COVID pneumoniae: Clinical and radiological follow-up of a prospective cohort

Introduction: COVID-19 has led to a rise in hospitalized patients with viral pneumonia and we are still learning about the follow-up process. Objective(s): To describe a cohort of hospitalized patients with COVID-19 pneumonia and their clinical and radiological evolution. Method(s): Prospective cohort study. COVID pneumonia patients from August 2020 to August 2021 were analyzed (n=125), with a standardized follow up. We describe clinical and radiological features during hospital stay and 1st and 3rd months after discharge. Extent Pneumonia: affection of 3 of 5 lobes in CT. Result(s): Table1: Cohort's description. Clinical follow-up: 39 patients(31,2%) persist symptomatic after 3 months from discharge(dyspnea 37). Radiological follow-up: 49 patients(39.2%) remain with extent pneumonia at third month CT. Table2: ILD pattern Vs No-ILD comparison at third month control. Conclusion(s): We present a detailed description of a COVID pneumonia cohort through a standardized follow-up process. Our findings suggest that ILD pattern associates with symptom persistence.

Sindrome De Embolia Gordurosa Na Doenca Falciforme: Serie De Casos

Introducao: A Sindrome de embolia gordurosa e uma complicacao rara da doenca falciforme, descrita principalmente na doenca nao homozigotica. Resulta de extensa necrose da medula ossea (MO), durante crise vasoclusiva (CVO), com liberacao de embolos de gordura na circulacao e disfuncao organica multipla. Os criterios diagnosticos sao envolvimento de multiplos/unico orgao histologicamente comprovado por embolia gordurosa e/ou medular necrotica ou desenvolvimento de insuficiencia respiratoria aguda (IRpA) e manifestacoes neurologicas ou falencia de multiplos orgaos com evidencia de necrose medular (laboratorial ou histologica). Objetivos: Descrever caracteristicas clinicas, laboratoriais e de tratamento de 5 pacientes com sindrome de embolia gordurosa atendidos no HCFMUSP entre 10/2021 e 07/2022. Resultados: Os 5 casos eram HbSS (4 mulheres),1 em uso de hidroxiureia (HU), 2 sem HU por hepatotoxicidade e em programa transfusional, 1 interrompeu o tratamento e 1 nunca havia usado. Mediana de idade no evento: 34 (22-52) anos. Fatores desencadeantes provaveis em 3 pacientes: infeccoes por Influenza, Covid19 e S.aureus Oxacilina resistente. A admissao, todos apresentavam dor generalizada e dessaturacao;4 apresentavam confusao mental e rebaixamento do nivel de consciencia com TC de cranio normal;3 com consolidacao pulmonar sendo iniciado antibiotico. Medianas e ranges de exames a admissao: Hb 5,7 (3,6-7,2)g/dL;leucometria 30900 (8620-51600)/mm3, 2 com desvio ate mielocitos, 2 ate metamielocitos e 1 ate bastoes;eritroblastos 38,5 (2,5-53,8) EOC/100 leucocitos;plaquetas 208 (46-507) mil/mm3;DHL 1296 (502->6000)mg/dL;Cr 1,59 (0,94-3,72)mg/dL;BI/BD 2,32 (2,09-4,84)/3,4 (2,57-12,8)mg/dL;TGO 101 (44-289)mg/dL;TGP 19 (18-29)mg/dL;GGT 185 (118-423)mg/dL;FA 369 (142-1060)mg/dL. Durante a internacao, todos evoluiram com reacao leucoeritroblastica (desvio ate mielocitos/promielocitos), aumento de DHL, TGO, TGP, GGT, FA, BI, BD (predominio de BD) e lesao renal aguda, 3 evoluiram com plaquetopenia e 2 com reticulocitopenia. Todos receberam concentrado de hemacias nas primeiras 24h e durante a internacao (mediana 13;range 2-19), 2 iniciaram hemodialise e 2 foram intubados e receberam drogas vasoativas (DVA). Nenhum desenvolveu CIVD. A biopsia de MO de 1 paciente mostrou tecido hematopoietico difusamente necrotico de padrao isquemico. A mediana de internacao foi 11 dias (range 2-22). 1 paciente faleceu em 48h, 1 foi extubado e teve DVA suspensa apos 17 dias, 4 pacientes receberam alta com Hb proxima ao basal e leucometria, plaquetas e funcao renal normais. Discussao: A sindrome de embolia gordurosa e caracterizada por IRpA e manifestacoes neurologicas, podendo haver comprometimento das funcoes renal e hepatica alem de reacao leucoeritroblastica ou pancitopenia, quadro apresentado por nossos pacientes embora nossos casos destoem da literatura quanto ao genotipo, onde apenas 15% sao HbSS. Suspeitar do diagnostico e fundamental para o desfecho dos casos. Na suspeita, a instituicao rapida de terapia transfusional, para reduzir HbS, e determinante para a sobrevida. Uma revisao sistematica descreveu mortalidade de 29, 61 e 91% para quem recebeu troca, reposicao ou nenhuma transfusao, respectivamente. Conclusao: A falta de suspeita diagnostica dificulta o reconhecimento da sindrome, determinando taxas altas de mortalidade. Familiaridade com o quadro clinico e inicio imediato de terapia transfusional tem se mostrado os unicos indicadores de sobrevida. Copyright © 2022

Colorectal Surgery During the First Wave of Covid-19 Pandemic: How the Coronavirus Affected Our Practice

Objective: The COVID-19 has quickly climbed to a global pandemic and hospitals had to adjust in order to manage the resources available. The aim of this article was to expose our experience and the means used to avoid delay in treating oncologic patients. Methods: Collection of data from all patient who underwent elective colorectal surgery for neoplasia during the state of emergency (between March 16th and May 16th 2020) and compared the surgical outcomes with the outcomes of the previous year. Results: A total of 28 patients received colorectal surgery from March 16th and May 16th 2020. Laparoscopy using the Air-Seal® was the most practiced approach (Pearson Chi-Square 0.014;p value 0.905). The complication rate was not statistically different from the previous year (Pearson Chi-Square 2.640;p value 0.104) as well as the rate of major complications (Pearson Chi-Square 0.754;p value 0.385). During the peak of infections, there was no increase in the number of days of hospitalization comparing to the previous year (p value 0.279). There was no delay in the oncologic surgical treatment (p value 0.010). Conclusion: We were able to demonstrate that it is possible to treat cancer patients during pandemic without compromising its possibility of cure. © 2022 Celsius Publishing House. All rights reserved.

Covid-19 and organisational development: important signs of a new pillar for sustainability

Purpose: The global pandemic has had a considerable effect on organisations’ performance and development and on the daily lives of the general population. This study aims to analyse the recent literature on the topics of Covid-19 and sustainability and proposes to rethink and redefine sustainability with the intersection of human health as a fourth sustainable pillar. Design/methodology/approach: Using the Scopus and ISI Web of Science databases, 119 articles were analysed in detail and classified according to concepts and principles for achieving sustainable development, based on the Brundtland Report, 1987. Findings: The results indicate a high number of publications in the social dimension, with a relevant proportion of studies in the health sector. This study allows us to conclude that all sectors of society are being affected by the pandemic. However, the enormous tension and the immediate impact felt by the health sector during the pandemic reflect directly on the population, and there are clear signs that in the medium and long term, instability and uncertainty in the environmental, economic and social dimensions will remain. In national health systems, monitoring, innovating in human resource management and investing in information technology can ensure organizations’ reliability and sustainability. The conclusion involves the suggestion of introducing health as a new pillar for sustainability to consolidate the basis and structure of the United Nations’ Sustainable Development Objectives. The use of fundamental concepts is necessary and must be aligned to reassess the results obtained in studies, in comparison with observational data. Practical implications: The implications arising from the inclusion of health as a fourth pillar of sustainability are diverse. The need to build a new theoretical and conceptual framework for sustainability derives from the fact that health reflects the concern of many postulants in this field of practices. The determining or conditioning conditions of the observed effects of the pandemic by COVID-19, whether situated simply as factors and/or economic, environmental or social reflexes that precede them, requires a conceptual development that allows its approach, as a complex object, whose determinations are subject to variable degrees of uncertainty and diversity. Originality/value: This study aims to redefine the concept of sustainability, considering that health has become a public health emergency of international interest. Health affects the supply chain, cash flow, interferes with the educational format and interrupts the workforce’s routine, among other aspects, showing the true nature of its importance and its impact in all spheres (economic, environmental and social). © 2021, Emerald Publishing Limited.