Mortality And Risk Factors Associated With Dialysis Patients With COVID-19 In A Brazilian Supplementary Health Service

Introduction. Patients with chronic kidney disease (CKD) and COVID-19 are at high risk of adverse outcomes due to the presence of comorbidities. However, it is still unclear whether dialysis therapy is associated with a worse prognosis in patients infected with SARSCoV- 2. The objectives were to assess mortality and risk factors associated with a worse prognosis of these patients (e.g., age, sex, comorbidities, Intensive Care Admission [ICU] admission, and need for invasive mechanical ventilation [IMV]). Methods. An observational, descriptive, retrospective study was conducted in the private healthcare maintenance organization (Unimed-BH) of Belo Horizonte and 33 surrounding cities in Brazil. We used data collected from the organization's database. We included adult inpatients with CKD on previous dialysis therapy who tested positive for COVID-19, from February 2020 to June 2021. Results. During the period, 16182 patients were admitted to Unimed-BH with a diagnosis of COVID-19. Of these, 333 (2%) had dialysis CKD. Male patients were 180 (54%), age ranged from 22.85 to 95.75 years and the mean was 60.91 years. Of the 333 patients, 109 (32.7%) were admitted to the ICU, and 56 (16.8%) required IMV. Among the 14 comorbidities analysed, the mean number of comorbidities was 6, with 93 (27.9%) dyslipidaemia, 74 (22%) diabetic, 270 (81%) hypertensive, 25 (7.5%) asthmatic, 42 (12.6%) with chronic pulmonary disease (CPD) and 122 (36.6%) with congestive heart failure (CHF). There were 66 (19.8%) deaths, 29 (43.9%) were male, the mean age was 60.8 years, and 23 patients (34.8%) were elderly (>60 years). Among the patients who died, 55 (83.3%) were in the ICU and 46 (69.7%) on IMV. The mean number of comorbidities was 9.27 being 16 (24.2%) dyslipidaemia, 44 (66.6%) diabetic, 60 (90.9%) hypertensive, 5 (7%) asthmatic, 10 (15%) with CPD and 32 (48.5%) with CHF. Conclusions. Dialysis patients appear more susceptible to unfavourable outcomes than the general population. Our findings are similar to those reported in the world literature which is still scarce. It is important to conduct more studies on this population.

Outcomes Of Centenaries Hospitalized Due To COVID-19 In A Private Healthcare System

Introduction. Life expectancy is increasing worldwide. However, during the COVID-19 pandemic, people 100 years or more (centenaries) were challenged by a potentially fatal disease. We evaluated the outcome of centenaries hospitalized due to COVID-19 in a private healthcare system of Belo Horizonte/Brazil (Unimed-BH). Methods. Administrative data were collected from the hospital database. Patients were included if they had a severe adult respiratory syndrome due to coronavirus type 2 (SARS-CoV-2) ribonucleic acid identified by quantitative real-time reverse transcriptase polymerase chain reaction (RT-qPCR) or by the International Code of Disease- 10th review (ICD-10) hospitalization codes U07.1, B34.2, or B97.2. Results. From March 1 2020 to October 31 2021, 316.4 & plusmn;12.9 centenaries/month were registered. Eighteen hospitalizations due to COVID-19 were identified. Median age was 101.8 years (interquartile range [IQR]:100.7,103.0). Most patients were female (83%). There was a median of 6.0 morbidities per patient (IQR:5.3,7.8), range 2-12 morbidities, among 71 possible morbidities. The most described morbidities were systemic arterial hypertension (94%), dementia (61%), and congestive heart failure (61%). Median length of hospitalization was 6.5 days (IQR:3.3,8.0). No patient was dialyzed. Seven (39%) patients died during hospitalization, of whom 3 (17%) were admitted to the Intensive Care Unit and 2 (11%) were oxygenated by invasive mechanical ventilation. No other patients were admitted to the Intensive Care Unit or invasively mechanically ventilated. Conclusions. Although the hospitalization rate was low, the mortality rate during hospitalization was high among centenaries. Further research is required to evaluate the actual risks of centenaries to be infected by SARS-CoV-2 and the subsequent outcomes.

Avaliacao Dos Niveis Soluveis De Podoplanina E Clec-2 Em Pacientes Com Covid-19

A imunotrombose e definida pela ativacao da hemostasia resultante de uma resposta inflamatoria e/ou infecciosa. Recentemente, a via PDPN/CLEC-2 tem se destacado em processos que medeiam a ativacao plaquetaria e a formacao trombotica. Alem disso, alguns estudos em modelos animais sugerem que a via pode desempenhar um papel importante no processo de protecao pulmonar na Lesao Pulmonar Aguda (LPA). Embora o papel da via PDPN/CLEC-2 nao seja totalmente compreendido, evidencias sugerem que ela pode se encaixar como uma nova via no conceito de imunotrombose. O objetivo do estudo foi avaliar os niveis circulantes de PDPN e CLEC-2 em pacientes com COVID-19 e explorar sua relacao com a gravidade da doenca e a ativacao da hemostasia. Foram incluidos 30 pacientes diagnosticados com COVID-19, alem de 30 controles saudaveis, com aprovacao etica (CAAE 36528420.3.0000.5404 e 30227920.9.0000.5404). As medidas de PDPN foram realizadas com kits de ELISA nos momentos D0 e D4 (4degree dia apos a admissao);A dosagem de CLEC-2 tambem foi realizada por ELISA apenas no tempo D0. Os dados clinicos e laboratoriais foram obtidos de prontuarios eletronicos. Para avaliar a expressao de PDPN em celulas pulmonares foi realizada uma analise "in silico" de scRNAseq. O tempo medio de permanencia hospitalar (LOS) foi de 12,9+/-9,8 dias, doze pacientes (40%) necessitaram de UTI com tempo medio de UTI de 6,1+/-9,7 dias. O D-dimero medio foi de 3,609+/-14,440 ng/mL. A dosagem de PDPN foi menor em pacientes com COVID-19 quando comparada a individuos saudaveis (p<0,0001), e a dosagem de CLEC-2 nao mostrou diferenca entre os grupos. Houve correlacao da PDPN com hemostasia e marcadores de gravidade, tais como: D-dimero (R= -0,529), RNL (R= -0,481), fibrinogenio (R= -0,401) e vWF (R= -0,513). Em relacao aos dados clinicos, os niveis de PDPN estavam mais diminuidos no grupo que necessitou de UTI (p=0,04). Alem disso, dados "in silico" de scRNAseq mostram uma diminuicao de PDPN no tecido pulmonar em pacientes COVID-19 quando equiparados a individuos saudaveis. Recentemente, estudos "in vivo" realizados em modelos animais destacam a via PDPN/CLEC-2 como importante no processo de protecao pulmonar frente a LPA, que ocorre devido a ligacao da CLEC-2 oriunda do complexo plaqueta-neutrofilo a PDPN expressa por macrofagos alveolares, esta ligacao promove a inibicao de citocinas/quimiocinas locais, reduzindo o estado inflamatorio local. Atualmente, nenhum trabalho avaliou a via PDPN/CLEC-2 na COVID-19, sendo um modelo interessante onde ha ativacao da hemostasia concomitante a lesao pulmonar, assim nossos resultados supoem que a via possa estar envolvida no processo de protecao pulmonar, uma vez que a diminuicao da PDPN na COVID-19 foi correlacionada com hemostasia e marcadores de gravidade. Copyright © 2022

Diakonia, crisis and COVID-19: from adversity to transformation

This article aims to identify the possibilities of the diaconal action of the Evangelical Church of Lutheran Confession in Brazil-IECLB in face of the crisis caused by COVID-19, which is taking place and which will bring relevant consequences for the socio-political context in the Country. At the beginning of the article, there is a report of the diaconal experience of the Sinodo Nordeste Gaucho and its way of acting in the 2020 pandemic situation. Based on a reflection on the relationship between crisis and transforming diakonia, the article returns to the origins and facts of the diaconal history of the IECLB, demonstrating how the church and it's Diakonia has acted in these difficult times that have already occurred.

Psychosocial impact caused by the covid-19 pandemic on health professionals

Objective: To describe the psychosocial impact caused by the pandemic of the new coronavirus on health professionals. Method: This is a narrative review carried out on the Virtual Health Library platform using the following descriptors "Health Professionals" AND "COVID-19", from May to June 2020. Results: A chart was developed showing the characteristics of the six selected scientific articles, according to title, authors, year of publication, journal, type of study and psychosocial impact. Conclusion: In the midst of the pandemic, professionals may feel helpless, overloaded with activities and severely affected physically and psychologically, becoming more vulnerable. There is need to adopt protective measures and a psychosocial action plan to provide better working conditions, medical care, psychological and therapeutic care, promoting qualifications and the use of integrative and complementary health practices. © 2021 Universidade Federal da Bahia. All rights reserved.

Recommendations for perinatal care in the context of the COVID-19 pandemic. (Special Issue: Transparency in research and publications on COVID-19.)

Objectives: to present scientific recommendations for perinatal care in the context of the COVID-19 pandemic.