence to social distancing among children and adolescents.
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Routine immunization during pandemics can be harmed. This study estimated the influenza vaccination coverage in older adults during the COVID-19 through the EPICOVID-19, a population-based study conducted in 133 cities from the 26 Brazilian states and Federal District. We selected 25 census tracts per city, with probability proportional to the tract's size, ten households by census tract, and one random individual interviewed. A total of 8,265 older adults (>=60 years old) were interviewed and asked whether they had been vaccinated against flu in 2020. Vaccination coverage was 82.3% (95% CI: 80.1-84.2) with no difference by gender, age, and region;higher vaccination coverage was observed among the wealthiest (84.7% versus 80.1% in the poorest) and among the more educated (87.3% versus 83.2% less educated);lower coverage among indigenous (56.9% versus > 80% among other ethnic groups). A positive association was identified with the number of comorbidities among men but not among women. Most of the population was vaccinated (97.5%) in the public health system. The private network was chosen mainly in the South by the wealthiest and more educated. Vaccination coverage was seven percentage points lower than the government target (90%), and inequalities should be reversed in future campaigns.
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OBJECTIVE: Describing the prevalence of chronic diseases and associated socioeconomic and demographic factors, evaluating the patterns of social distancing and the antibodies prevalence against SARS-CoV-2 and COVID-19 symptoms in carriers and non-carriers of chronic diseases. METHODS: Data from 77,075 individuals aged 20 to 59 from three steps of the EPICOVID-19 Brazil (a nationwide serological survey conducted between May and June, 2021) were assessed. The presence of antibodies against SARS-CoV-2 was examined by rapid tests. Self-reported prevalence of hypertension, diabetes, asthma, cancer, chronic kidney disease and heart disease were investigated. The prevalence of mask use, adherence to isolation measures and antibodies were evaluated separately amid carriers and non-carriers of chronic diseases. The prevalence of symptoms was analyzed among carriers and non-carriers of chronic diseases with antibodies. RESULTS: The prevalence of at least one chronic disease was 43%, higher in the Southeast region, among white and indigenous individuals, women, less schooled and in lower socioeconomic position. The use of masks when leaving home was similar among carriers and non-carriers of chronic diseases (98%). The proportion of participants who reported adherence to isolation measures was higher amid carriers (15.9%) than non-carriers (24.9%) of chronic diseases. The prevalence of antibodies to SARS-CoV-2 was similar amongst carriers and non-carriers (2.4% and 2.3%). The prevalence of cough, dyspnea, palpitations and myalgia was significantly higher among carriers, but the proportion of symptomatic patients was similar between groups. CONCLUSION: The prevalence of chronic diseases in Brazil is high and the COVID-19 pandemic affects carriers and non-carriers of chronic diseases similarly. Carriers present more severe forms of COVID-19 and higher prevalence of symptoms. Greater adherence to social distancing measures among chronic patients is disassociated from a lower incidence of COVID-19 in this group.
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OBJECTIVE: To evaluate the prevalence of reports of symptoms of COVID-19 among individuals with and without antibodies and identify those with greater capability to predict the presence of antibodies against SARS-CoV-2. METHODS: The study uses data collected in phases 5 to 8 of Epicovid-19-RS. The presence of antibodies against SARS-CoV-2 was evaluated by a rapid test. The occurrence of cough, fever, palpitations, sore throat, difficulty breathing, changes in taste and smell, vomiting, diarrhea, body pain, shaking, and headache since March 2020 was also evaluated. Then, the capability to predict the evaluated symptoms concerning the presence of antibodies was calculated. RESULTS: A total of 18,000 individuals were interviewed and 181 had antibodies against COVID-19 in phases 5 to 8. The proportion of asymptomatic individuals was 19.9% among participants with antibodies and 49.7% among those without antibodies. All symptoms were reported more frequently by individuals with antibodies. The division of the prevalence of symptoms among individuals with antibodies by the prevalence among individuals without antibodies showed the following prevalence ratios: for changes in smell or taste (9.1), fever (4.2), tremors (3.9), breathing difficulty (3.2) and cough (2.8 times). Anosmia and fever were the symptoms with a greater capability to predict the presence of antibodies. CONCLUSION: The prevalence of symptoms was higher among individuals with antibodies against SARS-CoV-2. The proportion of asymptomatic individuals was low. Altered smell or taste and fever were the symptoms that most predict the presence of antibodies. These results can help to identify probable cases, contributing to the clinical diagnosis and screening of patients for testing and isolation guidance in positive cases, especially in scenarios of the scarcity of diagnostic COVID-19 tests. © This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided that the original author and source are credited.